Are you at risk of cervical cancer ?

In Zimbabwe Cervical cancer kills 64 % of all people found with the disease! Thats a really high mortality rate !

Why is the mortality rate due to cervical cancer so high in Zimbabwe ?

A lot of women present late for treatment , when the precancerous lesions have developed to invasive cancer and the cancer is harder to treat.

Furthermore access to treatment of cancerous lesions e.g., cancer surgery, radiotherapy, and chemotherapy are limited, resulting in a higher rate of death from cervical cancer in Zimbabwe (Tachiwenyika et al 2021).

Efforts are underway to improve screening and early detection in the country. Zimbabwe has over 200 facilities using Visual Inspection with Acetic Acid (VIAC) and 60 sites conducting HPV tests.

The government has also introduced an HPV vaccination program, achieving 89.7% coverage in its first year. Recent initiatives involve training Village Health Workers (VHWs) to conduct community screenings, which has helped expand access to these services in rural areas​ (WHO | Regional Office for Africa).

Are you at risk of getting cervical cancer ?

Here are some risk factors that increase your chances of getting cervical cancer. There are a lot more than what we have included here. Women who do not have these risk factors are rarely found to have cervical cancer :

Human Papilloma Virus :

There is over 100 HPV types, but only 16 that can cause cervical cancer.

• They are transmitted through skin to skin contact for example through any type of sexual contact, ie. vaginal, anal or oral. Most people get HPV infection but not all people who get HPV infection get cervical cancer.

• HPV types that cause warts in or around the mouth, lips or genitals are classified as low risk types and are seldom linked to cancer

• High risk HPV types are those strongly linked to cancers mainly cervix, vulva, and vagina in women, penile cancer in men, and cancers of the anus, mouth, and throat in both men and women.

• The body often fights off most HPV infections, sometimes the body does not clear the infection and it eventually develops into cervical cancer, however this can take between 15 to 20 years and that’s why it's important to screen for cervical cancer at least once every year.

• There is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes. However you can vaccinate against HPV.

Low HPV Vaccination Rates

• Although the country has made progress with the introduction of HPV vaccination, coverage is still not universal.

• Women who missed vaccination as adolescents are at increased risk.

  
  

Smoking

• When you smoke, you introduce toxins and chemicals into your bloodstream, which then cause changes to the DNA of cervix cells and give rise to cervical cancer.

• Women who smoke are twice as likely as non-smoking women to get cervical cancer. Also, smoking decreases your chances of fighting off any HPV infections in your body.

Immune deficiencies

• If a woman’s immune system is already weakened through HIV or any other auto immune deficiency, they face a higher risk of catching HPV infections.

• When a woman’s immune system is destroyed through HIV, precancerous lesions can mature into invasive cancer at a faster rate than usual.

Long Term Use of Oral Contraceptives

• Women who have used oral contraceptives for 5 to 10 years are at a higher risk of cervical cancer.

Inserting herbs or foreign objects into the vagina

• Inserting foreign objects into the cervix weakens the cervix and creates an environment for infection to occur by affecting the normal balance of the bacteria inside a woman.

  
  

Multiple sexual partners

• Having different sexual partners increases the likelihood of getting the HPV, by increasing the likelihood of transmission of the virus.

• Increasing the use of condoms with sexual partners will reduce the chances of coming in contact with the HPV.

  
  

How often should you be screening for Cervical Cancer ?

The recommended frequency of cervical cancer screening for women in Zimbabwe aligns with the World Health Organization (WHO) guidelines. Typically, the suggested intervals depend on the type of screening test used:

1. For HPV DNA Testing:

   • Women should ideally be screened every 5 years, starting from the age of 25 up to 49 years. If resources allow, women should continue screening until 65 years.

2. For Visual Inspection with Acetic Acid (VIAC) or Pap Smear:

   • Screening is recommended every 3 years for women aged 25 to 49, as long as the results are negative and there are no other high-risk factors.

3. For Women Living with HIV:

   • Due to their higher risk, women living with HIV should be screened every year regardless of the method used, starting from age 25.

     
     

Where can you go for screening ?

It is recommended that every woman should have a cervical cancer screening 6 weeks after delivery and any sexually active woman 18 years and above should be screened.

In Harare and Bulawayo, women can access cervical cancer screening services at several key locations.

• In Harare, free screening is available at Parirenyatwa Hospital and Harare Central Hospital.

• In Bulawayo, women can visit the United Bulawayo Hospitals (UBH) and Mpilo Central Hospital for screening services.

• These centres provide Visual Inspection with Acetic Acid and Cervicography (VIAC), which is a cost-effective and efficient screening method for early detection and treatment.

Alternatively if you are looking for more information or support, reach out to local health organisations, such as the Cancer Association of Zimbabwe, for resources and guidance. If you’re in a rural area, ask community health workers or reach out to your local clinic for information or a referral.

References

Tachiwenyika E, Dhodho M, Muchedzi A, Sibanda TP, Mupanguri C, Mukungunugwa S, Mhangara M, Ganje N, Tapera T, Samushonga T, Muzondo M, Dube S, Tafuma T, Chingombe B, Maravanyika A, Nyamundaya T. (2021). Prevalence of Cervical Cancer and Clinical Management of Women Screened positive using visual inspection with acetic acid and Cervicography in selected public sector health facilities of Manicaland and Midlands provinces of Zimbabwe. PLoS One. 2023 Nov 29;18(11):e0294115. doi: 10.1371/journal.pone.0294115. PMID: 38019889; PMCID: PMC10686478.

WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention, 2013.