WUNRN
Tackling Cervical Cancer: Improving
Acccess to Cervical Cancer Services for Women in Southern Africa
Direct Link to Full 84-Page 2012
Study Report:
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SOUTHERN AFRICA - CALL FOR IMPROVED
CERVICAL CANCER SCREENING & SERVICES
JOHANNESBURG,
31 October 2012 (PlusNews) - Cervical cancer is the leading cause of
cancer death among women in southern Africa, but new research reveals that
governments’ attempts to address the disease have been inadequate.
Access to cervical cancer screening services is minimal, few
countries in the region have policies on the disease, and treatment remains a
major challenge.
The study, based on regional desktop research and field
research in Namibia and Zambia by the Southern Africa Litigation Centre (SALC),
assessed the state of cervical cancer services in southern Africa, particularly
in Namibia and Zambia, finding that many women access medical assistance only
when they have advanced cervical cancer, which is more difficult to treat and
can be extremely painful.
"The failure to provide access to cervical cancer services results in the
violation of fundamental rights and in the loss of countless lives. There is a
serious and urgent need to improve services for cervical cancer in the southern
Africa region," the report warned.
Guidance needed
The HIV/AIDS epidemic in southern Africa may have contributed to the high
number of cervical cancer deaths; women infected with HIV are more likely to develop cervical lesions that can become
cancerous.
But there is still a lack of clear and comprehensive national cervical cancer
management guidelines and policies in the region. Neither Namibia nor Zambia has comprehensive guidelines on the management of
the illness. Where guidance is available, it tends to be inadequate, focusing
on screening, with limited guidance about other forms of prevention or
treatments.
"The piecemeal approach to addressing cervical cancer in national policies
results in inconsistent commitment," the report added.
According to Nyasha Chingore, HIV project lawyer with SALC and the author of
the report, Botswana is one of the few countries with a broad, accessible
cervical cancer policy. As a result, more women in the country have access to
Pap smear screenings - in which a sample of cervical cells is collected and
checked for abnormalities. The number of screenings has increased from 5,000 per
year before 2002 to 32,000 per year in 2009.
Where there are no policies, or where policies are not easily accessible by
health systems, women are not made aware of the services that are available to
them. "With HIV, we all know that when you test positive, they must do a
viral load test and CD4 count test... Everybody knows the policy. We have
material in our support groups. But with this cervix cancer thing, we don’t
know what we are entitled to," said a study participant.
The report found "a significant amount of misinformation" in Namibia,
where most of the young women interviewed reported being informed - incorrectly
- by healthcare workers that contraceptives cause cervical cancer or are a risk
factor for the illness.
Stigma is also a major challenge. "It's not an easy topic to talk about.
You have to talk about sex, and you develop sores in places no one wants to
talk about," Chingore told IRIN/PlusNews.
Access to screenings in Zambia is determined by geographical location, with few
if any screening services available outside of the capital, Lusaka. While
cervical cancer services seem to be generally available in Namibia, access is
limited by factors such as the lack of prioritization of cervical cancer
screening by health workers.
Treatment and vaccines
"The treatment of invasive cervical cancer continues to be a major
challenge in the region due to the lack of surgical facilities, skilled
providers, chemotherapy and radiotherapy services. In Namibia and Zambia, there
is a dearth of treatment options, with hysterectomy being the most prevalent
form of treatment. There are few treatment options available to women who want
to preserve their fertility," the report said.
Because of structural problems, including inadequate laboratory facilities and
personnel shortages, patients and health workers often choose treatment options
without having proper diagnoses or adequate information, it added.
Two vaccines against the human papillomavirus (HPV) - a
sexually transmitted virus that can cause cervical cancer - are currently
available, but the cost of the vaccines has made it difficult for countries to
introduce vaccination campaigns. "Governments need to think about how to
make vaccines easily available... Whether it's through parallel importation or
compulsory licensing, there are options, they just need to be explored,"
Chingore told IRIN/PlusNews.
So far, Zambia and Lesotho are the only countries in the region rolling out
free HPV vaccination programmes, the report noted.
In June 2011, Merck announced it would provide the vaccine Gardasil to the
Global Alliance for Vaccines and Immunization (GAVI), for US$5 per dose, a
reduction of nearly 70 percent. Eligibility for GAVI support, however, is
determined by national income; while Lesotho, Malawi, Mozambique, Zambia and
Zimbabwe are eligible, Angola, Botswana, Namibia, South Africa and Swaziland
are not.
SALC urges southern Africa governments to integrate cervical cancer screening
into existing sexual and reproductive health services, to allocate adequate
resources to the management of cervical cancer, and to establish cancer
registries to assess the impact of cervical cancer screening programmes.