Friends Don’t Let Friends Get Cervical Cancer

(4 February 2019 – This post first appeared on the Global Health NOW blog:

This is a story about my best friend’s mother and my mother’s best friend. One died from cervical cancer. One survived.

They lived in the same rural Kenyan village where I grew up. No one there ever talked about the disease, which killed 311,365 women globally last year, the majority living in communities across Africa and Asia. No one knew it was caused by a common virus, HPV, that is preventable—or that when detected early, it’s easily treatable. Women who went to the clinic—or even to a hospital—never were asked when they last had a Pap test or any kind of screening. When they suffered symptoms, they wrongly blamed less stigmatized conditions like diabetes and high blood pressure, or some bad omen.

After my friend’s mother died, I helped organize a group of my mother’s friends at our house. My aim: to mobilize local women around a disease that might be affecting them even if they were feeling fine. Now that early detection and treatment can be provided where women live—at local health facilities and sites where they receive care for HIV, and even in their own homes—it’s time for country leaders, donors and civil society stakeholders to support HPV vaccine scale-up for all girls, and to accelerate screening and treatment options for middle-aged women, whose health needs have been long neglected.

My mother’s best friend Sabina was one of 15 women in that informal club diagnosed with cervical cancer. Caught an early stage, she was treated and now is cancer-free. But the global trend of this disease is trending upward. We can reverse that, though. Sabina’s granddaughter, one of 1.8 billion young people in the world today, has a good chance of escaping the disease altogether.

Why? New prevention, screening and treatment tools—namely, a vaccine, artificial intelligence, self-testing and a battery-powered treatment device. Those, along with a push by the WHO to eliminate cervical cancer, should mean better health for girls and women everywhere, even in Kenya’s most remote villages.

The Global Elimination of Cervical Cancer Initiative, launched in May 2018 at the World Health Assembly, aims to ensure that all girls and women—no matter where they live—have access to the vaccine, screening and treatment to stop needless deaths.

HPV is so common that almost every sexually-active person will get it at some time in their life—unless protected by vaccination. Increasing numbers of women living with HIV are even more at risk of getting cervical cancer because a compromised immune system is not as effective at clearing the cancer-causing HPV virus.

Artificial intelligence is a major technological breakthrough for cervical cancer prevention. It visually recognizes cervical pre-cancerous lesions, and does it better than a nurse, midwife or doctor. This AI image detection method has the potential to perform similarly to PAP and HPV tests in enabling accurate diagnoses while increasing access to screen-and-treat services in remote places that lack health professionals.

Self-screening for HPV is another promising innovation. An alternative to the traditional sample collection that’s performed by health professionals, DIY sample collection offers women autonomy, privacy, ease and accuracy. HPV sample self-collection and testing got a big thumbs-up in rural Botswana, where the Ministry of Health & Wellness helped introduce this cost-effective way to defeat its No. 1 cancer killer of women.

As more women get screened, more will have access to treatments—namely, cryotherapy, which freezes precancerous lesions and thermal coagulation, which uses battery-powered heat to zap them. WHO began developing guidelines for thermal coagulation, the more feasible method in low-resource settings, last year. Malawi already has ordered 300 devices, using money from The Global Fund.

Global investment in a comprehensive program of the HPV vaccine and screening would be cost-effective and could avert 5.2 million cases and 3.7 million deaths.

Together, we can marshal a movement akin to the one that’s bringing down the rate of maternal mortality worldwide. Today, fewer women die in childbirth than of cervical cancer.

It’s within our grasp to eliminate cervical cancer. We are all responsible to demand that happen now—for our friends’ mothers, our mothers’ friends, and their granddaughters.

Byline: Angela Mutunga, Jhpiego, with Celina Schocken, TogetHER

Image Courtesy of the Bill & Melinda Gates Foundation