detect changes in the cervix that are
likely to lead to full blown cancer
(precancerous lesion).
Cervical cancer has been shown
to be associated with the Human
Papilloma Virus (HPV) in more than
98% of cases and thus is classified as
a sexually transmitted infection.
Once infected with HPV one of 2
options can occur: if your immune
system is good you can clear the
infection and if it is not optimum
you get persistence of the virus with
subsequent development of cancer.
The best prevention strategies
are holistic, that include safe sex
practices; ABC’s Abstinence, Being
faithful or consistent condom use
and no smoking.
Avoid early marriages and advise
young girls to avoid engaging in sex
at early age. Stick to one partner
and avoid multiple partners. Your
risk of developing an HPV infection
increases the earlier you start having
regular sex and the more sexual
partners you have, although women
who have only had one sexual
partner can also develop it.
Note that although condoms can
reduce your risk of developing HPV
infection, the virus isn’t just passed
through penetrative sex.
It can be transmitted during other
types of sexual contact, such as skin
to skin contact between genital areas
and by using sex toys.
Avoiding smoking will also reduce
your chances of getting cervical
cancer because people who smoke
are less able to get rid of the HPV
infection from the body.
All women who are sexually active
should be enrolled into screening
programs. This is what will help us
detect lesions on the cervix that can later
lead to cancer – precancerous lesions.
There are several ways to screen
the most popular being the pap
smear. Another modality is Visual
Inspection with Acetic Acid & Visual
‘‘ Avoid early
marriages and
advise young girls
to avoid engaging
in sex at early age.
Stick to one partner
and avoid multiple
partners. Your risk of
developing an HPV
infection increases
the earlier you start
having regular sex
and the more sexual
partners you have,
although women who
have only had one
sexual partner can
also develop it.’’
Inspection with Lugol’s Iodine (VIA/
VILI), which is a more cost effective
strategy but equally effective and
being used by the Government of
Kenya in the Public Health set up.
The last involves testing for HPV but
has not yet achieved widespread use
in this country though it is available,
but much more costly than the
pap. Treating the lesions detected
lessens the probability of developing
cervical cancer.
How often should we screen? For
women between 25-49 years at least
once every 3 years. I still prefer the
annual screening if women can
afford it as I have seen interesting
cases develop in less than one year!
But 3 years is the standard guideline
nevertheless. Women who are 50-64
should be screened every 5 years
and for women older than 65 only
if they haven’t been screened since
they were 50.
Vaccination
Is there a vaccine? Yes the best
news from the last decade in terms
of cervical cancer prevention was
the development of cervical cancer
vaccines. There are two available in
the market – Cervarix which contains
a vaccine against two strains of HPV
16 and 18; and Gardasil which is
against four strains of HPV 16 &
18 – against cervical cancer; 6 & 11
– prevent viral warts which are quite
distressful to have.
Treatment for Precancerous lesions
If a patient is VIA/VILI positive
trained nurses can perform
cryotherapy for these patients and
this is the chosen strategy by MOH
(See and treat).
In conventional treatment if a pap
smear has a high grade lesion, a
colposcopic biopsy is taken and
the diagnosis can be CIN (cervical
intraepithelial neoplasia). Depending
on the severity of the lesions, mild
lesions can just be observed to see if
your immune system will clear the
infection. Severe ones can be treated
with either cryotherapy or by Loop
Electrosurgical excision procedure
(LEEP).
Treatment for Cervical Cancer
Overt cancer has 4 grades and early
disease up to IIA have the option
of surgery that is very radical and
includes removal of the womb,
adjacent tissues, and lymph nodes.
All cases of cancer can be treated
with radiation – radiotherapy which
can be enhanced with the use of
medication – chemotherapy.
With that I hope I have educated you
on cervical cancer and encourage you
to advocate for use of vaccination
especially in young girls (teenagers)
and to go for screening tests. Together
we can prevent cervical cancer.
Dr. Maureen Owiti is a Gynaecologist
based in Nairobi. You can commune
with her on this or related matters via
mail at: [email protected].