Judith Mkandawire lives at Kamwe in Mzimba North. In 2010 she was diagnosed with cervical cancer.
She narrates that the news about her being diagnosed with cervical cancer came as a hummer blow on her life.
Being HIV positive, she could see death knocking on her door.
But 14 years down the line, Mkandawire is full of life.
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According to Mkandawire, she decided to go for cervical cancer screening after members Coalition of Women living with HIV and Aids visited her area and encouraged them to go for cancer screening.
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“The bad thing about cervical cancer is that it does not have any signs. When you start seeing signs, it means it has advanced.
“So when I was going for screening, I was not feeling any pain. I was normal. But I was told by the doctor that I had been diagnosed with the virus causing cervical cancer and needed to undergo surgery. I was operated on January 13, 2010,” Mkandawire said.
She says she went for screening because she heard from an organisation and wonders as to whether those who haven’t heard any message on cervical cancer can go for screening or not.
She bemoans lack of access to screening facilities in rural areas, giving an example of Kamwe in Mzimba North where women are told to go to Rumphi for screening.
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“From Kamwe to Rumphi is K5000. When you go to the hospital, they will tell you we don’t have the screening equipment, come again another day.
“To those women without money, they will have to wait until they said tobacco and soya to go for screening. But the cancer will not be waiting for them to sell soya or tobacco. It will be advancing,” Mkandawire said.
Lonely Nthanda, from Area 24 in Lilongwe is another survivor of cervical cancer.
A few years ago, she was diagnosed with cervical cancer on her fourth time of screening.
She remembers that it was in 2012 that a public address system vehicle passed by Area 24 where it was calling for women to go for cervical cancer screening.
Nthanda says most women do not go for cervical cancer screening because he screening facilities are not close to them.
According to World Health Organisation (WHO), Human papillomavirus (HPV) is a common sexually transmitted infection which can affect the skin, genital area and throat.
Almost all sexually active people will be infected at some point in their lives, usually without symptoms. In most cases, the immune system clears HPV from the body.
Persistent infection with high-risk HPV can cause abnormal cells to develop, which go on to become cancer.
The UN body says persistent HPV infection of the cervix (the lower part of the uterus or womb, which opens into the vagina – also called the birth canal) if left untreated, causes 95 percent of cervical cancers.
“Typically, it takes 15–20 years for abnormal cells to become cancer, but in women with weakened immune systems, such as untreated HIV, this process can be faster and take 5–10 years.
“Risk factors for cancer progression include the grade of oncogenicity of the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking,” WHO says.
Associate Professor in the Department of Obstetrics and Gynaecology Division of Global Women’s Health at the University of North Carolina (UNC) Lameck Chinula, says cervical cancer can be found in all women but that women living with HIV and Aids are at a higher risk of having cervical cancer.
Chinula says globally, Malawi ranks second in terms of cervical cancer deaths with Eswatini being the top country.
According to Chinula, every year Malawi records 4145 new cases of cervical cancer and out of which, 3000 women die from the disease.
“Cervical cancer, unlike all other known types of cancers, is a largely preventable disease. It is one unique disease where we do know how it develops and there is a pre-cancerous stage which can span a period of 10 to 20 years from the time that a woman gets the Human Papilloma Virus which is a critical infection for the development of cervical cancer and to a time that a woman develops cervical cancer. So we have a window of opportunity where we can identify women at increased risk of cervical cancer,” Chinula says.
He notes that there are programmatic interventions that the World Health Organisation has put up as a framework for preventing cervical cancer which include primary prevention which encompasses preventing women from getting the HPV in the first place.
“And then we have secondary prevention which targets women who may have been exposed to HPV infection, they have no symptoms and we screen them to identify those who may be at increased risk of developing cervical cancer.
With screening you see women that have early lesions that are not cancer but that can be treated with simple measures as out patients,” adds Chinula.
He adds that as more women are being screened, they do find others women with cervical cancer who may require interventions such as surgery, chemotherapy and radiotherapy and other interventions.
In 2018, WHO Director General Tedros Adhanom Ghebreyesus said it was possible to eliminate cervical cancer as a public health problem.
“Through cost-effective, evidence-based interventions, including human papillomavirus vaccination of girls, screening and treatment of precancerous lesions, and improving access to diagnosis and treatment of invasive cancers, we can eliminate cervical cancer as a public health problem and make it a disease of the past,” Ghebreyesus said.
In 2020, the World Health Organisation set the 90-70-90 targets aiming to eliminate cervical cancer by 2030.
The target means that 90 percent of girls should fully vaccinated with the HPV vaccine by the age of 15; 70 percent of women screened using a high-performance test by the age of 35, and again by the age of 45; and 90 percent of women with pre-cancer should be treated and 90 percent of women with invasive cancer should be managed.
Dr Doris Kayambo is an obstetrician and gynaecologist at Mzuzu Central Hospital and says being diagnosed with cervical cancer should not be a death sentence.
According to Kayambo, Malawi has advanced in terms of screening, prevention and tertiary management.
“But as with every cancer, it depends on how early it has been diagnosed, how it has been diagnosed and also the location the patient is. For example, in the Southern Region we have onco-gynaecology services at Queen Elizabeth Central Hospital and Zomba. In the Central Region we have services at the Kamuzu Central Hospital and in the Northern Region at Mzuzu Central Hospital.
“When it comes to treatment modalities, the main treatment is surgery which as a country we are able to offer. If it is more advanced, we can offer chemotherapy to reduce the tumour and then do the surgery. Of course it is a very complicated surgery that not every cadre can manage to do,” Kayambo says.
Oncologist Dr George Chilinda says most people think that cervical cancer is not curable because most of the cases are detected at an advanced stage where there is very little the authorities can do about it.
“As a result, when people die from the disease, the message that goes out there is that the disease is not curable.
“This means we need to do more in terms of screening so that we detect it at an early stage. If we do that most people will be assisted and we may change the narrative that cervical cancer is not a death sentence,” Chilinda says.
Ministry of Health Expanded Programme on Immunisation Manager Dr. Mike Chisema says since Malawi started administering the HPV vaccination in 2019, the country has so far managed to reach 30 percent of the targeted population of girls between the ages of 9 and 15.
According to Chisema, it is only a few districts which have managed to hit 30 percent vaccination, adding that other districts are below 10 percent.
He cited issues of culture, traditional believes and others as among the factors contributing to the slow progress in the vaccine uptake.
Chisema says health officials need to do more in sensitising communities on the advantages of vaccination.
Chisema was quick to note that the HPV vaccination programme also faced challenges in a way that when it started in 2019, the country was faced with Covid 19 which was another equally demanding pandemic as it needed more resources.
In 2022, Malawi Developed the 2022-2026 which provides direction and recommendations for practical evidence-based interventions that should lead to significant progress in reducing the incidence and morbidity of cervical cancer, and improve quality of life of cervical cancer patients in the country.
According to the strategic plan, Malawi needs $74,474,582 for an effective fight against cervical cancer.
Health Committee of Parliament Chairperson Matthews Ngwale says the country has relied so much on development partners in the fight against cervical cancer.
According to Ngwale, government needs to commit more resources towards cervical cancer screening so that the screening is available to as many women as possible in the rural areas.
Ngwale says the resources need to be ring-fenced so that they go directly to the cancer fight and nothing else.
Health Minister Khumbize Kandodo Chiponda admits that Malawi is not doing well in the fight against cervical cancer.
According to Kandodo Chiponda more needs to be done in the areas of vaccination, screening and treatment.
“As a ministry, we have embarked on another campaign because we had a campaign but it was not very successful. So now we are doing another campaign to energise community to sensitive Malawians that we need go and have the girl child to receive the vaccine.
“The target group is from the age of nine to 15 and are only going to get one dose of HPV vaccine. We are working with the Ministry of Education, but also the Ministry of Gender and the Ministry of Local Government. As you know most of our children are in schools so we need education involved. We need to have parents or guardians involved as well,” Kandodo Chiponda said.
On cervical cancer screening, Kandodo Chiponda said government has integrated the screening with other clinics such as HIV clinic so that when women go for HIV testing, they also get access to cervical cancer screening.
3000 deaths in a year from a preventable disease such as cervical cancer is unacceptable. It is a crisis.
It is high time the authorities moved with speed to arrest the problem.
As oncologist Chilinda puts it, there is nothing painful than telling a sick woman that there is nothing the hospital can do just because the cancer has been detected at an advanced stage.
