January is Cervical Cancer Awareness Month, which is promoted by organisations and healthcare associations including the Malawi Association of Medical Laboratory Scientists with the aim of increasing awareness on the burden of this disease and emphasising the need for more effective action to emphasise the unrecognised threat and serious consequences of this disease.
Cervical cancer occurs when the cells lining a woman’s cervix (the entrance to the uterus from the vagina) begin to grow out of control. It is the fourth most common cancer among women worldwide—over one million women are estimated to have cervical cancer, with most of the cases remaining undiagnosed.
World Health Organisation (WHO) estimates suggest that every year there are at least 3,684 new cases of cervical cancer in Malawi and over 2,314 women die from the disease.
However, the exact cervical cancer morbidity and mortality among Malawian women is not clear because of the number of unrecorded cases.
Malawi has one of the highest cervical cancer rates in the world, but in spite of this high incidence, the cervical cancer screening rate is low.
Some of the factors that have been identified as contributing to the low uptake of cervical cancer screening services are: lack of awareness among women of cervical cancer screening, unavailability of cervical cancer screening services in some health facilities, and the gender and age of the health workers providing the cervical cancer screening services.
The Government of Malawi, in collaboration with WHO and the International Agency on Cancer, has established policies and programmes across the country to increase awareness of cervical cancer and establish screening and treatment centres to bring down cervical cancer numbers.
Malawi started screening for cervical cancer in the early 1980s through a donor-funded programme which was phased out due to sustainability problems. Later, in 1999, a re-launch of the cervical cancer screening programme was done as a pilot which was rolled out nationally in 2002.
Almost all cervical cancer is caused by Human Papilloma Virus (HPV), the most common sexually transmitted infection.
Some of the risk factors for cervical cancer are HIV infection, smoking, early sex debut, multiple deliveries, multiple sex partners and genetic factors.
Early-stage cervical cancer generally produces no signs or symptoms. Signs and symptoms of more advanced cervical cancer include: vaginal bleeding (after intercourse, between periods or after the menopause), watery, bloody vaginal discharge that may be heavy and have a foul odour, pelvic pain or pain during intercourse.
Cervical cancer is largely preventable through interventions such as HPV vaccination for all girls aged 9-14 years and screening of adult women.
Screening may be performed by trained healthcare workers using visual inspection with acetic acid or medical laboratory tests (HPV testing).
If detected early and managed effectively, cervical cancer is one of the most successfully treatable forms of cancer. Cancers diagnosed in later stages can also be controlled with appropriate treatment and palliative care.
Although modern medicines can provide effective treatment, Malawians still face significant challenges in providing appropriate treatment in a reliable and sustainable way.
Many people have been resorting to herbal medicines. It is frequently stated in scientific literature that 80 percent of African and Asian countries use traditional medicine for health care needs.
In 2021, Njova Tembo and others from the Department of Biomedical Sciences at the Kamuzu University of Health Sciences (formerly College of Medicine) conducted a study that revealed that herbal practitioners in Zomba were using 26 plant species from 19 families to treat cervical cancer and six families to treat cervical cancer-related illnesses.
The study also revealed that there was a need to improve conservation efforts for medicinal plants as some of them are being used unsustainably through root use.
This work may be important in the discovery of new drugs as the information provided might help select those medicinal plants that should be tested for their ability to prevent as well as treat cancer.
The greatest need, however, is to strengthen the collaboration among healthcare professionals including medical laboratory scientists and other stakeholders in order to better understand the unique potential of our medicinal plants.
We also need government commitment to and investment in training of personnel, infrastructure and resources to provide complete pathways of care so that women receive optimal care close to where they live.
With a comprehensive approach to prevention, screening and treatment, cervical cancer could be eliminated as a public health problem within a generation.