Harare, Zimbabwe – Having been diagnosed with cervical cancer in December 2016, Busi Mawudzi (49), notes that even though “the treatment journey was not a walk in the park”, being diagnosed and getting treatment early made the journey a lot more bearable.
“I had a backache and pain that would get to my pelvic area, was always fatigued and had heavy menstrual flow. I initially didn’t think of screening as I had a Pap-smear in 2014 but was later forced to because my symptoms got worse,” said Busi as she shared her journey.
She adds “I was initially told I had pre-cancer lesions and opted for hysterectomy and during the procedure, the team noted I had stage 1 cancer. I then did my six cycles of chemotherapy and had 28 days of radiotherapy in June and July 2017.
Busi however notes that generally cancer patients are stigmatized and this is even worse for women. She says that since cervical cancer is mainly caused by the Human Papillomavirus (HPV) which is sexually transmitted, society also frowns on such women regarding them as promiscuous.
Cervical cancer is preventable and treatable when detected early, yet it remains the leading cause of deaths amongst women in Africa. Nineteen (19) out of 20 countries with the highest burden of cervical cancer are in the African region. Zimbabwe is amongst the top five countries with high incidence of cervical cancer, with 61 of every 100 000 women being diagnosed annually.
In many parts of Africa including Zimbabwe, women are presenting with advanced cervical cancer due to limited access to cancer screening services, limited diagnostic facilities, poor health seeking behaviours mainly due to myths and misconceptions in communities on cervical cancer and cancer generally. The situation has also been compounded by high prevalence of HIV and AIDS, which increases the risk of developing cervical cancer six-fold.
Furthermore, patients have to pay out of pocket to access cancer services and these high treatment costs which are beyond the reach of many are a major barrier to treatment services. Insufficient palliative care services across the continuum of cancer care have also weakened cancer response in Zimbabwe and other parts of the region.
With more than 95% of cervical cancer cases being attributed to HPV infection, vaccination and screening are critical in eliminating cervical cancer. In 2014, the Government of Zimbabwe made great strides by piloting HPV vaccination in two districts and then introduced HPV vaccination nationally for girls aged 10-14 in 2018. Zimbabwe has one of the highest HPV vaccination coverage in the region, at about 86%.
Screening is also being provided at most health facilities targeting high risk populations such as women living with HIV. Cervical cancer screening coverage is currently at 20% (urban 3% and rural 10%) and available at 14% of all health facilities. Over 200 sites are screening using Visual Inspection with Acetic Acid (VIAC), and about 60 sites are carrying out HPV tests.
“We are putting our efforts more on the primary preventive measures of cervical cancer such as screening and vaccination because we know treatment is very expensive. Government will also amplify efforts towards community engagement to ensure more women turn up for these services for us to reach our targets,” said MoHCC Deputy Director for NCDs Dr Justice Mudavanhu.
Zimbabwe with support from Clinton Health Access Initiative (CHAI), International Atomic Energy Agency (IAEA), UNICEF, the World Health Organization (WHO) and local partners is also finalizing its National Cancer Control Plan (NCCP) to address challenges and gaps the country is currently experiencing in its cancer control. WHO has also been supporting with HPV vaccination since the demonstration period, training of health care workers and carry out post-coverage survey after vaccination activities.
In 2018, WHO came up with Global Strategy towards Elimination of Cervical Cancer as a public health problem. The Global Strategy seeks to ensure that 90% of girls are vaccinated against the HPV infection by age 15 by 2030. It also seeks to ensure that 70% of women are screened with a high-performance test by 35 years of age and again by 45 years of age while 90% of women identified with cervical disease receive treatment.
While the Government of Zimbabwe is putting in place efforts to increase access to cancer services in line with the strategy, public health experts point out that screening and vaccination remains the key pillars of cervical cancer control. Clinical Oncologist Dr Kudzai Makova says progress has been made in terms of access to screening services and prevention efforts, but challenges remain in areas around treatment and palliative care.
“One of the greatest challenges in Zimbabwe remains in providing uninterrupted treatment of cancer due to frequent breakdown of radiotherapy machines and this has to change,” adds Dr Makova. “Improving access to pain control medicines such as morphine will also benefit all cancer patients and not just those with cervical cancer.”
WHO African Region Technical Officer for Cancer Dr Sharon Kapambwe says there is need for strategies that promote screening, which could indicate pre-cancer or early signs of cancer that can be treated quickly and inexpensively, to increase treatment outcomes.
“Zimbabwe has all three pillars required to eliminate cervical cancer (vaccination, screening and treatment) and what has to happen now is the integration of cervical cancer services into other health care services. All stakeholders should come together under the leadership of the MoHCC to strengthen and accelerate implementation of the Global Strategy towards Elimination of Cervical Cancer as a public health problem,” notes Dr Kapambwe.