Early prevention, palliative care poor in fight against cervical cancer

Nigeria seems to be playing fiddle in the fight against cervical cancer without an adequate capacity for primary prevention and palliative care, despite bearing the fourth worst burden of death from the disease after China, India and Indonesia.

Some aspects of its layers of prevention, treatment and support care lack essential mechanisms that African peers such as Kenya and South Africa have hacked to get ahead of the disease, a new study published in the Journal of Cancer Policy shows.

The analysis, aimed at the content of policies for the prevention of cervical cancer in Africa, scored Nigeria two points on primary prevention, three on secondary and just one on tertiary prevention, a cumulative of six points.

Primary prevention activities work to reduce risk factors; through secondary prevention, precancerous cases are identified and managed, and tertiary activities focus on mitigating disability among those with the cancer.

Weaknesses indicated in Nigeria’s primary prevention programme include poor reduction of risk factors, which should otherwise involve widespread administration of vaccines against the human papillomavirus, with specific approaches for out-of-school girls through public health system or community-based campaigns.

In a country where about 12,075 women are diagnosed with cervical cancer each year, the second most frequent cancer among women, the study shows that campaigns about risk factors for cervical cancer are inadequate.

Also apart from the routine treatment plan that covers pathology services, surgery, radiotherapy and chemotherapy, palliative care involving psychosocial, family and spiritual support has been a struggling aspect of Nigeria’s tertiary prevention plan.

Read also: Survivors mark WHO’s first year of ‘Cervical Cancer elimination movement’ in Nigeria

“It is, however, particularly important for cervical cancer policies to address tertiary prevention – especially in lower-income countries where many women with cervical cancer receive late-stage diagnoses due to lack of access to primary and secondary prevention programmes, and where cervical cancer survival is lowest,” the report states.

South Africa earned 11 points on the ranking with a lower death load at 5,600 and incidence rate of roughly 56 percent per 100,000, compared with Nigeria’s 11.9 percent incidence rate.

This shows South Africa has double the strength of Nigeria in primary and tertiary prevention.

This is the same as Kenya, but a striking aspect about South Africa’s fight is the widespread coverage it has going on among girls under its HPV vaccination programme.

As of 2020, 75 percent of girls turning 15 had received the first dose of HPV vaccine, while 61 percent were completely vaccinated, the World Health Organisation (WHO) countries’ profiles of cervical cancer show.

The country has in-community or home-based care going on for palliative care with robust medical personnel per patient.

At least four in 10 women had been screened of cervical cancer as of 2019 compared with just one in 10 Nigerians in the same period.

One of the differences identified in the report is that policies from countries in Eastern and Southern Africa are more comprehensive than policies from other regions, especially those with above-average HIV prevalence such as Kenya, Malawi and South Africa.

Also, policy content may be influenced by donor priorities, as countries with more health financing from external sources have more comprehensive policies. Many cervical cancer prevention activities in low- and middle-income countries are donor-funded. HPV vaccines in some countries are for instance financed and supported through Gavi and generous support for screening activities through USAID and other partners.

Certain policy components are more likely to appear than others, across types and countries. For example, it is more common to specify target vaccination and screening groups and relatively less common to discuss sensitisation campaigns or education about risk factors.

However, the report also identifies that policy details are very mixed and are not always reflective of current evidence.

For example, the WHO strategy for cervical cancer elimination recommends twice-lifetime screening – ages 35 and 45. However, these policies vary widely in their recommendations around ages for cervical cancer screening; from beginning at age 20 – 35 and stopping at age 45 – 70.

Comprehensive and evidence-based policies are an essential step recommended toward improving population health outcomes – including for cancer control.