New treatment for cervical cancer: Hope for poor women

Hope for poor women? New treatment for Cervical CancerIn recent times, many eyebrows have been raised over the treatment of various cancers that affect women especially breast and cervical cancers.As Breast Cancer takes its toll on Ghanaian women, cervical cancer is also said to be the cause of 20 percent of all deaths caused by cancer in women.Although doctors say cervical cancer can be prevented if detected early poverty and lack of technological advancement in third world countries have prevented the early detection of the disease leading to the loss of many lives.Cervical cancer is defined as a malignant growth in the area of the cervix that spreads into surrounding organs as well as distant vital organs such as the liver, lungs and bones.Each year about 400,000 new cases of cervical cancer occur worldwide with 80 percent of these in women living in developing countries.It also accounts for 200,000 deaths among women each year.“Poor and economically deprived countries such as ours is thus at a great risk of the disease,” says Dr. Henrietta Odoi Agyarko, a deputy Director at the Ministry of Health. She said there is only limited or non-existent capacity to manage large pre-cancerous changes. Cervical cancer is an important women’s reproductive health issue and a public health problem in developing countries where diagnosis and treatment is usually unavailable.The World Health Organisation recommends that many African, Asian and Latin American countries need to boost their capacity to screen sexually active women to detect and treat what is termed “pre cancerous lesions.”“Patients practically report late with advanced inoperable and incurable disease when symptoms and signs occur and make it obvious to them that something is wrong such as irregular or heavy bleeding, offensive vaginal discharge, post menopausal bleeding among others,” said Prof. S.W.K Adadevoh a gynaecologist /obstetrician.“I have not been confronted with such high numbers of advanced stages of the disease overseas since screening every 3 to 5 years was done to detect and treat pre-cancerous lesions which otherwise will progress into destructive, debilitating and fatal stage,” Prof Adadevoh said adding “It was a great surprise and disappointment for me to note that screening methods were not available in the country, only the rich can go in for the traditional screening method which is the Pap Smear when they travel outside.”According to Prof. Adadevoh there was no treatment whatsoever to offer poor women apart from palliative measures, death was the ultimate result-he said.The Ministry of Health has over the past 10 years made serious attempts to change this situation by looking for development partners for funding and support to establish a suitable and appropriate screening program for the country.In 1999, a team of experts from the JHPIEGO Corporation, an affiliate of the John Hopkins University, Baltimore, Maryland in the USA visited Ghana and made contacts with the Ministry of Health to carry out a demonstration project to test the Safety, Accessibility and Feasibility (SAFE) of VIA as a screening method for low resourced countries like Ghana and an alternative to Pap smear.The VIA method is the Naked eye Visual Inspection of the Cervix using Acetic Acid (Vinegar). According to the Ministry of Health this procedure has been tested and proved to be safe and reliable.Again a second major finding is that it can easily be studied and performed competently by midwives.Countries like Malawi, Thailand and Peru also took party in the SAFE project.In November 2001, the Ministry of Health formed the multidisciplinary Cervical Cancer Care team. This comprised Gynaecologists, Pathologists, Surgeons and radiation Oncologist.Ridge Hospital was selected to start off with the urban phase of the study, which started off, with the training of clinical supervisors.A year later, the study was extended to the Amasaman Health Centre with the training of four Nurse-Midwives as service providers.Prof. Adadevoh said efforts are being made to improve women’s awareness about the disease.“The unfortunate characteristic of cervical cancer is that by the time clinical signs and symptoms become obvious and noticeable, the condition has advanced far beyond cure.However she said women are generally infected with the causative microorganism between the ages of 10 and 40 years“There is therefore along latent period which is characterised by slow insidious and gradual changes of cells in a haphazard manner which precedes the invasive stage of the disease.She said if these pre-cancerous changes or lesions are detected early, treatment can lead to complete cure adding “If we are able to take advantage of this phenomenon, cervical cancer may be almost always be preventable.”After detection of changes in the cervix with VIA, a system of treatment called Cryotherapy is applied.Dr. Odoi Agyarko said with the establishment of the VIA as an acceptable alternative to Pap Smear, it is now possible to combine VIA with an out patient treatment of pre-cancerous lesions or changes.She said the Amasaman Health Centre is the first rural centre to have this facility by the kind courtesy of Rotary club International.Since January 2002 when the nurses were trained, they have screened a total of 2,702 cases out of which 199 were positive. They were all treated instantly.Dr. Odoi Agyarko also said the new method is safe for screening women at a local community health centre, it is also acceptable to both clients and service providers, feasible for use under field conditions.While the traditional method of screening, the Pap Smear is expensive, inconvenient and not always available, Dr. Odoi Agyarko says the VIA is affordable, does not require electricity and requires no anaesthesia.“Reproductive health policy and standards documentation has now been reviewed with greater emphasis on cancers of both female and male reproductive system.She said the VIA and Cryotherapy have been incorporated into the policy as the first choice screening and treatment method respectively. Again Odoi Agyarko said strategies have been drawn up for the scaling up process to gradually cover the whole country through human resource development, resource mobilisation both financial and material as well as provide education, information and counselling to sexually active women including adolescents and the youth. The Minister for Women and Children’s Affairs Gladys Asmah has asked all women in The reproductive age to take advantage of the programme and have themselves screened. “A healthy family is a happy family,” she says.According to Asmah, Spousal support is needed in the prevention and treatment of disease that affect mainly women. “In this regard, all spouses should make it not only their duty and obligation but to realise that it is the right of all women to have their unflinching support in order to achieve optimal health to enable them perform their marital, professional and social duties effectively and efficiently,” she advised. Author: By Isabella Gyau Orhin