Cervical cancer – abnormal growth of the cells of the cervix after a long-lasting infection with certain strains of Human Papillomavirus (HPV) – is the second most common cancer in women worldwide after breast cancer. This cancer is unique to women as men do not have cervices and are therefore healthy carriers. In 2018 alone, according to Arbyn and colleagues, the World Health Organization (WHO) reported that 570,000 women were diagnosed with cervical cancer globally, while 311,000 women died from the disease Worse still, 85% per cent of the deaths occurred in Low- and Middle-income Countries (LMICs). The rise of cancer cases in LMICs is attributed to a range of factors, namely the lack of local health policy vision, funding, development and implementation. The two most prominent issues standing in the way of eradicating cervical cancer in Africa remain our reluctance to adopt a preventive approach (rather than a curative one) and our refusal to adapt sexual education to our new realities. We can curtail the menace of cervical cancer in Africa by addressing these two lacunas.
Cultural resistance to adequate sexual education
Sexual education heavily relies on socio-cultural trends and information circulation. The 20th and 21st centuries played pivotal roles for humanity, especially with regard to technological advances. This shift considerably modified the social fabric of African societies by spreading various sexual information via social media platforms. The youth’s naïveté and curiosity, coupled with the African culture of secret and unspoken taboos, contributed to making us accept and adopt this new information source with traditional gatekeepers and educators failing to challenge it effectively. Sexual topics are not publicly tackled in most African cultures because they are considered private matters and are therefore limited to family confines, if ever mentioned.
The common fear is that publicly talking about sex would expose the youth to the practice earlier. That fear was justified when information channels were controlled by elders; however, with the current information age where sexual (mis)education is one-click away from the average youth, that argument loses its premise.
As a result of this failure in our societies to adapt to new circumstances, terms such as “sexual liberation” spread like a wildfire via those channels so much so that the focus has squarely been on the sexual act and not the consequences. Consequences that will ultimately be borne not only by the affected ones but also the community. The high rate of unwanted and teen pregnancies, maternal mortality, unsafe abortions, gynaecological cancers (especially cervical cancers) and the likes is evidence of the failure of our societies to address a critical and fast-changing sociocultural phenomenon.
As much as abstinence is now regarded by many as a thing of the past in today’s world, the use of barrier methods, such as contraceptives (condoms), should be an essential component of the sexual education discussion that must also include boys. “Sexual liberation” does not provide exemptions from its attendant consequences. It is the responsibility of our leaders and cultural gatekeepers to take ownership of the sexual education needs of the population so that such avoidable risks can be handled. We need to get our youth at the adolescent age and equip them with adequate sexual and reproductive education and avail them helpful tools that will properly “liberate” them. In regard to public health, our culture should be adjusted to the current needs and not past realities.
Like most cancers, cervical cancer is a progressive disease which when identified in its early stages can be cured. However, the Surveillance, Epidemiology and End results (SEER) database that tracks the 5-year survival rates for cervical cancer estimates that the early diagnosis of cervical cancer can significantly increase patients’ relative survival rate. When the disease is localized in the cervix, the relative survival rate is of 92%; 58% when it hasn’t spread beyond the pelvis; and 17% when it spreads to other (distant) organs.
The majority of cervical cancer cases can indeed be prevented with the current knowledge and resources as evidence from most of the high-income countries and some LMICs has proven. The most popular cases being in South America, specifically Colombia where its incidence declined from 120.4 per 100,000 in 1962 to 25.7 per 100,000 in 2007, with the mortality rate declining from 18.5 in 1984 to 7.0 in 2011. These achievements were reached by tightening national cervical cancer screening policies and implementation. According to a study published in the World Journal of Clinical Oncology, “the systemic screening with the Papanicolaou cytological test (Pap smear) to find pre-invasive cervical lesions and early-stage cancer has drastically reduced the incidence and death from cervical cancer in the United States and other industrialized nations.”
For Africa to win decisively against this disease, it must also prioritize national screening policy agenda and vaccine sensitization and uptake as pillars of cervical cancer elimination. Otherwise, it is the state that ends up dealing with the complications and delays of a curative approach that could have been avoided with a preventive one. Building cancer centres and heavily investing in cancer treatment is one proven approach in addressing the cervical cancer burden, but it is a counter-intuitive one if not combined with as much investment in prevention strategies.
Prevention strategies will essentially focus on the factors that prevent the eradication of this cancer. For instance, early sexual debut and having multiple sexual partners have been directly linked with cervical cancer, because these factors increase HPV circulation and spread. This is a problem that sexual education and related policies of providing young people with contraceptives would address. But risky sexual activities are not the only factors involved.
Obviously, not having access to proper screening tools (such as Pap smear and HPV tests) is also considered as a risk factor. Here, the government, for which the wellbeing of the youth and the sustainability of the society are its major concerns, has to step in – and urgently too.
Further, weakened immune system such as having HIV or any chronic disease predisposes affected women to developing invasive cervical cancer. Additionally, long-term use of oral contraceptive pills has been associated with cervical cancer when taken consistently for more than 5 years.
Overall, cervical cancer prevention mainly focuses on the factors that people can implement by modifying their social habits. In general, it has been proven that healthy nutrition and regular physical exercise are basic factors that help in the prevention of Non-Communicable Diseases (NCDs). With regard to cervical cancer, healthy social habits should include a responsible sexual behavior, which can only come about as a result of a proper sexual education.
In conclusion, early sexual education, regular pap smear screenings and HPV vaccination programs are the main weapons in the preventive arsenal of cervical cancer. Again, this requires a clear national policy agenda.
The cervical cancer battle will be won more fundamentally by preventing it, rather than by reacting to it by trying to cure it.