Christelle Mugwaneza, 32, had always heard about the importance of cervical cancer screenings and the prevalence of cervical cancer. Despite this knowledge, she had second thoughts about screening.
"Women had associated the screening with promiscuity and some said it was very painful. I did not want to subject myself to the pain yet I did not have multiple partners,” she says.
A few years later, a friend was diagnosed with cervical cancer, luckily at an early stage. It was treated after she noticed chronic vaginal discharge. It is then that Mugwaneza realised the dire need for screening and made her first appointment with the doctor at the age of 28.
Young girls all over the country are vaccinated against HPV as a means to wipe out cervical cancer. Net photos
"I knew that it was going to be a bit awkward because I did not know what to expect, but I was prepared to deal with it considering the screening could save my life. Despite my preconceptions of what cervical screening would be like, my experience was genuinely fine. I feel content knowing that the few minutes could save my life,” she says.
Cervical cancer is one of the most common cancers that affect women even though it is a preventable disease.
Pre-cancerous and cancerous processes in the cervix can be detected early if screening is done.
As the name suggests, cervical cancer starts in the cervix, the lower part of the uterus that opens at the top of the vagina. All women are at risk, and deaths occur 15 to 25 years after infection with human papilloma virus (HPV), which is transmitted during sex.
As of last year alone, Rwanda registered 485 cases of cervical cancer, according to Rwanda Biomedical Centre.
Being one of the most common malignancies affecting women, especially in developing countries, several measures have been undertaken locally by the Ministry of Health to sensitise women about prevention of cervical cancer.
In 2011, the Ministry of Health introduced an immunisation programme against HPV, for young girls aged 9 to 12 years across the country. Rwanda has the highest coverage of immunisation in the whole world at 95 per cent, according to Dr François Uwinkindi, the Director of Cancer Programme at Rwanda Biomedical Centre.
Dr Ian Shyaka, a surgeon at Rwanda Military Hospital, reveals that most people who are infected with HPV have no signs or symptoms as most HPV infections are temporary and resolve within two years.
"At least 80 per cent of women are exposed to the HPV virus during their lifetime. Most of the time, the body’s immune system gets rid of the virus before it does harm.
"When the virus persists, normally in 10 to 20 per cent of cases, there is a chance of developing cervical pre-cancer or cancer. However, it usually takes many years for HPV infection to cause cervical cancer.”
For women above the age required for vaccination, the Ministry resorted to cervical cancer screenings that have since been introduced in 26 hospitals and 240 health centres in Rwanda.
The immunisation, Uwinkindi is hopeful, will eliminate cervical cancer cases in years to come, once all young girls that are not sexually productive receive vaccination, and women encourage to screen for the virus.
"The process of elimination is progressive because it takes some years for the virus to be cancerous, but with vaccinations and screenings in place, we will see it was prevented or treated early in older women,” he says.
Most women contract HPVs soon after becoming sexually active. According to him, cases of women attending screenings has gone up over the years, given the positive results the vaccinations and screenings have proven.
"In the beginning, women did not trust us to vaccinate their daughters because they thought it brought infertility and screening was of no use. We have proved to them that the vaccines are approved by the World Health Organisation and time has made clear to them the effectiveness of the screenings,” Dr Uwinkindi says.
Cervical cancer screenings a dire need
According to David Mwesigye, a gynaecologist at Rwanda Military Hospital, Papanicolaou test, also known as the Pap smear or cervical smear test, is not quite common in Rwanda because it is not affordable for every woman in Rwanda; it costs between Rwf15, 000 to Rwf20, 000 and is available at a few of the hospitals in the country.
The Pap smear is a screening test used by gynaecologists where cells scraped from the opening of the cervix are examined under a microscope to detect pre-cancerous and cancerous processes in the cervix.
Instead, screenings are preferred for the masses as they require a shorter time, are quite affordable and applicable for every woman. According to Mwesigye, visual inspection with Acetic Acid (VIA) is usually preferred for screening of pre-cancer and cancer of cervix. Pap smears on the other hand, are usually done for people who show signs of cervical cancer such as heavy menstruation, abnormal vaginal discharge, bleeding after menopause, as well as HIV positive women, due to their low immunity levels.
Shyaka, however, warns that cervical cancer may not cause any symptoms at first, although when it does cause symptoms, it can cause vaginal bleeding that occurs in between menstrual cycles, after sex or even after menopause.
What happens when detected?
Currently, Rwanda has five hospitals that can provide cervical cancer treatment, including University Teaching Hospital of Kigali, University Teaching Hospital of Butare, Butaro Cancer Centre of Excellence, Oshen-King Faisal Hospital, while Rwanda Military Hospital offers surgery and radiation therapy for cancer patients.
"By the time you reach the radiation and chemotherapy stage, there are fewer chances of survival and it is so painful, which is why it is important that it is detected early for surgery so as to remove the cancerous tissue,” Mwesigye advises.
Furthermore, compared to the cost of treating this cancer, the cost of prevention is a drop in the ocean. Prevention includes sticking to one partner, and early cervical cancer screening.
He adds that in the past, experts recommended that every woman undergo screening every year. This has changed, screening is suggested every three years for most women over the age 21. More frequent testing may be needed if test results are not normal, or for women with HIV or other specific immune system conditions.
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