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PREVALENCE OF CERVICAL CANCER IN KENYA Thesis Statement: Cervical Cancer is the second most common form of cancer in women in the world after breast cancer. IntroductionCervical cancer is a type of cancer that forms in the tissues of the cervix. It is usually a slow-growing cancer that is asymptomatic and can only be detected through screening tests. Cervical cancer is mostly caused by HPV infection, with 99% of cervical tumours having HPV detection. (Marth , et al., 2017)In developed countries the burden of cervical cancer is quite low, the situation however constitutes a major health problem in developing countries.
Every year more than 270 000 women die from cervical cancer, more than 85% of these deaths are in low- and middle-income countries, because of poor access to screening and treatment services, the vast majority of deaths occur in women living in low- and middle-income countries. Sub-Sahara Africa records the highest incidence of cervical cancer and high mortality affecting women in the world. East Africa is the highest recorded a 42.
7 % of cases of cervical cancer. Sub-Sahara Africa unfortunately has no screening programs for early precancerous lesions detection in most countries. Screening activities in the region are done as pilot or research projects which on completion are discontinued. Since 2001, South Africa is the only country with a national cytology-based screening program although coverage remains poor and the impact on invasive cervical cancer is unknown.Implementation of cervical cancer prevention and control programmes contributes to the attainment of the Millennium Development Goals through universal access to sexual and reproductive health services to improve women’s health, to the 2010 UN Secretary-General’s Global Strategy for Women and Children’s Health and to the 2011 Political Declaration of the UN General Assembly High Level Meeting on Noncommunicable Diseases.
(WHO, 2013)Prevalence of cervical cancer Cervical cancer predominantly affects younger women ” more than half of cervical cancer cases occur in women under the age of 45 years. Worldwide cervical cancer is considered the fourth most common cancer affecting women. The highest incidences of cervical cancer are reported in Eastern, Southern, Middle and Western Africa and Melanesia, and the lowest incidences are in Australia/New Zealand and Western Asia. (Ferlay , Soerjomataram, & Ervik, 2013)Nearly 90% of cervical cancer deaths occur in developing countries and the large geographic variation in cervical cancer rates reflects differences in screening availability and HPV infection prevalence (Marth , et al., 2017)The disparity in prevalence between the developing and developed world can be attributed to lack of awareness of cervical cancer and the lack of effective cytological screening programs in developing countries. (PATH, 2000)Risk factors of cervical cancer Human papillomavirus (HPV) infectionThis is the most important risk factor for cervical cancer and being a group of more than 150 related viruses. Some of which cause a type of growth called papillomas commonly known as warts. It can spread from one person to another during skin-to-skin contact. One way is through sexual activity, which includes vaginal, anal, and even oral sex. There are low risk types which are not linked to cancer and high-risk types strongly linked to cancers, including cancer of the cervix, vulva, and vagina in women, penile cancer in men, and cancers of the anus, mouth, and throat in both men and women.HPV infection is common and in most times the body clears the infection itself. However, in certain cases it doesn’t clear and becomes chronic. Chronic infection especially by high risk types which can eventually cause cancer such as cervical cancer. There is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes. SmokingWhen someone engages in smoking they expose themselves and those around them to many cancer-causing chemicals that affect other organs other than the lungs. The harmful chemicals are absorbed through the lungs into the blood stream and carried throughout the body.Women smokers are twice as likely to develop cervical cancer than their non-smoking counterparts. Tobacco by products have been found in the cervical mucus of women who smoke. With researchers believing that the harmful substances alter the DNA of cervix and may be the contributor of cervical cancer development.Having a weakened immune systemDamage of the woman’s immune system by infection of Human immunodeficiency virus (HIV), the virus that causes AIDS which has been seen as a major problem is sub-Saharan Africa, puts them at a higher risk for HPV infections. The immune system is vital in destroying and slowing the growth and spread of cancer cells. In HIV infected women, cervical pre-cancer might develop into an invasive cancer faster than normal.Report from Moodley 2001 showed that women with HIV developed cervical cancer at an earlier age than HIV negative women. It was also reported that in Kenya women under 35 years who had invasive cervical cancer were two more times likely to be HIV positive (Gichangi, Estamble, & Bwayo, 2003)Women who take drugs to suppress their immune response such as those being treated for autoimmune disease or those who have has an organ transplant.Chlamydia infectionChlamydia is a common bacterium spread by sexual contact that can infect the reproductive system. It leads to pelvic inflammation which leads to infertility. Some studies have shown that women with past or current chlamydia infection found through blood tests and cervical mucus have higher risk of cervical cancer. Its asymptomatic and they women only realize this is they are tested for chlamydia during a pelvic exam. A diet low in fruits and vegetablesWomen may be at increased risk for cervical cancer if their diet doesn’t include enough fruits and vegetables. Being overweightAdenocarcinoma of the cervix is more likely to develop in overweight women which may lead to cervical cancer. Long-term use of oral contraceptives (birth control pills)Evidence from research show that there is a risk of developing cervical cancer with prolonged use of oral contraceptives. The risk increases with usage and goes down when usage is stopped and return to normal after about 10 years after stopping. Having multiple full-term pregnanciesNo one really knows why this is true but it’s been noted that women who have had 3 or more full term pregnancies are at an increased risk of developing cervical cancer. This may be attributed to hormonal changes during pregnancies or the fact that the might have a weaker immune system at this time, allowing for HPV infection and cancer growth. Being younger than 17 at your first full-term pregnancy which is a common practice in sub Saharan Africa following early marriages, leads to such women being almost twice more likely to develop cervical cancer later in life. Having a family history of cervical cancerCervical cancer may be hereditary. The risk being higher in families where a mother or a sister had cervical cancer than in families that no one had it. Researchers suspect that this may be attributed to a family condition that make their bodies less capable to fight off HPV infection. Factors for high prevalence Socio-cultural factors There are various socio-cultural factors that may result to increase of cervical cancer cases. This includes; early marriages, polygamy, prostitution and high parity are common in sub Saharan Africa in which Kenya is included. HPV being sexually transmitted in such relationships increases the risk of cervical cancer among the wives and women involved. (Bayo & Bosch, 2002)Circumcision is another practice that has been noted to reduce the prevalence of certain STIs, HIV and HPV transmitted sexually. The prevalence of HPV has been shown to be higher in uncircumcised men than in circumcised men. (Auvert, et al., 2009) Socio-economic factorsMoney has been seen to influence health in many sectors. Many women of low-income status do not have access to adequate health care services, including Pap tests that has been seen to be a particularly effective way of diagnosing cervical cancer. This means they may not get screened or treated for cervical precancers meaning they have a greater risk of having cervical cancer.Sub-Sahara Africa experiences a widespread of conditions that reduce the quality of living conditions. These include wars, political chaos, internal conflicts, natural disasters, famine and drought. Such conditions reduce access to medical care that might detect cervical cancer early and refugee- like conditions, social vices like rapes, prostitution that increases the spread of HPV that is a major risk factor. (Suba, et al., 2006)Lack of awareness and knowledge of cervical cancer.Cervical cancer has not been reorganized as a health priority in sub Saharan Africa. Major focus has been put on infectious diseases that ravage the region such as malaria, tuberculosis, leprosy, diarrheal diseases and acute respiratory diseases, however all of this are symptomatic unlike cervical cancer in the early stages. Several studies have shown lack of knowledge of cervical cancer in Africa regardless of literacy levels. (Anorlu, Rabiu, & Abudu, 2007)Poor cervical cancer screeningIt has been noted that few women in sub Saharan Africa have ever been screened for cervical cancer. Several reasons can be attributed to this which includes: women not feeling at risk due to lack of knowledge, the asymptomatic nature of cervical cancer, fear of vaginal examination and test being unpleasant for most women. These factors make detecting cancer of the cervix hard because the only way to diagnose it is through the tests. (Gichangi, Estamble, & Bwayo, 2003)Conclusion and recommendations Cervical cancer is one of the most preventable human cancers because of its slow progression, cytologically identifiable precursors, and effective treatments if detected early. Educational interventions targeting socially and economically disadvantaged women in which information provision is complemented by sexual negotiation, skill development can encourage at least short-term sexual risk reduction behavior. This has the potential to reduce the transmission of HPV, thus possibly reduce the incidence of cervical cancer.ReferencesAnorlu, R., Rabiu, K. A., & Abudu, O. O. (2007). Cervical Cancer Screening Practices Among General Practitioners in Lagos, Nigeria. Journal of Obsterics and Gynecology, 81-84.Auvert, B., Sobngwi, J., Cutler, E., Nieuwoudt, M., Lissouba, P., Puren, A., & Taljaard, D. (2009, Jan). Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm. Journal of Infectious Diseases, 14-19.Bayo , S., & Bosch, F. (2002). Risk Factors of Invasive Cervical Cancer in Mali. International Journal of Epidemiology, 02-09.Ferlay , J., Soerjomataram, I., & Ervik, M. (2013). Cancer Incidence and Mortality Worldwide. Lyon: GLOBOCAN.Gichangi, P., Estamble, B., & Bwayo, J. (2003). Knowledge and practice about cervical cancer and Pap smear testing among patients at Kenyatta National Hospital, Nairobi,. International Journal of Gynecological Cancer, 27-33.Marth , C., Landoni, F., Mahner, S., McCormack, M., Gonzalez-Martin, A., & Colombo, N. (2017). Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. In ESMO, Annals of Oncology, (pp. 72-83). Oxford: Oxford Univeristy Press.PATH. (2000). Planning Approriate Cervical Cancer Prevention Programs. Seattle: PATH press.Suba, E., Murphy, S., Donnelly, A., Furia, L., Huynh, M., & Raab, S. (2006). Systems Analysis of RealWorld Obstacles to Successful Cervical Cancer Prevention in Developing Countries. American Journal of Public Health, 480-487.WHO. (2013). Comprehensive cervical cancer prevention and control: a healthier future for girls and women . Switerzland: WHO Press.
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