Monday, 27 May, 2024
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Rwanda could become first country to eliminate cervical cancer

Although cervical cancer is the most common cancer among women in Rwanda, killing 940 in 2019, the country has made great strides in raising awareness around the disease – and is on track to become the first country in Africa, and possible the world, to eliminate cervical cancer.

The World Health Organisation will consider cervical cancer to be eliminated when all nations record just four new cases of the disease for every 100 000 people each year, yet while Rwanda is making progress eliminating the disease, the high cost of vaccines, insufficient budget, and apathy about women’s health, remain stumbling blocks.

Despite that, the country is rapidly expanding cervical cancer testing and has deployed tens of thousands of community health workers to raise awareness of the disease.

Along with its human papillomavirus (HPV) vaccination programme for 12-year-old girls, (the virus that causes cervical cancer), which has surpassed other countries – including the United Kingdom – in coverage, officials believe Rwanda is on track to become the first country in Africa, and possibly the world, to eliminate cervical cancer, reports The Guardian.

“We are among the frontrunners,” says Francois Uwinkindi, manager of the noncommunicable diseases division at Rwanda Biomedical Centre, part of the Ministry of Health. “Australia is probably the first country that might be able to eliminate cervical cancer.” But Rwanda could get there first, he adds.

Community health workers go door to door in villages warning about the dangers of cervical cancer and encouraging women to attend screenings.

Results should take 10 days. If the swab comes back positive, the women will be contacted either by phone, or by a community health worker who will tell them to go back to the health centre for a thermal abrasion, a treatment using a heated probe to destroy precancerous cells in the cervix.

In Huye, in the south of Rwanda, the screen-and-treat initiative began last year, reaching 13 377 women out of a total of 63 953 who were eligible. According to Uwinkindi, a little over half of health facilities in Rwanda have functional screening services. “Two years from now, we should have all facilities covered,” he says.

How the COVID pandemic reversed some progress against cervical cancer

WHO says cervical cancer is the fourth most common cancer in women worldwide. About 90% of deaths from the disease occur in low- and middle-income countries.

Normally, it takes 15 to 20 years for cervical cancer to develop. It can take five to 10 years in women with weakened immune systems, such as those with untreated HIV.

“We know that cervical cancer is a preventable cancer, which is also potentially curable if we are able to diagnose it early enough,” says Princess Nothemba Simelela, assistant director general for family, women, children and adolescents at the WHO. “Women continue to die needlessly from this cancer.”

The burden is the greatest in Africa, she adds, because access to public health services is limited and screening and treatment for the disease have not been widely implemented.

The WHO has sought to galvanise efforts to tackle the disease. In 2020, it adopted the global strategy for cervical cancer elimination by 2030. To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below four per 100 000 women. In Rwanda, the rate in 2020 was 28.2. In eSwatini it was 84.6 – one the highest in the world. In the UK, meanwhile, the rate was 9.9 and in Australia, 5.6.

To achieve the goal, countries must ensure 90% of girls are fully vaccinated with the HPV vaccine by the age of 15; 70% of women must be screened by the age of 35, and again at 45; 90% of women who are precancerous should be treated while 90% of women with invasive cancer should have the condition managed.

In 2011, Rwanda became the first African country to introduce a national HPV vaccination campaign, offering vaccines to all 12-year-old girls in schools. Since it began, the programme has consistently achieved over 90% coverage. More than 1.2m girls and women have been fully vaccinated with two doses.

Before the vaccine was introduced, teachers told students about the importance of the vaccine, and the threat posed by cervical cancer. Community health workers went from house to house explaining the benefits of the vaccine and dispelling myths, such as links with infertility.

Coverage over the past two years has dropped as the COVID-19 pandemic forced schools to close. Hassan Sibomana, who works for Rwanda’s Ministry of Health and is responsible for co-ordinating immunisation programmes, says catch-up campaigns are under way.

What would it cost to fund a cancer-free future?

But eliminating cervical cancer isn’t cheap. The HPV vaccine programme is being financed by the Rwandan Government and Gavi, a global vaccine alliance.

“More than 80% of the cost of vaccines are covered by Gavi, so you understand it is not easy to sustain this programme,” says Sibomana.

Screening is also expensive. An HPV test is $25 (R444). The Rwandan Government covers part of the cost, with the rest coming from Unitaid (via the Clinton Health Access Initiative), Partners in Health and the World Bank.

Uwinkindi has plans to get the screening programme included under Rwanda’s community health insurance plan, which costs $3 (R53) per person for a year.

Similela, at the WHO, admits that “costs (of preventing and identifying cervical cancer) are prohibitive”, though she says work is being done to change this. She wants to see manufacturing of vaccines, tests and devices move to Africa.

She believes costs are so high because cervical cancer affects women, not men. “I believe that if this were a cancer that affected men in the way it does women, we would be having a different conversation,” she says. “Advocacy and allocation of resources would be a different ballgame altogether.”

She adds: “What I see (worldwide) is women get a lot of attention when they’re pregnant, but beyond that nothing exists really in the public health system for women.”

Rwanda appears to be going against this narrative. “In our culture, we consider women as the hearts of the family,” says Uwinkindi. “We know that if you empower women, you empower the entire family and society.”

The country provides chemotherapy and radiotherapy for cervical cancer, and gynaecologists can learn how to perform advanced procedures through a fellowship programme. Uwinkindi admits some women who are diagnosed with cervical cancer “get lost in follow up”.

Similela recognises that Rwanda is “a frontrunner” on the path to eliminate cervical cancer and is an example for others to follow. The Gambia and Malawi are also doing well, she adds.

She says she thinks Rwanda could be the first country to eliminate cervical cancer. “(I feel it) very strongly, because of their political leadership, the commitment that you see when you speak to them and the conviction of their efforts.”

 

The Guardian article – How Rwanda could become one of the first countries to wipe out cervical cancer (Open access)

 

See more from MedicalBrief archives:

 

HPV vaccine significantly lowers infection rates in teen girls — CDC study

 

High rates of cervical cancer found in women living with HIV

 

Three-pronged approach could eliminate cervical cancer within 100 years

 

Cervical cancer survival rates determined by race in SA

 

Australia may be first to eradicate cervical cancer with HPV school vaccinations

 

 

 

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