A potential breakthrough has been made in the treatment of cervical cancer, but it is issues of accessibility, affordability and education that remain key.
Earlier this year, scientists working at the Kenyatta National Hospital in Nairobi made a potentially momentous breakthrough in the fight against cervical cancer. In a world-first clinical trial led by the University of Manchester, researchers found that the commonly used antiretroviral drug lopinavir could kill the virus that leads to the disease.
The study examined 40 Kenyan women with the human papilloma virus (HPV) who were asked to self-apply the drug - which is usually taken orally - to the cervix twice a day for two weeks. Just three months later, cervical smears found marked improvements in over 90% of the women, with no adverse effects reported.
"For an early stage clinical trial the results have exceeded our expectations," said Ian Hampson, one of the trial's lead researchers. "We have seen women with high-grade disease revert to a normal healthy cervix within a comparatively short period of time."
Although cervical cancer is largely well-managed in many developed countries, the disease is a growing concern across much of Africa. According the World Health Organisation (WHO), there are an estimated 530,000 new cases of the disease each year, leading to over 270,000 deaths, and around 90% of these cases occur in developing countries. Of the 20 countries with highest incidence rates worldwide, 16 are African, while the disease is six times more prevalent in Kenya than it is in Western Europe.
It is in this context that researchers hope lopinavir could prove significant. "If it can be proved it works," Hampson told Think Africa Press, "it would have major implications since it is relatively cheap - around $25 per patient as used in our study - and can be self-administered by women which means no costly surgical procedures and fewer associated complications... It is our hope that this treatment has the potential to revolutionise the management of this disease most particularly in developing nations such as Kenya."
Catching it early
Further trials need to be conducted before the treatment is rolled out more widely, but if these prove successful, there are various reasons to be hopeful. However, it is important to recognise that while lopinavir is notable for its cost and ease of use, Kenya's main problem in tackling cervical cancer has not typically been the absence of effective medical treatments. As the World Health Organisation points out, there are already "efficient, low-cost screening approaches suitable for low-resource areas and vaccines that are efficacious in preventing the infections and precancerous changes that can lead to cervical cancer."
As with many other health issues on the continent, one of the underlying reasons that the disease presents such a heavy burden in Africa comes down to other problems such as poverty. In the likes of Kenya, for instance, women often struggle to access the necessary health facilities, and many of those that do find they cannot afford treatment. Moreover, those that do seek treatment typically come up against Kenya's under-staffed and under-resourced healthcare system - facing long waits of several months to be seen - and hospitals that may lack the relevant equipment.
Another difficulty is the challenge of educating communities about the disease and the need to get regularly screened to catch the cancer as early as possible. As David Makumi, vice chair of the Kenya Cancer Association, stresses: "The challenge has been late presentation. Most early cervical cancer can be detected easily with pap smears or other cheaper screening modalities, and treated. Early cervical cancer has been treated successfully with curative intent for many years."
Indeed, while there are tried and tested treatments for the early stages of the cancer - and while lopinavir could soon be used to cure the pre-cancerous virus - these will only help if patients are regular screened, that stigma around the disease is reduced, and that people come to recognise the need to detect the disease as early as possible.
This is a lesson that Helen Masama, a 40-year-old mother of three, learnt firsthand when she was diagnosed with cervical cancer a few years ago. "When I told my children about this sickness, they broke down in tears. It was like the cancer had already killed me," she says. However, because the illness was caught early enough, it was possible to operate. "I learned how important it is to have a pap test regularly," she says. "If I hadn't had that pap test that led to my cancer diagnosis, I might not be here today. I am living proof that screening can find cervical cancer at an early stage when treatment works best."
Stop it before it happens
As well as encouraging women to get screened regularly and improving treatment for those with the disease, there is also another route to tackling cervical cancer that Kenya is currently attempting - preventing the disease before it can even develop through vaccination. "The primary prevention of HPV is through immunisation, administered to teenage girls before they become sexually active," explains Rose Ngau, a service provider at Family Health Options Kenya. "We must stop cervical cancer before it happens."
This is how many countries across the world have combated the disease and neighbouring Rwanda recently became the first low-income African country to achieve nationwide access to the vaccine.
In Kenya, however, although an internationally-supported project helped immunise 20,000 schoolgirls for free in Kitui County, the prohibitively high cost of the vaccine elsewhere has constrained its use to those who can afford private medical care. And once again, a combination of poverty, a struggling healthcare system, and insufficient awareness-raising have so far limited the effects the vaccination could have.
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"Our lawmakers need to do more," says Ngau. "We need to strengthen patient advocacy in international settings to build a global grassroots movement [that portrays] accurate perceptions of cancer; to prevent stigma from inhibiting people in their cancer control efforts; to help people affected by cancer receive the support, services, and information they need, all of which will help in decreasing the global cancer burden."
As Masama, the cervical cancer survivor, is keen to emphasise, "this disease is no longer a death sentence." Medical tests and treatments exist - and if the trials of lopinavir prove successful, healthcare professionals will have yet another useful weapon in their armoury - but ultimately it is issues around accessibility, affordability and education that are now key.
Rachuonyo Duncan a Kenyan journalist based in Nairobi, and a contributor for Mcclatchy Newspaper. He has written for the Nation and Star Newspapers in Kenya on health, environment and current affairs. He is also a Kiswahili presenter on Radio Star.
