Mothers visiting health facilities are being subjected to screening. Photo by Arnest Tumwesige
Robert Ojok and Eden Mic
Kitgum: St. Joseph’s Hospital Kitgum is using antenatal visits to do mandatory screening for cervical cancer.
The hospital started the mandatory cervical cancer screening following a low turnout by women to voluntarily screen, despite the rising cases.
Cervical cancer is ranked first of all six cancers that affect only women. It is caused by the Human Papillomavirus (HPV), a virus passed from person to person during sexual intercourse. It is also caused by smoking, having multiple sexual partners, giving birth to many children, and using birth control pills.
Statistics from St. Joseph’s Hospital indicate that out of 126 women screened for cervical cancer from October 2023 to March 2024, at least 52 turned out positive.
Dr. Pamela Atim, the Executive Director of St Joseph’s Hospital, Kitgum, explained that the hospital decided to use antenatal visits to offer free cervical cancer screening because every female of reproductive age is at risk of getting cervical cancer.
Dr. Atim said that although every woman of reproductive age is at risk of getting cervical cancer, those who engage in sex at an early age are more at risk because of their underdeveloped reproductive organs.
Dr. Atim appealed to women who are HIV positive to do annual screening for cervical cancer because their immunity is low and predisposes them to acquire cervical cancer.
Since HIV compromises one’s immunity, it causes changes in the cells of the cervix, which cells can rapidly become cancerous.
At St Joseph’s Hospital, every HIV-positive female is screened annually for cervical cancer screening, and those who are HIV-negative are screened every three years.
In 2010, the Ministry of Health developed a strategic plan for preventing and controlling cervical cancer and tasked health centers III to offer low-cost screening by offering HPV vaccination.
Dr. Atim said most patients who go for voluntary screening go because the disease is advanced and they are already bleeding, having an offensive discharge from their vagina, or because they have pain, all of which are bad signs.
She said if women do routine screening, the medical workers would identify abnormal lesions on the cervix early.
“… if we identify a lesion on your cervix, we should urgently investigate it, and if it is a cancer, we offer you definitive treatment, and most times it is surgery to remove this cancer, and then you get 100% cure,” Dr. Atim said.
Dr. Atim also called upon health workers at the health facilities to closely examine patients, and be able to determine a normal discharge and that signaling danger, and make referrals where they are not sure.
More funding need to enhance curative
Dr. Ann Mary Gleason, an oncologist working in Lacor Hospital, argued that prevention mechanisms of cervical cancer should be prioritized as part of medical education to health workers and extended to the community.
“The government of Uganda should allocate more funding to Uganda Cancer Institute to enhance preventive and curative measures such as health education and treatment of various cancer cases,” Dr. Ann said.
Dr. Martin Origa, a specialist in cancer of the female reproductive system at Uganda Cancer Institute (UCI), argued that continued medical education on palliative care will also help to manage the expectations of patients, ease referral pathways, and make the health workers follow the right medical procedures.
“There are so many patients nowadays, and this involves a lot of planning before radiation,” Dr. Origa said.
Re-equiping health workers
Dr. Origa revealed that UCI is developing a 3-curriculum for uro-oncology training in thematic areas of surgical uro-oncology and intervention radiology to improve patient care.
Dr. Origa added that the training would benefit a team from the Uganda Cancer Institute before, it is rolled out to other facilities like Mulago National Specialized Hospital, regional referral hospitals, and selected medical facilities that handle cancer.
Northern Uganda Cancer Centre, an affiliate of the UCI located in Gulu City conducts free screening of various cancer cases, while cancer management is done on referrals from general and regional hospitals.
Challenges faced by cancer patients in Uganda result in enormous delays in the initiation and continuation of cancer treatment. These challenges are often a result of the poor socioeconomic status of patients; inadequate infrastructure for cancer care, and inefficiencies in the health care system.
Prof. David Kitara Lagoro, a lecturer at Gulu University, implored the Uganda Cancer Institute to conduct more research into prevention mechanisms.
According to experts, a woman infected with HPV may take up to two years to develop signs of cervical cancer, which include pelvic pain, pain during sexual intercourse, abnormal vaginal bleeding, and abnormal growth of cells in the cervix, among others.
For this reason, the World Health Assembly (WHA), a decision-making body of the World Health Organization (WHO) in 2020, adopted the global strategy to speed up the elimination of cervical cancer as a public health problem.
The strategy focuses on prevention through vaccination, screening, and treatment of precancerous lesions and treatment and palliative care for invasive cervical cancer, requiring that all pillars must be implemented collectively and at scale to achieve the goal of elimination.
WHA believes that when countries understand their burden and risk factors, they can, therefore, design interventions that reduce the exposure of women to these risk factors.
The WHA global strategy requires countries to reach and maintain an incidence rate of four per 100,000 women. However, according to the 2020 Global Cancer Statistics, Uganda leads in the prevalence of cervical cancer in the world with 54.8 for every 100,000 women.
At least 6,959 cases of cervical cancer are registered yearly in Uganda, with 4,607 deaths, according to the Uganda Human Papillomavirus and Related Cancers factsheet for 2023 by ICO/IARC HPV Information Center.
