Rising cervical cancer cases attributed to late diagnosis

Masaka- Health authorities at Masaka Regional Referral Hospital have attributed the increasing number of cervical cancer cases at the facility on late screening.

Statistics from the hospital’s maternity department indicate that 16 cervical cancer cases are registered monthly with majority at advanced stages and can only be referred to Uganda Cancer Institute in Mulago hospital, Kampala.

Cervical cancer screening is offered at Masaka hospital’s department of antenatal, child health and gynaecology and other HIV/Aids healthcare services.

According to Dr Gonzaga Ssenyondo, the head of gynaecology department, about 50 mothers are screened monthly, but majority emerge with cancers at advanced stages.

“Out of 16 cancer patients registered monthly, about 10 of the patients have advanced cancers, while many others, especially those between 25 and 30 years, present a pre-cancerous cervical lesion,” Dr Ssenyondo told Daily Monitor in an interview last weekend.

A pre-cancerous cervical lesion is an abnormality in the cells of a woman’s cervix that can develop into cervical cancer if not treated in time.

Dr Ssenyondo says the facility only has the capacity to effectively attend to cancer patients in early stages and those with pre-cancerous lesions.

“Screening people who cannot get treatment appears as wastage of time because even when we refer them to Mulago for radiotherapy, many do not go due to financial hardships and end up dying silently in villages,” Dr Ssenyondo says.

He says some cancer patients go back to the facility and resort to palliative care.
Palliative care is an approach that improves the quality of a patient’s life facing problems associated with life threatening illnesses through physical, psychosocial and spiritual treatment.

Dr Ssenyondo says the trend of cases is closely linked to HIV/Aids since infected mothers are more prone to cervical cancer and its progression is high among people with compromised immunity.

“That is the reason why we always advise HIV-positive women to embrace early screening so as to detect and contain the disease in case they present pre-cancerous lesions before it spreads fast due to their suppressed immunity,” he says.

A research study by Dr Noleb Mugisha, an oncologist specialising in cervical cancer at Uganda Cancer Institute, indicates that despite being on ARVs and having regular care in HIV clinics, HIV positive women usually present cancer at a late stage.

Dr Mugisha says most women who were contacted during their study had been on HIV treatment for about six years were at an advanced cancer stage when they first appeared for diagnosis.
Dr Ssenyondo says because the virus (Human Papillomavirus) is sexually transmitted, many women can survive with it for years and if undetected, it eventually converts normal cells on the surface of the cervix into cancerous ones.

“Unfortunately, cervical cancer does not show signs unless when it is advanced, where chances of healing are minimal. That is why we advocate for early and regular screening because when the cancer is detected in its initial stage, it can be treated and patients get healed, but late diagnosis compounds the low survival rate,” he says.

Dr Senyondo advises youth to abstain from sex and discourages adults from having multiple sexual partners.

In an effort to fight the disease, the government rolled out a vaccination campaign in October 2015 targeting 850,000 girls ranging from the ages of nine to 13 to be immunised against cervical cancer.

By June last year, statistics at Uganda National Expanded Programme on Immunisation indicated that about 381,054 girls (48 per cent) out of the 850,000 national set target, had received the first dose of the vaccine.

Mr Emmanuel Kaggwa, the Masaka District disease surveillance focal person, says by March last year, only 1,627 girls had completed their dose, which is 40 per cent of the targeted 4,056 girls in the area.

Cervical cancer at A glance

Cause: Cervical cancer occurs is caused by a sexually-transmitted Human Papillomavirus (HPV). As the infection spreads, it causes abnormal tissue growth and other changes to cells within the patient’s cervix.

Symptoms: Dr Herbert Kalema, a gynaecologist at Masaka hospital, says the signs one should get suspicious of are; foul vaginal discharge, constant bleeding that occurs during sex or bathing and after some time, the bleeding becomes spontaneous. However, he says, many victims tend to ignore the signs until the late stages when they start feeling abdominal pain, difficulty in passing urine or when they experience weight loss and general body weakness.

Deaths: The World Health Organisation (WHO) estimates that in 2014, approximately 3,915 Ugandan women were diagnosed with cervical cancer and 2,160 died from the disease.

The prevalence of cervical cancer in Uganda is at 34 per cent and low screening uptake has resulted in the country having one of the highest cervical cancer incidence rates in the world with 47.5 per 100,000 women every year. Infections including those from HIV/Aids and Hepatitis contribute about 50 per cent of cancer deaths with 300,000 new cases annually, according to the statistics from Kampala Cancer registry.

Gaps: Due to the absence of a national cervical cancer prevention and control programme, the cases and deaths are more likely to increase.
According to WHO projection, by 2025, about 6,400 new cervical cancer cases and 4,300 deaths will occur annually if no attempt is accorded to reduce the scourge.

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