“No woman should accept to be duped into shunning the use of contraceptives just because of the rumoured risks of acquiring cervical cancer”. Dr Gonzaga Ssenyondo, a consultant Obstetrician/Gynecologist at the Masaka Regional Referral hospital precisely dismisses the misconception many people have about family planning services.
Dr. Ssenyondo, a specialist in Reproductive Health Disease Control, says; he is aware that many people have diversionary and dissenting beliefs about cervical and other reproductive cancers and the uptake of family planning methods thus unwittingly abdicating from the use of these lifesaving services.
“There are no reliable studies which have shown that contraceptives per say, can cause cervical cancer, although many people continue associate them with the disease. There are a number of factors that must be present for one to acquire cancer” he says, adding that this occurs regardless of whether one uses or doesn’t use any contraception methods.
He defines cancer as abnormal cells growth in one’s body, which gradually results into abnormal functioning of the affected body organ and eventually spreads to the whole system , leading to general illness and subsequently death if treatment is not sought in time.
Dr Ssenyondo explains that scientific proof indicates that in 99.5 percent of cervical cancer cases, their major causal factor is the Human Papilloma Virus (HPV), which is sexually transmitted.
The same virus is also associated with other types such as; anal, throat and esophagus cancer.
“This virus is highly reflected on one’s sexual behaviour. Besides having multiple sexual partners which is the obvious cause, homosexuals and those that practice oral sex also stand higher risk of contracting the virus,” he expounds.
However, other sexually transmitted infections such as; gonorrhea, syphilis, chlamydia among others that cause genital ulcers are also known to act as co-factors to the virus spread.
For a word of advice, Dr Ssenyondo urges all women in their reproductive age group to seek routine check-up and screening for all those diseases and conditions that exposes them to cancer.
According to him, people should as well pay extra attention to their genetic background because the disease can also trade within the family linage of birth.
“Chances are high if one’s mother or sister had either cervical or breast cancer, these genetic factors can predispose even the next generation to the disease, either through directly getting the infections or in reducing the immunity to fighting against cancer growth” He says.
The advantage, clients who enroll on contraceptives have over their fellows who tend to avoid them, is that the former, get chances of being medically examined to ascertain the appropriate contraception methods that suits their blood groups, and in the process, medical personnel can ably detect the problem and attend to it before it’s too late.
Dr Ssenyondo, who is also a national master trainer in cervical cancer prevention and treatment, further explains that mothers with uncontrolled births are highly prone to contracting cervical cancer.
“Because of the unregulated changes (contraction and expansion) that occur during un-spaced pregnancies and producing of many children, the cervix weakens hence developing cancerous cells”. This significantly explains how the benefits of contraceptives in protecting women to live longer outweigh the risks of acquiring cervical cancer.
Dr Ssenyondo adds that although many experts have mainly portrayed HIV/Aids infected persons to be standing the highest chances of acquiring cervical cancer due to their lowered immunity; again people must as well be very careful of other diseases that affect the immune system ;especially those that predisposes one to multiple chronic infections. Diseases such as diabetes if it not well controlled can highly expose one to cancer.
He adds that all cancers are equally dangerous, only that some patients get healed if they get a chance of accessing the services before it gets to the advanced stages. He further warns patients diagnosed with infections against visiting herbalists who hoodwink them they cure the disease.
Research indicates that “Breast Cancer” which is more caused by genetic factors is more prevalent in the developed countries like in Europe than in the developing countries that are hit hard by cervical cancer.
Particularly, Uganda has one of the highest prevalence rates of cervical cancer, which is at about 45-50 women per hundred thousand in the reproductive age group
However, Dr Ssenyondo says in Masaka sub region ,the trend go as high as eighty women per 100,000 reproductive mothers, and that this is due to the high prevalent factors of HIV/Aids spread and multiple sexual behaviours.
To explain the difference in prevalence, Dr Ssenyondo says it’s so because the developed countries have struggled to lower the cervical cancer rates by ensuring reliable screening and holistic prevention and treatment services in place, unlike in low income countries, like Uganda, where such services are still scarce and expensive .
“In Uganda, many people are still applying the Syndromic approach to the treatment of sexually transmitted diseases. This remains a problem in the country because this approach doesn’t include the screening for cervical cancer, more often we have seen health workers treating the problem as just a mere abnormal vaginal discharge and by the time it is detected, it is already in the advanced stages,” he revealed.
“Some have even mistaken cancer as a mere menstrual disorder, commonly known as “Ekikulukuto” in Luganda, and resort to herbs, not knowing that it slowly eat them up”.
But the good news is that during their last meeting as Disease Control specialists, Dr Ssenyondo says they raised the concern and unanimously recommended to the Ministry of Health to review the guidelines for the treatment and prevention of STI’s; to provide for routine universal screening for all those persons that are prone to different reproductive cancers.
“This is what the European countries implemented long ago to reach at their promising results.” he added.
He explains that apparently, what is being carried out in Uganda, is opportunistic screening offered only to those women that turn up at health facilities with complaints of a sort, thus omitting the many that haven’t registered the symptoms as yet.
Dr Herbert Kalema, a senior obstetrician at Masaka Regional hospital also emphasises that all cancers by the time they show symptoms, it’s too late and require surgical operation, urging that the best way to prevent and treat them is to emphasize screening without necessarily looking for the symptoms.
Sadly ,according to Dr Ssenyondo, cases of vulval cancer (also associated with HPV) has started rising in Masaka, reflecting that in the last two years, they have registered at least 10 cases already in advanced stages.
He also acknowledges the inadequacies in the number of specialists who can effectively screen for cancer, confidently revealing that in the whole Masaka sub region, not more than 10 percent of health workers can actually do it even as simple as it appears.
“There isn’t that required critical mass of skilled health providers able to effectively screen for cervical cancer. This is a challenge to government; to build more capacity of the existing medical practitioners as well as training more new ones on top of providing the basic equipment for screening ,preventive, treatment and points accessible to the community,” he urged, adding his observation since 2003 when he started attending to cancer patients, the cases have increased.
He prefers having the services taken down to all district health Centre IVs, other than waiting for people to travel long distances to the available facilities that are located in Masaka Town.
Sister Ruth Nanyonga ,(an enrolled midwife) ,and one of Dr Ssenyondo’s many trainees says ,every time they conduct cancer outreaches from Masaka hospital ,the number of cases they register are alarming, calling for intensified public awareness about cancer.
Sister Nanyonga’s desire is that cancer is given equal priority as other programmes of; prevention of mother to child HIV/Aids transmission, anti-malaria fight among others.
The experts all dispel rumours that second hand clothes can cause cervical cancer, describing them as baseless talk the public should ignore.
Basic treatment procedures
Cancer of the cervix is the most killer of women in Uganda yet it is a preventable disease.
Dr Ssenyondo explains that early detection of changes that lead to development of all reproductive cancers ensures successful prevention by a halting progression to a later stage that is less untreatable.
The treatment process begins with visual inspection with acetic acid, and if the cervix is found to be normal, that will mark the end of examination, and one is recommended to undergo another screening after five years. While if the cervix is found to be abnormal, one is offered a treatment with Cryotherapy, to destroy the abnormal cells. A patient is afterwards required to go back for review after 12 months to ascertain the situation. But Ssenyondo emphasizes that all this is done with absolute confidentiality.
However, with advanced cases a biopsy is taken for further examination and on recommendation of the expert the patient may be referred to the National Cancer institute in Mulago for Radiotherapy or even complete removal of the uterus.