• by Susan Anyangu (nairobi)
• Thursday, October 01, 2009
• Inter Press Service

Faced with an increase in the number of cervical cancer cases, Kenya has adopted a simple, cheap yet effective visual inspection method of detection. Ideal for low resource settings, the test is offering reprieve to thousands of women who die annually from the disease.

'It is now possible to test for lesions that if left alone will lead to cervical cancer. Using table vinegar, which costs less than a dollar, we can test six to ten women,' says Margaret Odhiambo a nursing officer at Kisumu Provincial Hospital.

Government hospitals in Kenya are now encouraging women of reproductive age to undergo the free test.

'We are now testing between 20 to 30 women in a day which is a marked increase from past records when we relied on Pap smear. In the past women have been coming to us when the disease has advanced and little can be done,' says Odhiambo.

According to statistics from World Health Organisation and United Nations Population Fund (UNFPA), cervical cancer is caused by the human papillomavirus and affects about 500,000 women worldwide each year and kills 270,000 annually.

According to Dr Paul Mitei, the head of department in the gynaecological ward at Kisumu Provincial Hospital, cervical cancer is one of the leading killers in Kenya - and indeed the rest of the world.

Yet it is possible for a trained medical worker to visually detect the presence of the lesions within ten minutes, he says.

The method involves dilating the vaginal walls, applying a solution of acetic acid found in vinegar and performing a visual inspection using a bright halogen light (torch). Once the solution is applied, suspect lesions turn white, while healthy tissue shows no colour change.

'Once detected, the lesions are treated instantly through freezing and within 10 minutes the patient can go home and will not need to be seen for another five years,' says Dr Mitei.

Dr Mitei explains the lesions are treated using cryo-therapy - a process through which liquid nitrogen is used to freeze the affected tissue and destroy the lesions. In other cases, a loop electro-surgical exicision procedure is used to excise the lesions; a painless electric current quickly cuts away the tissue surrounded by a small lop of wire.

Not all hospitals have cryo-therapy equipment, according to Jacton Omotto the district gynaecologist at Siaya District Hospital, but he says most provincial hospitals are equipped. Discussions are underway with donors to purchase more equipment for distribution countrywide.

According to Dr Omotto, studies across the world have proven the efficiency and effectiveness of the visual detection of lesions.

'Studies have proven the visual inspection method is as efficient as Pap testing in identifying cervical cancer precursors. However, Pap requires much more sophisticated equipment, training and logistics. The visual inspection method can be done by any trained medic,' Omotto says.

'In the past, when we suspected cervical cancer we would refer the patient to a higher level facility for testing and treatment,' he adds. 'However, due to poverty many would not travel to Nairobi where Kenyatta National Hospital is located. Instead they would stay home and would be brought back in a critical condition.'

When Violet Opala learnt of this simple mode of detecting cancer, tears streamed down her cheeks. The information rekindled memories of her mother, who died of cervical cancer early this year.

Opala contends that had her mother got a chance to be tested using the visual inspection method, she might be alive today.

'Following the fatal diagnosis, my mother was in and out of hospital for four years then she succumbed. By the time she was diagnosed, the doctors told us it was too late and the cancer had spread,' Opala explains.

She adds, 'I am told cancer is hereditary. My sisters and I have been worried sick at the possibility of testing positive. However, we have never undergone the test due to the prohibitive costs of getting checked. Fear has also been a contributing factor, the idea of waiting for the results is simply agonising.'

Now that the visual inspection is being offered, the thirty-eight year old says she may brave it all and get tested.

'It is encouraging to know that if the lesions are found in their early stages they can be treated. Maybe my sisters and I can get the much needed reprieve that my mother never got,' she says.

Dr Omotto concurs, adding that increasingly younger women in early twenties are being diagnosed with cancer of the cervix.

'It is a reality on the ground that cases of cervical cancer are on the increase and this is mainly due to increased risk factors. What we have noticed is that HIV positive women tend to develop cervical cancer, 'Omotto says.

What is unfortunate according to Kisumu hospitals Mitei, is that many patients come to hospital when it is too late and their condition is beyond the stage where even surgery can be used to intervene.

'Cervical cancer has been mystified and unfortunately many remain ignorant to the fact that early detection can be life saving. Once the pre-cancerous lesions are detected they can be treated,' Mitei says.

The two doctors contend there is a huge discrepancy between cervical cancer deaths in rich and poor nations.

Eighty to 85 per cent of deaths related to cervical cancer occur in the developing world, a majority of these in Africa.

'In richer nations, screening using Pap smear is in place to spot the disease and treat it early, saving the lives of thousands of women. However, a successful Pap testing requires highly sophisticated laboratory equipment and trained technicians. This has thus not worked well in poorer regions including Kenya,' says Omotto.

In that regard, he contends, this inexpensive visual inspection method will provide hope for thousands of women.

There is a vaccine available that prevents strains of the human papillomavirus which causes cervical cancer. However, the vaccine is prohibitively expensive. Medics thus contend the best option is to detect the pre-cancerous lesions early.

© Inter Press Service (2009) — All Rights Reserved. Original source: Inter Press Service