General
Source: The Monitor
She always thought that a pap smear was an important test that every woman should take.
But Joy, a mother of two had never taken the initiative of doing the test. However, one day during a cervical cancer seminar, she randomly decided to have the test since they were offering it at no cost.
When her results came out, they showed that she had abnormal cells around her cervix. With the knowledge of her status, she started treatment immediately. Seven years down the road, Joy now considers herself a cervical cancer survivor.
Joy's experience paints a picture of how fortunate all cervical cancer patients would be if they had gone for a random cancer screening. Therefore, it is the need to have many cervical cancer survivors like Joy and no more women suffering from this ailment that every January is observed as a cervical cancer awareness month globally.
The reason for the creation of awareness is that, "Anyone with a cervix can contract cervical cancer."
However, this sounds like a myth to most Ugandan women because unlike a few women like Joy, a number of them in Uganda have never taken any cervical cancer screening test like the Pap smear, a screening test is used to detect changes in cells lining the cervix.
Mr Alex Ngobi Pande, a Social Worker with Women Awareness Against Cervical Cancer (WAACC) says in March 2011, the organisation offered breast and cervical cancer screening in Kibale District. But out of the 3,000 that turned up for the test, only 1093 registered.
Mr Ngobi explains, "People fear having the test. At times the failure of women to go for screening is because cervical cancer is a silent sickness that only shows signs after 15 to 20 years of infection. So given the culture of most Ugandans, they go to hospital when they are sick."
Since cancer of the cervix does not present with any pains, Dr Mike Kagawa, a gynecologist and a lecturer at the Gynecology and obstetrics department at Mulago referral hospital, says cervical cancer is the leading cause of cancer deaths amongst women in Uganda. "Because by the time they come to hospital, their cancer is always in the late stages making it difficult to achieve a cure".
He explains that this silent killer which usually exhibits when in late stages is caused by a sexually transmitted agent.
Dr Dan Murokora, also a gynaecologist and the Medical director for Uganda Women's Health Initiative, explains, "Cervical cancer is caused by a human papulluma virus (a virus that is easily transmitted sexually between individuals) which embeds itself in the nucleus of the cells on the cervix causing them to start growing abnormally."
Dr Murokora adds that the initial infection of the cervix happens when people get their first sexual contact. Normally the body is able to clear this infection. But with repeated sexual contact, "chances are that the infection may persist causing the cells to grow in an abnormal way over time."
When the cells start growing abnormally, it takes quite some time (15 to 20 years) before a woman notices some isolated symptoms like bleeding after periods, some irregular periods are pointers to cancer of the cervix. A discharge with a bad smell and passing of blood while bathing or after sex are usually late symptoms when the disease is advanced.
But to rule out cases of detecting cervical cancer in its late stages, Dr Kagawa advises that since it's common amongst women who have been sexually exposed before, no matter how often, "All women from the age of 21 up to the stage of menopause should have a pap smear test within three years of having their first sexual encounter."
Dr Murokora says, Uganda is one of the countries with a high mortality due to cancer. "Cervical cancer causes 70 per cent of gyneacological deaths and 40 per cent of radiotherapy patients are treated for advanced cervical cancer. Meanwhile, over 80per cent of women with cervical cancer are diagnosed with advanced disease, usually stage three and four and the five year survival rate stands at less than 20 per cent."
He explains that the high mortality due to cancer in the country has been attributed to late disease presentation, reflecting lack of access to early diagnosis and treatment as a result of the poor status of the cancer care system in the country.
Further to this, the cost of cancer treatment in this country is still out of reach to many women.
But for those that can access it, the screening using the Pap smear should be every year for three years after which you start spacing the tests at intervals of once every three years. He explains, "The repetition of the test is to ensure that a woman's chances to have the abnormal cells are detected early."
The Medical director however cautions that if you decide to go for a test, have it done by a qualified health personnel. "The test should be conducted by a trained health worker who should either be a gynaecologist or a trained mid wife.
It should also be taken in a health centre by a person who has a clear vision and in a place with good lighting."
Dr Murokora explains that during the test, "The health worker uses a small instrument to open up the woman's private parts so that the cervix can clearly be seen. The health provider will then insert either a small and smooth wooden spatula or a cyto brush into the vagina up to the cervix to obtain some of the cells around it."
The whole process takes approximately 15 minutes and it takes a minimum of three days to get the results from the laboratory after taking the test. Dr Murokora mentions that the results might show that the cells around your cervix are either normal or abnormal.
"Results that show abnormal cells mean that the cells around your cervix are undergoing changes that could become cancerous whereas results that show normal cells may signify that there is no abnormality at the moment."
In case of abnormal cells, Dr Dan says that treatment is prescribed depending on the severity of abnormality of the cells. "If it's mild, the treatment could be postponed. This is because these normally regress on their own. But if the abnormality is severe, the woman is put on pre-cancer treatment."
However, while the screening and treatment services are readily available in Kampala, they are hard to attain in health Centres outside Kampala. Mr Ngobi says that the challenge is, "there is no national cancer policy that requires all women to be tested for cancer whenever they go for checkup but we are trying to push for it and I am sure it will create a difference."
TIME....... TIPS
The pap smear test can be done at Mulago hospital, Nsambya Hospital, Mild May, Mbarara Hospital, Itojo, Nakasongola health Centre 4, Mbale Hospital, KCCA health centres and the Reproductive health Centre for prices ranging from Shs5,000 to Shs30,000 in private hospitals and clinics. But it's free in all government hospitals.