Cervical cancer and its impact on women’s Health.

Cervical cancer is a serious health concern in Kenya, with an estimated 5,200 new cases and 3,200 deaths reported annually. It is the leading cause of cancer-related deaths among women in Kenya, posing a significant threat to their health and well-being. 

The high rate of cervical cancer in Kenya underscores the importance of regular screening and early detection to improve outcomes and save lives.

Key Message on Cervical Screening:

✔️Regular cervical screening is critical for protecting women aged 25-49 against cervical cancer.

✔️The three methods of cervical screening are HPV DNA test, Pap smear and VIA/VILI

✔️Most health facilities in Kenya offer at least one form of cervical screening, talk to your nearest provider or contact us for advice.

✔️Cervical screening is a fast, simple procedure with minimal discomfort.

✔️In the event of abnormal results, your provider will walk you through the recommended additional testing and treatment options.

What is Cervical Cancer?

Cervical cancer is a type of cancer that develops in the cervix, the lower part of the uterus that connects it to the vagina.

Cancer occurs when normal cells in the body start to grow uncontrollably. In cervical cancer, this uncontrolled growth takes place in the cells lining the cervix.

Understanding Cervical Cancer Development and the Role of HPV

The cervix is the lower part of the uterus that connects it to the vagina. The cells lining the cervix are normally healthy, but sometimes these cells can undergo abnormal changes that can lead to cervical cancer.

The most significant risk factor for developing cervical cancer is infection with certain types of Human Papillomavirus (HPV). HPV is a very common virus transmitted through skin-to-skin contact during sexual activity. There are over 200 types of HPV, but only some are linked to an increased risk of cervical cancer. (High-risk HPV types)

Here’s how HPV can contribute to cervical cancer development:

• HPV Infection: During sexual contact, HPV can enter the body and infect the cells of the cervix.
• Abnormal Cell Changes: In most cases, the body’s immune system naturally clears the HPV infection. However, in some instances, certain types of HPV can cause persistent infection and trigger abnormal changes in the cervical cells.
• Precancerous Cells: These abnormal changes, if left undetected and untreated, can gradually progress over years into precancerous cells.
• Cervical Cancer: If precancerous cells are not identified and addressed through screening, they have a small chance of developing into cervical cancer over time.

It’s important to remember that not all HPV infections lead to cervical cancer. In fact, most HPV infections clear up on their own without causing any problems. However, regular screening is essential to detect any precancerous changes early on and prevent them from progressing into cancer.

Understanding Different HPV Types and Risk Factors for Cervical Cancer

As mentioned earlier, Human Papillomavirus (HPV) is a common sexually transmitted infection, but not all HPV strains pose the same risk for cervical cancer. Here’s a breakdown of different HPV types and associated risk factors:

Types of HPV:

• Low-Risk HPV: These types, like HPV 6 and 11, are responsible for about 90% of genital warts. While unpleasant, they are not considered high-risk for developing cervical cancer and usually clear up on their own.
• High-Risk HPV: Certain HPV strains, particularly HPV 16 and 18, are classified as high-risk because they are linked to a higher chance of developing cervical cancer. These specific types are responsible for roughly 70% of cervical cancer cases worldwide.

Read More: Role of HPV Testing in cervical cancer screening in Kenya

Risk Factors for Cervical Cancer:

While HPV infection is the most significant risk factor, other factors can contribute to developing cervical cancer:

⭐Early Age of First Sexual Intercourse: Starting sexual activity at a young age (before age 18) allows for a longer exposure window to HPV.

⭐Multiple Sexual Partners: Having multiple sexual partners throughout your life increases the chances of encountering someone carrying HPV.

⭐Weakened Immune System: Conditions that weaken the immune system, like HIV/AIDS, can make it harder for your body to fight off HPV infection.

⭐Smoking: Smoking habits can weaken the body’s immune response and potentially contribute to cervical cancer development.

⭐Family History: Having a close family member with a history of cervical cancer might indicate a slightly increased risk.

**It’s important to remember that having HPV does not guarantee you will develop cervical cancer. **

Many women with HPV infections never experience any related health problems. However, understanding the different types and risk factors associated with HPV empowers you to make informed decisions about your health and prioritize regular screening.

Recommended Cervical Cancer Screening Guidelines for Kenyan Women

Early detection of cervical cancer is crucial, and Kenya has established screening guidelines to empower women to take control of their health. Here’s an outline of these recommendations based on age and risk factors:

General Screening Guidelines:

• The Ministry of Health, Kenya, recommends initiating cervical cancer screening for women between the ages of 21 and 49.
• Screening is typically offered every 3 years using either an HPV DNA Test, Pap smear or a Visual Inspection with Acetic Acid (VIA) test, depending on available resources.
• After the age of 59, screening frequency may be reduced based on individual risk factors and past screening history. It’s important to discuss this with your healthcare provider.

Considerations for Individual Risk Factors:

• Early Start to Sexual Activity: Women who began sexual activity at a young age (before 18) or have a history of multiple sexual partners might be advised to start screening earlier or have more frequent screenings.
• Weakened Immune System: Women with compromised immune systems due to conditions like HIV/AIDS may require more frequent screening as determined by their healthcare provider.
• Previous Abnormal Results: A history of abnormal Pap smears or a positive HPV test might necessitate more frequent follow-up screenings as recommended by your doctor.

Consulting Your Healthcare Provider:

These guidelines provide a general framework, but it’s vital to discuss your individual situation with your healthcare provider. They can assess your specific risk factors and recommend the most appropriate screening schedule for you.

Remember, early detection is key to successful treatment of cervical cancer. By following the recommended screening guidelines and consulting your healthcare provider, Kenyan women can proactively safeguard their health and well-being.

Types of Cervical Cancer Screening Tests Available in Kenya

3 main methods have been found to be very effective in screening for ealy changes in the cervix

These are:

🩺HPV DNA testing

🩺Cervical cytology aka pap smear

🩺Visual Inspection of the cervical surface with acetic acid (VIA) or Lugol’s Iodine (VILI)

Let us briefly introduce each method. Remember to discuss with your healthcare provider to enable you to choose the right one for you.

The HPV DNA Test: Detecting the Root Cause of Cervical Cancer

The HPV DNA test is a highly effective screening tool for identifying the presence of certain strains of Human Papillomavirus (HPV) linked to cervical cancer. Unlike the Pap smear, which looks for abnormal cell changes caused by HPV, the HPV DNA test directly detects the genetic material (DNA) of the virus itself.

What Does the HPV DNA Test Detect?

The HPV DNA test specifically targets high-risk HPV strains, particularly HPV 16 and 18, which are responsible for the majority of cervical cancer cases. By detecting the presence of these specific HPV strains, the test can offer valuable insights into a woman’s risk of developing cervical cancer.

Benefits of the HPV DNA Test:

• Early Detection: The HPV DNA test can identify HPV infection even before precancerous cell changes develop, allowing for earlier intervention and potentially preventing cancer altogether.
• Increased Accuracy: Compared to the Pap smear, the HPV DNA test offers higher accuracy in detecting the presence of high-risk HPV strains.
• Reduced False Positives: The HPV DNA test can help reduce the occurrence of false-positive results sometimes seen with Pap smears, leading to unnecessary anxiety and procedures.
• Long-Term Risk Assessment: A positive HPV DNA test can inform healthcare providers about a woman’s long-term risk of developing cervical cancer, allowing for personalized screening plans.

Who Might Benefit from the HPV DNA Test?

The HPV DNA test can be a valuable tool for a wide range of women, particularly:

• Women with a history of abnormal Pap smears
• Women who have multiple sexual partners or began sexual activity at a young age
• Women with weakened immune systems

“It’s important to note that a positive HPV DNA test doesn’t necessarily mean cancer is present. “

Many women with HPV infections clear the virus naturally over time. However, the test provides valuable information for your healthcare provider to determine the best course of action for monitoring and potential follow-up steps.

How Often Should I Get HPV DNA Testing?

The recommended frequency of HPV testing in Kenya is 5 years. The test can be used in conjunction with a Pap smear or as a follow-up to an abnormal Pap result. Generally, discussions around the most effective screening approaches should take place between a woman and her healthcare provider. 

They can assess individual risk factors and past screening experiences to determine if the HPV DNA test is appropriate and how often it might be recommended.

Bonus: Self-Sampling for HPV Testing in Kenya

While traditional clinic-based HPV testing plays a vital role in cervical cancer screening, new advancements are making it even easier for women to access this crucial health service. Self-sampling for HPV testing is a promising approach gaining traction in Kenya.

What is Self-Sampling for HPV Testing?

Self-sampling empowers women to collect their own cervical cell samples at home using a specially designed swab or brush. This eliminates the need for a pelvic exam during the initial screening stage. The collected sample is then sent to a laboratory for HPV testing, following the same procedures as a clinic-based test.

Benefits of Self-Sampling in Kenya:

• Increased Accessibility: Self-sampling offers a convenient option for women who might face challenges accessing healthcare facilities due to distance, time constraints, or social stigmas surrounding cervical exams.
• Empowerment and Privacy: Self-sampling allows women to take control of their health screening in a private and comfortable setting.
• Potential for Increased Screening Rates: By providing a less invasive option, self-sampling could encourage more women to participate in regular HPV testing, ultimately leading to earlier detection and improved health outcomes.

Important Considerations for HPV DNA Self-sampling

• Accuracy: Studies have shown self-sampling to be as effective as clinic-based testing in detecting high-risk HPV strains.
• Follow-up Procedures: Even with a positive self-sample test, a follow-up appointment with a healthcare provider remains necessary for colposcopy or biopsy, if needed, to confirm the diagnosis and determine the best course of action.
• Availability: While self-sampling for HPV testing is gaining momentum in Kenya, it might not be universally available yet. Discuss this option with your healthcare provider to understand their capabilities and recommendations.

Read More: Benefits of Home self sample collection for cervical cancer screening

The Future of Cervical Cancer Screening in Kenya

Self-sampling for HPV testing presents an exciting opportunity to expand access to cervical cancer screening in Kenya. By combining traditional methods with innovative approaches like self-sampling, healthcare providers can empower more women to prioritize their health and achieve better health outcomes.

The Pap Smear: A Quick and Easy Screening Test

A Pap smear is a widely used cervical cancer screening test. Here’s a quick overview of the procedure:

• During a pelvic exam, your healthcare provider gently inserts a speculum to open the vagina and visualize the cervix.
• Using a soft brush or swab, they collect a sample of cells from the surface of the cervix.
• The collected cells are then transferred to a slide and sent to a laboratory for examination under a microscope.

What Does a Pap Smear Check For?

The Pap smear primarily looks for abnormal cell changes in the cervix that could be precancerous. These abnormal cells, if left undetected and untreated, have a small chance of developing into cervical cancer over time.

By identifying these abnormal cells early, a Pap smear allows for prompt intervention through procedures like colposcopy or biopsy to remove them before they become cancerous.

The Ministry of Health, recommends initiating cervical cancer screening with either a Pap smear or a Visual Inspection with Acetic Acid (VIA) test, typically every 3 years for women between the ages of 25 and 49. Women with continued risk for cervical cancer should be screened upto the age of 65.

This frequency may be adjusted based on individual risk factors and past screening history. Always discuss the most suitable screening approach with your healthcare provider to ensure optimal protection.

Read More: Our Comprehensive article on Pap Smear for Cervical Screening

What to Expect During a Cervical Screening Appointment.

Cervical screening is a fairly straightforward procedure, sample collection  takes at most 15 minutes

Arrival and Registration: Arrive at your healthcare facility and complete any necessary registration procedures.

Consultation: Discuss your medical history and any concerns with your healthcare provider.

Pelvic Exam: Lie on an examination table with your legs positioned in stirrups. Your healthcare provider will gently insert a speculum to visualize the cervix.

Pap Smear or VIA Test: Depending on available resources, your provider might perform a Pap smear (collecting cervical cells) or a VIA test (applying acetic acid solution to the cervix to detect abnormalities).

Sample Collection: If a Pap smear is performed, a soft brush or swab will be used to collect a sample of cells from the cervix.

Conclusion: Your provider will discuss the procedure and answer any questions you may have. You might be advised on when to expect results and next steps.

How to ensure comfort and privacy of the procedure.

Privacy assured: The entire procedure is conducted in a private room with a chaperone present if you wish.

Quick and painless: The Pap smear or VIA test itself takes only a few minutes and is generally not painful.

Minimal discomfort: You might experience slight pressure or cramping during the pelvic exam, but it’s usually very manageable.

Open communication: Discuss any anxieties you have with your healthcare provider beforehand. They can explain the procedure step-by-step and address your concerns.

Understanding Your Cervical Cancer Screening Results: A Breakdown of Bethesda System Terminology

The results of your cervical cancer screening, whether through Pap smear or, are reported using The Bethesda System 9TBS) terminology. Here’s a breakdown of some common results you might receive:

1. Negative for Intraepithelial Lesion or Malignancy (NILM): 

This is the most desirable outcome, indicating no evidence of abnormal cells or cancer.

2. Atypical Squamous Cells of Undetermined Significance (ASC-US): 

This result suggests the presence of slightly abnormal cells, but the cause is unclear. It might necessitate a repeat Pap smear in 6 months or further investigation depending on your healthcare provider’s recommendation.

3. Low-Grade Squamous Intraepithelial Lesion (LSIL): 

This result indicates the presence of mildly abnormal cells that are likely caused by a low-risk HPV infection. Typically, follow-up with a Pap smear in 1 year is recommended to monitor the situation

4. Atypical Squamous Cells of Undetermined Significance, Favor Neoplasia (ASC-H):

This result suggests the presence of atypical cells with a higher chance of being precancerous. Your healthcare provider might recommend a colposcopy for further evaluation.

5. High-Grade Squamous Intraepithelial Lesion (HSIL): 

This result indicates the presence of moderately or severely abnormal cells with a higher risk of progressing to cancer. Further investigation through colposcopy and biopsy will likely be recommended.

6. Atypical Squamous Cells, Cannot Exclude High-Grade SIL (AGC): 

This result suggests the presence of abnormal cells that could be high-grade. A colposcopy and biopsy will likely be recommended for a more definitive diagnosis.

7. Carcinoma in Situ (CIS): 

This result indicates a precancerous glandular cell abnormality in the cervix. Further evaluation and treatment will be necessary.

8. Squamous Cell Cancer, Invasive (SCC)

Rarely, a cancer may be diagnosed through a pap smear. In such cases, the woman will most likely have symptoms suggestive of cancer such as bleeding, pain or discharge. 

Remember:

• This is a simplified explanation, and the interpretation of results depends on your individual medical history and other factors.
• It’s crucial to discuss your specific results with your healthcare provider, who can explain their meaning and recommend the most appropriate course of action.

Explainer: What Happens if My Cervical Cancer Screening Results Are Abnormal in Kenya?

If your cervical cancer screening results are abnormal, there’s no need to panic. It doesn’t necessarily mean cancer is present. Here’s what typically happens in Kenya:

• In more than 99% of the cases, abnormal results do not mean you have cancer. It just means there are some changes in the cervix which need to be treated before they can turn into cancer. Your healthcare provider will discuss the results with you and explain their significance.
• Your doctor will recommend follow-up procedures like colposcopy, a procedure where the cervix is magnified for a closer look.
• If necessary, a biopsy (tissue sample) might be taken during the colposcopy for laboratory analysis.
• Based on the colposcopy and biopsy results, your healthcare provider will determine the best course of treatment, which could involve procedures to remove precancerous cells.
• In instances where cancer is diagnosed, It will likely be in very early stages and with prompt treatment, a complete cure is possible.

Further Reading: What is Colposcopy and Biopsy in Evaluation of Cervical Lesions?

Additional Considerations for Cervical Screening in Kenya

• Cost and Insurance Coverage: 

Cost sometimes can be a barrier for women to access cervical cancer screening services. Luckily, the direct cost of the test is coming down. Most insurance covers are embracing the need for prevention and are covering this cost. NHIF has been at the forefront and exploring potential insurance coverage options in Kenya.

Click here to discover the prices of laboratory tests in Kenya

• Accessibility of Screening Services: 

Innovative solutions like the AI-based cervical cytology program, sample self-collection and awareness campaigns are increasing access to screening services. More needs to be done to reach women in arid, rural and urban poor environments

• Addressing Stigma: 

The potential social stigma surrounding cervical cancer screening exists in some parts of Kenya. Concerted efforts are required at all levels to combat it and emphasize the importance of prioritizing women’s health and well-being.

Don’t Delay, Take Control: Schedule Your Cervical Cancer Screening Today!

Cervical cancer is a preventable disease, but early detection is crucial. By prioritizing regular cervical cancer screening, Kenyan women can significantly reduce their risk and ensure their long-term well-being.

Here’s how you can take control of your health:

• Talk to your healthcare provider: Discuss your risk factors and schedule a cervical cancer screening appointment.
• Don’t be afraid to ask questions: Understanding the process and potential results can alleviate anxiety.
• Prioritize your health: Regular screening is an investment in your future well-being.

Remember, early detection saves lives. Don’t wait, schedule your cervical cancer screening today and empower yourself with the knowledge and tools for a healthy future.

Ready for your cervical screening? Contact us 24/7 to schedule your appointment

Here are some additional resources to help you find cervical cancer screening services or support in Kenya:

• Ministry of Health, Kenya: https://www.health.go.ke/
  • This website provides information on various health services available in Kenya, including cervical cancer screening programs.
• National Cancer Institute of Kenya: [National Cancer Institute of Kenya ncikenya.org] (English)
  • The National Cancer Institute of Kenya offers information and resources on various cancers, including cervical cancer. They might have information on screening services or partner organizations.
• Marie Stopes Kenya: https://mariestopes.or.ke/
  • Marie Stopes Kenya is a healthcare organization providing various reproductive health services, including cervical cancer screening. You can explore their website or contact them to find a clinic offering screening near you.
• Embrace HER Kenya: https://cmmb.org/linda-uzazi-empowering-mothers-in-kenya-to-help-themselves/
  • Embrace HER Kenya is a non-profit organization focused on empowering women through health education and advocacy. They might have resources or information on cervical cancer screening initiatives.

Cervical cancer screening: Take Home Message

In this comprehensive guide, we have covered the key aspects of cervical cancer screening. Here is a summary of key points

• Regular cervical screening is critical for protecting women aged 25-49 against cervical cancer.
• The three methods of cervical screening are HPV DNA test, Pap smear and VIA/VILI
• Most health facilities in Kenya offer at least one form of cervical screening, talk to your nearest provider or contact us for advice.
• Cervical screening is a fast, simple procedure with minimal discomfort.
• In the event of abnormal results, your provider will walk you through the recommended additional testing and treatment options.
• Contact us or any of the organisations that offer screening services in your local area.

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