Sita Deuja, 55, is a cervical cancer survivor. After surgery and treatment, this resident of Bhaktapur no longer has cancer. It’s been six years, but how she contracted the disease remains a mystery to her.
Kabita Karki, a 45-year-old mother of three from Khotang, however, has a different story. She believes the long-term use of a reusable cotton cloth for menstrual bleeding was the cause of her cervical cancer.
Many Nepalese women have heard of cervical cancer, but they know very little about it despite their training. There are also many common misconceptions surrounding the disease in Nepal.
Some women we interviewed blamed it on the increased use of pesticides.loaded food, others believe the cause is the use of contraceptives.
Even those who have had or have cervical cancer do not know that almost 99% of cases are caused by the human papillomavirus (HPV) which is sexually transmitted, and therefore do not know that it is preventable.
Cervical cancer is the fourth common cancer among women around the world, and Human Papillomavirus and Related Diseases Report 2019, it is the leading cause of female cancer in Nepal with nearly 3,000 new cases diagnosed each year.
Cervical cancer is preventable and if caught at an early stage it can be treated successfully. In fact, most HPV infections resolve on their own and don’t cause any symptoms, but a persistent infection can cause cervical cancer in women.
As a primary prevention, HPV vaccination could be administered to girls between the ages of 9 and 13, before they become sexually active and are potentially exposed to HPV. The HPV vaccine is very effective in reducing cervical infections caused by the carcinogenic type of HPV (it can prevent 9 out of 10 cases) and the development of precancerous lesions on the cervix.
Another crucial intervention to prevent cervical cancer is a screening program. But the poor financial situation of families and low levels of literacy constitute obstacles to timely detection and treatment. On the other hand, limited access to health means a lack of adequate screening facilities, resulting in late diagnosis, in which case the cancer has reached an advanced stage and cannot be treated.
Other factors affecting diagnosis and treatment include the lack of awareness programs and the stigma associated with reproductive health.
Sita and Kabita have recovered, but they and their families could have saved themselves and their families a lot of hardship, mental stress and money if they had been better informed about the disease.
But not all women are so lucky, many do not survive even after spending a fortune trying to treat the disease. Their deaths could have been prevented with early diagnosis and prompt treatment.
In 2020, the World Health Organization launched a global initiative to eliminate cervical cancer, setting milestones to be achieved by 2030: 90% of girls under 15 should be fully immunized for HPV, 70% of women should be screened with a high performance test at age 35, then again at age 45 and 90% of people identified with cervical disease should receive appropriate treatment.
A comprehensive approach has been recommended to prevent cervical cancer through HPV vaccination, screening and treatment of precancerous lesions. To achieve the goal, Nepal needs clear cervical cancer prevention and management strategies.
The first step in preventing cervical cancer is to increase public awareness and overcoming the misinformation and stigma associated with HPV. Until all women are aware of the disease and the services available for the disease, they will continue to die from cervical cancer.
Many women are unaware that the government has implemented a free cervical cancer screening program at health facilities across the country, and therefore needs to be well communicated.
Education campaigns and mass awareness programs should be intensified, and in schools, adolescents should be informed in detail about reproductive health and safe sexual behavior.
Nepal is also expected to increase the rural reach to increase the number of screenings in the country. Likewise, health authorities should invest in HPV vaccination in adolescents as a primary prevention of cervical cancer.
We could also promote highly sensitive self-sampling kits for HPV testing that allow easy sample collection by the patient herself, without the need for trained personnel or infrastructure to perform a pelvic exam.
Self-sampling methods for cervical cancer screening could be an alternative approach to health facility screening to alleviate the socio-cultural barriers associated with the disease in Nepal.
The fight against cervical cancer is also a fight for women’s rights. It is unfair that women endure unnecessary pain and suffering and possible death from completely preventable disease.
Prevention of cervical cancer is possible with cost-effective, evidence-based, available and acceptable tools. What Nepal now needs is greater commitment from government, development partners and the public health professions to prevent and reduce the prevalence of this public health burden and help save the lives of thousands of women.