Ondo, 27 January, 2023 - It's 10 am on a Wednesday, and Ilemobayo Wuraola, a health worker, is holding a cervical cancer awareness talk for women attending the Family Planning (FP) clinic at Arakale health centre in Akure, Ondo State. 

“Cervical cancer screening is importanct for early detection of the disease, and it is advisable for women of child bearing age or sexually active females to get tested,” she says. 

She advises the women to take advantage of the free cervical cancer screening programme provided by the government at primary health care (PHC) centre to know their status. 

Following her talk, 15 women chose to conduct their first screening for Human Papillomavirus (HPV). The HPV viruses, if not detected and treated appropriately, persistent infection with high-risk types may progress to cervical cancer. It is, however, preventable through HPV vaccination, early and regular screening with Visual Inspection with Acetic acid (VIA), Pap smear to find any pre-cancerous lesions and effective treatment.

Cervical cancer is the second most common cancer affecting women in Nigeria and the fourth most common cancer among women globally. In 2020, Globally, it was responsible for 604,000 new cases with 342,000 deaths. 

A clarion call

Cervical cancer ranks as the 2nd  most frequent cancer among women in Nigeria and the 2nd most frequent cancer death among women between 15 and 44 years of age. The HPV types 16, 18, 31, 35, 51, 52 are all high risk and are prevalent serotypes in Nigeria with serotypes 16 and 18 responsible for 66.9% of Nigeria’s cervical cancer prevalence. 
 
To raise awareness and call for action against the silent killer, the World Health Assembly in 2020 adopted the Global Strategy for cervical cancer elimination. 
 
The strategy targets 

• Vaccination: 90% of girls are vaccinated with the HPV vaccine by the age of 15;  
• Screening: 70% of women screened using a high-performance test by the age of 35 and again by the age of  45; 
• Treatment: 90% of women with pre-cancer treated, and 90% of women with invasive cancer managed.

Impacting lives 

In Nigeria, the  World Health organization (WHO), the Clinton Health Access Initiative (CHAI), and other key stakeholders are supporting the country to embark on cervical cancer screening and awareness creation about the disease. 
 
With funding from the Susan Thompson Buffet Foundation, WHO is providing catalytic support to five states (Anambra, Ondo, Kebbi, Niger and Ekiti), to provide routine cervical cancer secondary prevention services across public health facilities, with the aim of reaching up to 5,000 women per state. 

Efforts have been targeted at demand generation, capacity building of healthcare workers, screening and diagnosis, appropriate treatment, and establishing robust patient tracking systems.

One of the beneficiary of the scheme in Ondo State, Mrs Oladele Funmilayo, a 40 year old trader and mother of three, diagnosed with pre-cancerous leison in August 2022 and had undergone treatment was full of praise for the health workers and government. 

“I came to the clinic to access FP services, but when the health worker spoke about the cervical cancer screening, I thought why not, especially seeing that it was free? It is called arun jejere (Yoruba – literally meaning a devouring disease), but I do not know much about it,” she says. 

Screening the women for cervical cancer, the health workers use a simple technique that involves applying dilute acetic acid (a component of ordinary vinegar) to the cervix and observing the reaction on the cervix with naked eyes. 
 
The process gives an instant diagnosis as the cervix turns white if there are any abnormalities when exposed to acetic acid.

In the case of Mrs Funmilayo Oladele, the health worker recognized patches of pre-cancerous lesions that if not treated, could develop into full-blown cancer. 
 
At first, Mrs Oladele was frightened, knowing she could not afford the cost of treatment which could impact her life negatively.  

“I felt relieved when the health worker told me I can access treatment at no cost. She said the treatment was part of the free cervical cancer screening and treatment programme implemented by the Ondo State government and some other partners. 

My husband and family have been very supportive, especially during treatment. I am happy I benefitted from the programme because I  don’t know what might have happened in the future,” she says. 

Raising to the challenge 

Lauding the initative and impact among the targeted audience, the Ondo State   Commissioner of Health, Dr Banji Ajaka, says the figures of women who have been screened for cervical cancer in the state have been impressive. 

He noted that the campaign was a deliberate effort to ensure that people  (especially vulnerable women and girls) know about the disease, are screened and those positive are treated.  

In addition, the WHO Country Representative, Dr Walter Kazadi Mulombo, reitiarated that WHO would remain steadfast in its support to the government on its course to elimimating the killer disease.
 
He underscores that as long as Cervical Cancer is picked-up early and prompt treatment commenced, it is both preventable and curable 

“It is one cancer that can be eliminated in our lifetime as a public health problem by ensuring a comprehensive approach to prevention, screening, and effective treatment,” he adds.
 

Technical Contacts:

Dr Anne Jean Baptiste; Email: jeana [at] who.int (jeana[at]who[dot]int) 
Dr Sodipo Olutomi Yewande; Email: sodipoo [at] who.int (sodipoo[at]who[dot]int)