Progress report: St. Albert’s Mission Hospital Cervical Cancer Prevention Program

Hi, Everyone,
BHA has received the 2014 second-quarter report for the St. Albert’s Mission Hospital Cervical Cancer Prevention Program. The project began in August 2013 to reduce the suffering and death from cervical cancer, the leading cause of cancer death of women in Zimbabwe and the region.

St. Albert’s director Dr Julia Musariri, and program director Dr. Neela Naha, obstetrician/gynecologist at St. Albert’s, say that the screening and treatment program has been well received by women in the district, and that it has drawn women from outside the district.

From the program’s beginning in August 2013 through 31 June, 2014, St. Albert’s has screened 1,864 women for changes on the cervix that could become cancerous. They detected 63 cases of precancer (3.4%) and 25 possible cancers(1.3%). Of the women screened, 23% were HIV-positive.

The St. Albert’s program prevents cervical cancer by examining the surface of a woman’s cervix – the opening of the womb – for patches of cells that are in danger of becoming cancerous.

The precancerous cells are detected using a method called visual inspection with acetic acid and camera (VIAC). Dr. Naha removes the patches using a method called cryotherapy, or another method called loop electrosurgical excision procedure (LEEP). Removing the precancerous cells early stops cervical cancer from developing.

St. Albert’s VIAC screening results from 1 August 2013 through 30 June 2014

Clients screened 2013
Aug-Sept
2014
Jan-June
Total %
Total number screened 917 947 1,864
VIAC negative 884 892 1,776 95.3
VIAC positive 25 38 63 3.4
Possible cancer 8 17 25 1.3

VIAC screening results by HIV status

HIV-positive clients 2013
Aug-Sept
2014
Jan-June
Total %
Total 226 205 431 23.1
VIAC negative 205 176 381 88.4
VIAC positive 18 23 41 9.4
Possible cancer 3 3 6 1.4

HIV-negative clients 2013
Aug-Sept
2014
Jan-June
Total %
Total 681 730 1,411 75.7
VIAC positive 5 10 15 1.1
Possible cancer 4 10 14 1.1

VIAC examinations also reveal possible cervical cancer and noncancerous conditions such as cervicitis, cervical polyps, strawberry lesions, prolapsed uterus, cysts, and schistosomiasis (also called bilharzia).

Other findings among screened clients

Finding 2013
Aug-Sept
2014
Jan-June
Total %
Polyps 28 21 49 2.6
Strawberry lesions 12 14 26 1.5
Uterine prolapse 1 0 1 0.1
Nabothian cysts 23 24 47 2.9
Cervicitis 119 270 389 20.9
Biopsies done 5 27 32
Cryotherapies done 1 15 16
Total hysterectomies 0 4 4

General observations

  • Most polyps are benign and due to chronic cervicitis and HPV
  • In some clients, thick aceto-white lesions are due to schistosomiasis; these women were given treatment. Bilharzia treatment is needed for adults in the district.
  • Most clients with suspicious cancer have opted for traditional treatment. There is need for more follow ups and palliative counseling.
  • Most clients with cervicitis (inflammation of the cervix) have used vaginal drying agents, often herbs pushed into the vagina to dry it before sexual intercourse, to increase sexual pleasure. In addition to causing cervicitis, the practice is believed to cause abrasions that increase a woman’s risk of HIV infection. The high incidence of the practice – as revealed by the St. Albert’s VIAC screening program – indicates that intensive community health education is needed about the risks of the practice.
  • Most clients suspicious for cancer are women above age 50.

Outcomes of Women with Possible Cervical Cancer

When Dr. Naha identifies a woman with suspected cervical cancer, she takes a small sample of the abnormal cells – a  biopsy – and sends it to Harare for diagnosis.

Treatment options for women with cervical cancer in Zimbabwe are often limited to palliative care – that is, care to keep them as comfortable and as free from pain as possible.

The St. Albert’s VIAC program has so far identified 27 women (1.3%) with suspected cervical cancer. Fourteen of the women came from the Centenary District (St. Albert’s district) in Mashonaland Central Province, and 13 came from other districts.

Of the 14 women in the Centenary District with suspected cervical cancer:

  • Three were sent to Harare and there was no word yet about their management;
  • One had a total hysterectomy;
  • Two sought traditional treatment; one died of cervical cancer;
  • Five were given palliative care; one died of cervical cancer;
  • Three were lost to follow-up (the hospital has no information about what happened to them).

Of 17 women with suspected cervical cancer who came to St. Albert’s from other districts for VIAC screening:

Province of origin Cases of suspected
cervical cancer
Comments
Harare 2 Both lost to follow-up
Mashonaland West 2 Referred back to their local health facilities for palliative care
Mashonaland Central
(Bindura district)
2 Both diagnosed with CIN III; had total hysterectomy in Harare
Mashonaland Central
(Mazoe district)
3 2 lost to follow-up
1 had CIN III; lost to follow-up
Mashonaland Central
(Guruve district)
3 1 discharged home on palliative care
2 referred to Harare; lost to follow-up (one had CIN III)
Mashonaland Central
(Mt. Darwin district)
5 2 opted to go to Karanada hospital for hysterectomy
1 was referred to Harare for treatment and lost to follow-up
2 opted for traditional healing, both have died (one was HIV-positive).

VIAC and treatment using cryotherapy or LEEP are endorsed by the World Health Organization as an effective, low-cost way for low-resource countries to reduce the incidence of cervical cancer.

The Zimbabwe Ministry of Health and Child Care has established VIAC screening and treatment programs at several of the nation’s major public hospitals.

The St. Albert’s Cervical Cancer Prevention Program was developed and initiated by St. Albert’s Mission Hospital in collaboration with BHA and with Dr. Lowell Schnipper, chief of Hematology/Oncology and Clinical Director of the Beth Israel Deaconess Medical Center Cancer Center, and the Theodore and Evelyn Berenson Professor of Medicine at Harvard Medical School. Support for the project has been provided by a grant from the Sarita Kenedy East Foundation and by donations to Better Healthcare for Africa.

Thanks and be well, everyone…Darrell

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