As Malawi joins the global community in commemorating World Cancer Day, our news analyst MERCY MALIKWA writes how early detection and diagnosis is an enabler to precise treatment:
One morning in 2012, Bertha Chimenya of Dziwe in Blantyre Rural received news of her sister’s admission to Ndirande Health Centre. She quickly set off to visit her ailing sister.
While at the health centre, Chimenya, 48, first heard about cervical cancer from conversations other women, who were also at the facility to cheer up and take care of relations, were having.
“I heard some women talking about this cancer in hushed tones. I think they did so because at that time, there was much stigma about it. Women with this cancer were presumed to be HIV positive,” she says.
Chimenya had no time to procrastinate and she went to find out from a doctor at the health centre. She was told everything she needed to know. Thereafter, she did not hesitate to ask the doctor for screening.
“I did not get the screening easily. At first, the doctor turned me down, but he later gave in to my persistence. I was tested, and the test lasted in about five minutes. The wait for results was the longest,” she says.
She said she was dumbfounded when the results came out and the doctor told her that she had signs of cervical cancer. To her relief, the doctor assured her that it was good she went for screening early. Her cervix was treated, and she was told to go for a checkup after five years.
Five years went by quickly. She returned to the health centre and good news awaited her after checkup. The cervical cancer signs which she had earlier were no longer there, she was cleared.
Such was the beauty of early screening for Chimenya. That visit to see her sister at Ndirande Health Centre made her free from cervical cancer which, according to Ministry of Health (MoH), accounts for 45.4 percent of all cancers in women, with over 2 300 women developing it and over 1 600 dying from it annually.
National Cervical Cancer programme manager Twambilire Phiri says cervical cancer screening detects pre-cancerous lesions in women and if found, the cervical pre-cancerous lesion is treated and cured before it progresses to cancer.
Phiri, who is also MoH chief reproductive health officer says there are two possible screening measures in the country and these are visual inspection with acetic acid (VIA) which is available in all health facilities; pap smear and human papillomavirus (HPV) testing.
“All women of child bearing age (25-49) should go for screening once every three years. However, any woman who requests for the service, should be screened. HIV positive women should go for cervical cancer screening once every year because of the increased risk,” she says.
Oncologist Dr. Leo Masamba says whether diagnosed early or late, every form of cancer has treatment. However, to cure cancer, it is important to get treatment in early stage, he says, adding that most cases of cancer in Malawi are detected late.
“Over 75 percent come with the disease at an already advanced stage. There are several problems that lead to this and they include lack of awareness of the population and lack of awareness of some of the medical terms of cancer symptoms and signs. This reduces chances of cure,” he says.
The oncologist says there are people that have now become hooked with herbal medicine for most illnesses and some of these are taking advantage of desperation that cancer causes, the weak medicolegal infrastructure of the country, and the ignorance of the people.
“This further delay people to be on proven medical therapies. For this reason, more people are dying needlessly,” adds Masamba.
For cervical cancer, Phiri says, treatment depends on the stage of the cancer, the age and the general health of the woman.
She says, for a cervix with a cancer that is just starting, treatments offered include thermal coagulation, which destroys abnormal cells at very high temperatures and is available in all hospitals and health centres.
“The other one is cryotherapy which freezes abnormal cells at very low temperatures. It is available in all hospitals and some health centres. Then there is Loop Electrosurgical Excision Procedure [Leep] which removes abnormal tissue using a special surgical technique. It is available in all central hospitals and at Malamulo Mission Hospital in Thyolo,” Phiri says.
She adds that in early stages, but large enough beyond what can be treated by coagulation, cryotherapy and Leep, the treatment is hysterectomy (removal of the uterus).
On this, Masamba says the intermediate stages that cannot be removed surgically, radiotherapy (strong forms of x-rays) and chemotherapy (cancer drugs) still remain a cure for cervical cancer.
“Whilst stages of cancer that are advanced or incurable can be treated palliatively with radiotherapy and chemotherapy to control pain and bleeding, the same methods can be used to treat cancer that is spread beyond the cervix to other body parts,” he says.
For Women Coalition Against Cancer (Wocaca) executive director Maud Mwakasungula, there is no better way to fight cancer than having frequent medical check-ups.“Because cancer comes in various forms, it is advisable for people to seek medical attention if they notice any abnormal lumps, growths, swellings, or any other condition which is persistent,” she says.