Cervical cancer, every woman’s nightmare

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By Sharon Kavhu

Barbra Matombo from Nyamweda village in Mhondoro is one of many unfortunate women who have died from cervical cancer in Zimbabwe, where the death rate is estimated at 1,541 per year.

Matombo died aged 36, leaving her three young daughters motherless in 2016. She died after two years of severe pain as a result of this deadly disease, which has become every woman’s nightmare.

“When cancer started developing in her cervix, there were no signs or symptoms of anything abnormal on her. She lived her life as normal as any other woman,” said Matombo’s aunt, Ndakaitei Madzivadondo.

The Southern Times spoke to Madzivadondo last week, who looked after the late Matombo by giving her home-based care before she died.

While she thought everything was normal, things started turning ugly when Matombo started having irregular bleeding and pain in her cervix before developing bulky lumps in her womb, Madzivadondo narrated.

“Barbra started complaining of pain in the cervix in 2013 when her husband died. Initially, she thought the pain was just one of the minor opportunistic infections that people living with HIV may have, so she did not go to the clinic.  The pain developed from mild to severe and she developed a lump beneath her anus, that’s when she went to the clinic,” said Madzivadondo.

“The lump caused pain on her backbone and at the back muscles of her legs. At the clinic, the nurses said it was a boil in its early stages. So, they gave her some tablets, hoping that it would burst and let out the pus.

“However, after a few weeks, it opened, exposing abnormal flesh that seemed cancerous and the flesh was covering her reproductive system. She was then referred to a hospital where they told her that she had developed cervical cancer and that cancer had fully developed.

“Cancer had damaged her cervix and womb and doctors told us to give her home-based care, as there was nothing left for them to do to make things better. So, we went home with her until the Lord called her.”

Madzivadondo said Matombo suffered for two years at home where she was in severe pain, which made her groan in pain, especially when she wanted to relieve herself.

During that time, cervical cancer screening was not yet common in the rural areas and many people in the remote areas were ignorant about the disease. Matombo died in ignorance, if she had known about the disease, maybe she would have gone for chemotherapy before cancer had spread.

According to the Ministry of Health and Child Care (MoHCC) - Zimbabwe, cervical cancer refers to a situation whereby abnormal cells in the cervix start to grow very quickly and cannot be controlled by normal body processes. 

“Over time, normal cells in the cervix will be taken over by the cancer cells, which may spread to other parts of the body and disturb normal function.  With early diagnosis and treatment, cervical cancer is manageable and curable.  However, delaying to seek help causes debility and death,” said health minister David Parirenyatwa.

Parirenyatwa said cervical cancer in caused by the human papillomavirus (HPV), which is the most common viral infection of the reproductive tract.

Information from UNICEF shows that HPV is a common virus, which spreads easily through skin-to-skin contact during sexual activity with an infected person.

Chief of Health and Nutrition, Nejmudin Bilal-UNICEF said:

“HPV type 16 and 18 are associated with about 70 percent of all cervical cancer cases.  

The risk factors for HPV infection and cervical cancer include early sexual debut and multiple sexual partners.”

In a separate interview, a Zimbabwean gynaecologist, who preferred anonymity, said the risk factors for cervical cancer include HIV infection, use of vaginal herbs or creams and partner with multiple partners (polygamous relationship).

“Normally, when one gets HPV they are able to clear the infection naturally via the immune system. However, if an individual is HIV positive their immune system is compromised and this makes them more prone to developing cancer and should be screened more frequently like every year compared to those who are HIV negative, who can be screened after every three years,” said the gynaecologist.

He said cervical cancer seems to be more common in people with low socioeconomic status, as suggested by the World Health Organisation (WHO), due to lack of screening programmes.

WHO indicates that cervical cancer is the second most common cancer in women living in less developed regions, which constitute 85 percent of cervical cancers globally.

The gynaecologists also highlighted that women in the African regions practice cultures that makes them prone to cervical cancer. “Some women have developed a culture of tightening their reproductive organs using vaginal herbs and creams. The use of such substances has a high chance of causing inflammation, which results in higher chances of acquiring HPV. Similarly, the act of vaginal douching whereby women clean the inside of their vagina is also discouraged because it disturbs the normal flora.

 The vagina has bacteria called lactobacilli, which create an acidic environment not suitable for growth of other organisms, but if it is disturbed, the natural protection is distorted.”

He said cervical cancer has no early signs like other diseases. When signs start showing, cancer would be in its late stage and the only effective way to fight it is to be screened.

A Zimbabwean oncologist, Dr Nomsa Tsikayi from Harare said screening for cervical cancer has been found to significantly reduce the incidence of cervical cancer, as it identifies early pre-cancer before it becomes invasive.

“Screening takes advantage of the fact that pre-cancer on the cervix can be present for an average of 10 years before it becomes invasive. During this period, tests such as VIAC or Pap smear can be done to identify these curable conditions early,” she said.

According to Dr Tsikayi, Southern African Development Community (SADC) countries are most affected by the HIV pandemic, which has been linked to the development of cervical cancer.

She said: “It is, therefore, important to strive towards the eradication of HIV and also proper management of the patients that are affected by the virus in order to maintain as strong an immune system as possible. 

It is also important for the SADC countries to develop comprehensive cervical cancer screening and make the HPV vaccine available to the majority of people.”

In Zimbabwe, the incidence of cervical cancer is reported to be 35 per 100,000 women, as suggested by MoHCC statistics.  The statistics show that 2,270 new cases are reported annually with 1,541 associated deaths and 99 percent of cervical cancers are associated with HPV infection. 

Globally, cervical cancer is the second commonest cancer in women.  According to WHO, every year, 530,000 new cases are diagnosed with each year claiming 275,000 lives. Of the 530,000 diagnosed annually, over 85 percent occur in developing countries.

The organisation estimates that by 2050, cervical cancer cases will amount to one million out of which 900,000 will be in developing countries.

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