Sita Deuja, 55, is a cervical cancer survivor. After surgery and treatment, this Bhaktapur resident is now cancer-free. It has been six years, but how she contracted the disease is still a mystery to her.
Kabita Karki, a 45-year-old mother of three from Khotang, however, has a different story. She thinks that long-term use of reusable cotton cloth for menstrual bleeding was the cause of her cervical cancer.
Many Nepali women have heard of cervical cancer but they know very little about it despite their educational background. There are also many prevalent misconceptions around the disease in Nepal.
Some women we interviewed blamed it on the increased consumption of pesticide-laden food, others think the cause is use of contraceptives.
Even those who have had or have cervical cancer are unaware that almost 99% of the cases is caused by the Human Papilloma Virus (HPV) that is transmitted sexually, and hence do not know it is preventable.
Cervical cancer is the fourth most common cancer in women worldwide, and according to the Human Papillomavirus and Related Diseases Report 2019, it is the leading cause of female cancer in Nepal with nearly 3,000 new cases diagnosed annually.
Cervical cancer is preventable and if detected in an early stage, can be treated successfully. In fact, most infections with HPV resolve spontaneously and cause no symptoms, but persistent infection can cause cervical cancer in women.
As primary prevention, the HPV vaccination could be administered to girls between 9-13 years, before they become sexually active and potentially get exposed to HPV. The HPV vaccine is highly effective in reducing cervical infections with the cancer-causing type of HPV (it can prevent 9 out of 10 cases) and the development of precancerous lesions in the cervix.
A screening program is another crucial intervention to prevent cervical cancer. But the poor financial status of the families and low literacy levels act as barriers to timely detection and treatment. On the other hand, limited access to health means a lack of adequate screening facilities, resulting in late diagnosis, by which point cancer has developed to an advanced stage and cannot be treated.
Other factors affecting diagnosis and treatment include the shortage of awareness-raising programs and the stigma associated with reproductive health.
Sita and Kabita regained their health, but they could have saved themselves and their families much hardship, mental stress and money if they were better informed about the disease.
But not every woman is as 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 timely treatment.
In 2020, the World Health Organisation launched a global initiative to eliminate cervical cancer, setting intermediate targets to be achieved by 2030: 90% of girls up to 15 years of age should be fully vaccinated with HPV, 70% of women should be screened using a high-performance test by age 35, and again by age 45 and 90% of those identified with the cervical disease should receive appropriate treatment.
A comprehensive approach has been recommended to prevent cervical cancer through HPV vaccination, screening, and the treatment of precancerous lesions. To meet the target, Nepal needs clear cervical cancer prevention and management strategies.
The first step in preventing cervical cancer is to increase public awareness and overcome the misinformation and stigma associated with HPV. Until and unless every woman is aware of the disease and the services available for the condition, they will continue to lose their lives to cervical cancer.
Many women don’t know that the government has been providing a free screening program for cervical cancer from its health facilities across the country, and hence it should be well-communicated.
Educational campaigns and mass awareness programs should be scaled up, and in schools, adolescents should be taught about reproductive health and safe sexual behavior in detail.
Nepal should also increase rural outreach to boost the screening numbers in the country. Similarly, the health authorities need to invest in vaccination against HPV in adolescents as primary prevention of cervical cancer.
We could also promote highly sensitive self-sampling kits for HPV testing that allows for easy sample collection by the patient herself, without requiring any trained personnel and infrastructure to perform a pelvic examination.
Self-sampling methods to cervical cancer screening could be an alternative approach to health facility-based screening to mitigate socio-cultural barriers associated with the disease in Nepal.
The fight against cervical cancer is also a fight for women’s rights. It is unjust for women to go through unnecessary pain and suffering and the possible death resulting from a completely preventable disease.
Preventing cervical cancer is possible with cost-effective, evidence-based tools that are available and acceptable. What Nepal now needs is more commitment from the government, development partners and public health professions to prevent and reduce the prevalence of this public health burden and help save the lives of thousands of women.