- Medical experts emphasise the importance of early detection via screening and treatment while noting minimal lab facilities hindering the process
Cervical cancer ranks as the second most common cancer among females in Sri Lanka, accounting for nearly 1,500 diagnoses and 800 deaths each year. Projections concerning Sri Lanka have warned of a potential related death toll of 58,754 by 2070 and 115,137 by 2120 due to cervical cancer, in the event a proper intervention is not made by the relevant parties. In view of the urgent need, the Ministry of Health, together with several other stakeholders, has spearheaded a range of initiatives to eliminate cervical cancer across the country. As part of the programme, a pilot project has been carried out in the Kalutara District to encourage females to undergo a human papilloma virus (HPV) deoxyribonucleic acid (DNA) test for the early detection and lowering of the cervical cancer rate in the country.
Definition
Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The HPV infection causes more than 90% of cases, but not all who have had HPV infections develop cervical cancer. Cervical cancer typically develops from precancerous changes called cervical intraepithelial neoplasia over 10 to 20 years, and the diagnosis is typically by cervical screening followed by a biopsy. The early stages of cervical cancer may be completely free of symptoms. Vaginal bleeding, contact bleeding (bleeding after sexual intercourse), or a vaginal mass may indicate the presence of a malignant tumour. Moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. Symptoms of grown cervical cancer may include a loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen legs, heavy vaginal bleeding and bone fractures.
Discussing progress
To discuss the progress of the initiatives aimed at eliminating cervical cancers in Sri Lanka, a panel discussion had been convened by Roche Diagnostics India on Wednesday (21), and several experts including the Director of Maternal and Child Health and Consultant Community Physician Dr. Chithramalee de Silva, Consultant Histopathologist at the National Hospital for Respiratory Disease in Welisara Dr. Ramani Punchihewa, Consultant Community Physician and the National Programme Manager for the Well Woman Programme Dr. J. Padmaka Silva, and the Chairperson of the Rotary Cervical Cancer Elimination project Nirmali Samaratunga, attended it. Moderated by Dr. Sandeep Sewlikar, the discussion highlighted the steps taken by the Government towards the elimination of the cervical cancer, programmes undertaken such as Well Women Clinics, the pilot project launched in the Kalutara District to analyse different methods of cervical cancer screening among females in the 35-year and 45-year cohorts, and the steps taken by the Family Health Bureau (FHB) to align cervical cancer elimination targets in line with the World Health Organisation’s (WHO) guidelines.
Islandwide prevention programmes
Speaking during the event, Dr. de Silva said that breast cancer was the most common cancer among females in Sri Lanka and that cervical cancer was the second a few years ago, while the prevalence of cervical cancer has now come down to the fifth place. She said that most of the females who are between the ages of 50-60 become victims of cervical cancers, and that it becomes a significant burden to their households. “If a female of this age dies of cancer, it is an irreparable loss. That is why the Health Ministry focused on the early detection and prevention of cervical cancer in the 1990s. In 1996, the then Health Minister handed over the related responsibilities to the FHB. We studied the methods that can be used to detect cervical cancer. As a result, the performance of Pap smear tests commenced in 1998.” After focusing on other methods that can be used to detect cervical cancer, she said that a pilot project was launched in 2018 to use HPV DNA tests, and as it was found to be more effective, it was gradually expanded. “Due to the current economic situation in the country, it has become a challenge to carry out these tests all over the island. Despite this, we are working to test about 200,000 females in the ages of 35 and 45 every year. We are focusing more on areas where cervical cancers are largely prevalent, but laboratory facilities are minimal.”
Cervical cancer, preventable
Dr. Padmaka Silva explained the interim targets of eliminating cervical cancer in Sri Lanka, and said that the WHO had declared that cervical cancer is a completely preventable disease. While it will take 70 years to eliminate it from the country, he said that three interim targets to be achieved during that period have been identified. “The first interim target is vaccination. Under this programme, school girls under the age of 15 are being vaccinated, and it is being implemented as a national programme. The second target is to detect this cancer early by referring females to undergo tests. There are about 1,000 Well Women Clinics at each Medical Officer of Health (MOH) Division, and they provide testing facilities free of charge. Any female at the age of 35 or 45 can attend these clinics and undergo an HPV DNA test. About 60% of females in the ages of 35 and 40% of those in the age of 45 have been tested through these clinics by now. As the third interim target, we identify females in pre-cancerous conditions and refer them for the necessary treatment facilities.”
Dr. Punchihewa, who significantly contributed a lot to the pilot project implemented in the Kalutara District, said that one of the main objectives of the project was to investigate the possibility of using HPV DNA tests as a primary test for cervical cancer detection. “We first tested about 10,000 females aged 35 and 45 years. We used various methods such as distributing pamphlets and conducting awareness programmes to attract females for this. In addition, doctors and other related health professionals were given the necessary training related to these tests. We have worked to computerise every test result.”
Since all the participants highlighted the screening of females at the ages of 35 and 45, The Daily Morning queried them on whether the females in those two ages would be recommended to undergo HPV DNA tests. In response, Dr. Padmaka Silva said: “Currently, the WHO has recommended that females aged 35 and 45 years undergo these tests.” However, he said that females in other ages (between 35 and 45) are also able to participate in the Well Women Clinics and get the relevant test done. “We are specifically inviting the 35 and 45 year-old females to participate in the clinics, but, if someone who is not in those two ages feels like participating in the clinic and undergoing tests, they are welcome to do so.”
Creating awareness
When queried by the media as to whether the methods such as the distribution of pamphlets would be significantly helpful in attracting females who do not have proper knowledge about cancer-related conditions to clinics and testing programmes, Dr. de Silva said that when launching a project like this, they should use every available channel. “In addition to distributing leaflets, we use all methods such as physical awareness programmes and poster campaigns. Females can also be informed through the current vaccination programme. For example, when a school girl is informed about cervical cancer at school and given the vaccine, they may ask their mother at home if she has done anything to prevent cervical cancer.”
Addressing the event, Samaratunga illuminated the role played by organisations such as the Rotary Club of Colombo in raising awareness and facilitating access to cervical cancer detection programmes across the country. “The Rotary International worked with the WHO to eliminate polio, or poliomyelitis (a disabling and life threatening disease caused by the poliovirus) some time ago, and achieved successful results. It is with that vision that we work together with global and Sri Lankan stakeholders to eliminate cervical cancer,” she said, and added that the Rotary Club of Colombo had made a significant contribution to improve cervical cancer screening facilities in the country by donating buildings and advanced technology based equipment to the health sector at the request of the FHB.
Dr. Sewlikar concluded the event emphasising the crucial need for a multipronged strategy to tackle cervical cancer in Sri Lanka. “We are inspired by Sri Lanka’s efforts and are delighted to support the FHB as a diagnostic provider. With the WHO prequalification for our HPV DNA test, we are confident that together we can help countries overcome this preventable cancer and empower females through timely screening.”
Both Dr. de Silva and Dr. Padmaka Silva said that it is best for a country like Sri Lanka to detect cancer and provide the patients with necessary treatment at an early stage, as treatment for any grown cancer is very expensive. “The Government has to bear huge costs for treatment methods such as cancer drugs and radiotherapy. No matter how much the cost is, the chances of curing the cancer is also very low when it is grown. However, cervical cancer is 100% curable through early detection and treatment.” They said that the Government has made substantial allocations for cervical cancer treatment and that treatment centres have been established across the country. However, since it is difficult to cure the disease at the later stage, they requested the females of the relevant age categories to voluntarily participate in the clinics islandwide and assist in the early diagnosis of this cancer condition through the relevant tests.