Women in this country face a 1 in 42 risk of developing cervical cancer in their lifetime, but a lack of up-to-date figures means these numbers may be the tip of the iceberg. there is.
aAs the world celebrates World Cancer Day on February 4, we focus on a persistent and deadly enemy: cervical cancer. In South Africa, the disease is the second most common cancer among women and the leading cause of cancer-related deaths. Women in this country face a 1 in 42 risk of developing cervical cancer in their lifetime, but the lack of up-to-date figures means these numbers are just the tip of the iceberg. It may be.
The intersection of cervical cancer and high rates of HIV infection in our country adds further complexity. Women living with HIV often suffer from immunosuppression, which increases the risk of developing cervical cancer and makes it more likely to be diagnosed at an advanced stage. Compounding this are the socio-economic realities faced by many women, including a lack of regular testing, limited access to health services, and cultural barriers that delay preventive care.
In 2020, the World Health Organization (WHO) introduced the Cervical Cancer Elimination Strategy. These include vaccinating 90% of girls against human papillomavirus, the causative agent of cervical cancer, screening 70% of women for precancerous disease, and treating 90% of women. To achieve these ambitious goals, our mission is clear: we must “close the care gap.”
Pap smear, a screening tool in our arsenal
Early detection is your best defense in the fight against cervical cancer. Prevention is only possible if there is adequate screening for precancerous conditions. According to the National Indicator Data Set, national pap smear uptake in 2019-20 was 47%, ranging from 32% in the Northern Cape to 58% in Mpumalanga. While achieving high coverage of Pap smear screening is important, it is equally important to be aware of the test's sensitivity for detecting precancerous conditions, which varies from 90% to as low as 30%. This variability highlights the need for integrated, high-quality screening tools that can reliably identify women at risk.
The effectiveness of cervical cancer screening programs, including the quality of pap smears and follow-up protocols for abnormal results, plays an important role in early detection. Inadequate screening programs can lead to missed opportunities for early intervention.
Another factor to consider is the adequacy of the smear itself (defined as the presence of cervical cancer cells). Insufficient samples can reduce the sensitivity of the test and result in missed diagnoses. The validity of all pap smears performed by the National Institutes of Health has increased from 54% in 2010 to 67% by 2022.
Detecting anomalies is only half the battle
Ensuring that women with abnormal Pap smears receive timely colposcopy services is a source of failure in our health care system. Although national data are not available, only about half of women referred for colposcopy services in the Western Cape receive colposcopy services. The situation is probably even more dire in other regions. For example, the association with hospital treatment in Johannesburg is as low as 16%. These statistics highlight an alarming situation. This is far below the WHO goal of connecting 90% of women with pre-cancer or cancer to treatment. Without intervention, advances in screening will be wasted.
“While we have made advances in cervical cancer screening over the past 20 years, the true measure of our system's effectiveness lies in the continuity of care after diagnosis.,” says Dr. Kari van Schalkwyk, a cervical cancer epidemiologist.. “Our data highlight critical gaps in the cancer treatment cascade: treatment linkages. Screening efforts are laudable, but without the necessary strategies to ensure that women who screen positive are directed to timely and appropriate treatment, there is little hope. This gap is not just a medical oversight. It is a systemic failure that disproportionately affects the most vulnerable in our society. ”
The challenges are wide-ranging. In areas where routine screening uptake and linkage to treatment is low, women are often diagnosed at a later, more advanced stage of cervical cancer.
The stage at the time of diagnosis can be a matter of life or death. Her 50% to 70% of women are diagnosed at stages III and IV. Five years after diagnosis, survival rates drop significantly from approximately 75% for stage I to a dismal 25% for stage III and nearly zero for stage V. These figures call for reform in the national approach to cervical cancer to prioritize early detection. Improve your connection to treatment.
Inadequate awareness of the disease and sociocultural barriers also prevent women from receiving timely care. Here, targeted educational efforts focused on recognizing symptoms, reducing cancer stigma, and encouraging early health care-seeking can play an important role in promoting early detection. can.
The stage at which cervical cancer is primarily diagnosed also serves as a barometer of the effectiveness and reach of the healthcare system. The availability and quality of health infrastructure significantly influences the stage at which cervical cancer is diagnosed. In areas with limited health care resources, delays in screening, diagnosis, and treatment referral may result in further disease progression at the time of diagnosis. This difference is not just clinical. It really shows the inequality.
Ten years have passed since the rollout of the human papillomavirus vaccine program in public schools, but the vaccination rate among targeted female students remains at about 80%. Vaccination is available in private pharmacies for women up to the age of 26, but this option is not available to everyone, leaving the majority of adult women vulnerable to cervical cancer. It has become.
The WHO's ambitious goal of eliminating cervical cancer requires a coordinated, evidence-based approach to prevention, screening and treatment. This goal is more than just a vision; it is a clear call to action, especially for policymakers who hold the key to overcoming the systemic barriers to our progress. This World Cancer Day, we call on policymakers to recognize the barriers to ending cervical cancer and tackle them head-on.
It is time for healthcare providers, communities and policy makers to come together to overhaul the current state of cervical cancer treatment in South Africa. We can “close the care gap” by investing in health infrastructure, increasing public awareness and education, improving the quality of testing programs, and ensuring equitable access to health services. This collaborative effort will not only change the course of cervical cancer in our country, it will also protect the health of future generations of South African women.
Dr. Yuri Mansamy is a scientific officer at the DSI-NRF Epidemiological Modeling and Analysis Center of Excellence at Stellenbosch University.