When was the last time you went for a Pap smear?

CERVICAL cancer is the second-most prevalent cancer among women in Namibia – especially those between the ages of 15 and 44.

Globally it is one of the most common cancers in women worldwide, with more than 570 000 new cases and 311 000 deaths reported in 2018.

Nationally, the current estimates indicate that 375 women are diagnosed with cervical cancer every year, and 214 die from the disease.

This is according to the International Agency for Research on Cancer, an intergovernmental agency under the World Health Organisation.

Dr Cornelia Ndifon, the cervical cancer prevention technical adviser to the Ministry of Health and Social Services, says these estimates are based on cases reported to clinics, but many cases and deaths are not reported.

“Cervical cancer is a silent killer. Cancer start as microscopic, and by the time you see a symptom, the basement membrane has been damaged,” she says.

Ndifon says women should not wait for symptoms before taking action.

Cervical cancer can be dealt with by getting vaccinated against the human papillomavirus (HPV), which is a common sexually transmitted infection that can lead to cervical cancer, screening, which includes Pap smears and the treatment of precancerous lesions, and the diagnosis and treatment of invasive cervical cancer and palliative care.

Through regular Pap smears and new screening methods, such as visual inspection with acetic acid, doctors and clinicians are able to monitor cells on the cervix for any abnormalities, and to treat them.

A Pap smear is used to detect potentially precancerous and cancerous processes in the cervix.

According to the Johns Hopkins Programme for International Education in Gynaecology and Obstetrics, 12 271 women in Namidia were screened between October 2019 and June 2020.

Of those, 2 114 were found to have precancerous lesions, and 100 with suspected cancer, and 1 648 (82%) women with pre-cancerous lesions received treatment.

Overall, only 23,6% of all women between 15 and 64 in Namibiawere screened during this time.

State cervical cancer screening is available in all 14 regions of the country.

Ndifon says unprovoked irregular bleeding between periods in women of reproductive age, back pain, as well as bleeding after sex are symptoms of cervical cancer.

In advanced cases, increased vaginal discharge, sometimes foul smelling, is present.

“But with stage-one cancer, you will not feel symptoms. This is why we recommend screening, and if it is starting and it is precancererous, we treat it,” she says.

Dr Lisoma Chatty, the health ministry’s medical officer for cervical cancer prevention, says cervical cancer has five stages.

There is also a pre-cancer stage, during which doctors identify abnormalities in the cervical area.

At pre-cancerous stage, two treatment options are available: ablative treatment, where doctors apply heat or cold to destroy abnormal tissue, and surgery.

“At stages zero and one, the cancer is confined to the cervix only and has not spread to the surrounding tissue and other organs. This is treatable. They are going to remove either the cervix itself or the uterus, depending on the cancer infiltration,” Chatty says.

Screening allows doctors to identify abnormalities and what stage the cancer is in.

“With advanced cancer we need to do something more drastic,” Ndifon says.

Stage two and three cancer would warrant radiation and chemotherapy, she says.

Patients would also undergo surgery to remove pelvic lymph nodes, followed by radiation therapy with or without chemotherapy.

Women living with HIV are at four to five times greater risk of developing cervical cancer. Approximately 85% of new cases and 90% of deaths occur in developing countries, where vaccination, screening and treatment rates are low.

Increasing vaccination against HPV, along with screening and treatment for precancerous lesions, are key to eliminating cervical cancer within this century.

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