Voices: ‘She knew something was wrong. It was too late’: Cervical cancer warning signs - and how we can eliminate it

A doctor points at a screen with the tests of a patient suffering from cervical cancer during her first session of 3D high rate brachytherapy at the Bolivian Radiotherapy and Oncology Institute (IBRO) in El Alto, Bolivia (AFP via Getty Images)
A doctor points at a screen with the tests of a patient suffering from cervical cancer during her first session of 3D high rate brachytherapy at the Bolivian Radiotherapy and Oncology Institute (IBRO) in El Alto, Bolivia (AFP via Getty Images)

In September 2019, 67-year-old Eno noticed she was bleeding again, even after menopause. She was pleasantly surprised and thought it was a sign of her youth returning, but when she experienced pain, fatigue, and a strange malodorous discharge, she knew something was wrong.

But, it was too late. She had cervical cancer and the disease had spread to other organs. When I saw her, there was little we could do. She soon passed away from the disease.

Unfortunately, this wasn’t a rare event. Every two minutes, a woman dies from cervical cancer. If we do the math, about 720 women die from this disease every day.

Cervical cancer is the fourth most common cancer in women. In 2018, the CDC says about 570,000 women were diagnosed with the disease and 311,000 died of it.

Nine out of ten cervical cancer deaths happen in low and middle income countries, and in high income countries, minorities are less likely to receive vaccines and screenings. As a result, Black and Hispanic women are disproportionately affected by cervical cancer in places like North America.And in the UK, poor women are 65 percent more likely to have the condition compared to the most affluent.

But it doesn’t have to be that way. Cervical cancer is a preventable, treatable, and curable condition. We have the tools, strategies, and skill to eliminate it. All we need now is the will.

Perhaps if Eno had received the human papillomavirus (HPV) vaccine sometime between 9 and 26 years old, she would have a lower chance of HPV infection which causes more than 99 percent of cervical cancer cases. If the same vaccine was given to people she would be intimate with (both men and women), it would reduce her risk even further.

Had she been part of a screening program between 25 and 64 years, the earliest signs of cervical cancer may have been detected. The condition would be treated even before she noticed any symptoms.

If she knew the symptoms of cervical cancer, she would have been more suspicious of strange, unexpected bleeding rather than considering it a blessing. So many ifs.

January is Cervical Cancer Awareness month, a perfect opportunity to create awareness about cervical cancer and galvanize individuals, communities, corporations and countries to make cervical cancer prevention and screening a priority.

This year, we have another opportunity to make a difference. The theme for this year is: We can end cervical cancer. Get informed. Get vaccinated. Get screened.

Get informed

The cervix is the lowest part of the uterus. In many ways, humanity is indebted to this small organ. Without interventions, all pregnancies would end in miscarriage if the cervix wasn’t keeping them in the uterus till term.

Cervical cancer is a condition where cells in the cervix multiply uncontrollably and migrate to distant parts of the body, where they continue to do so. It takes years for cervical cancer to show symptoms. When it does, it’s often too late. Possible symptoms include: pain in the abdomen, groin or back, fatigue and feeling unwell, irregular or unexpected vaginal bleeding, bleeding when you use the bathroom and odorous vaginal discharge.

Get vaccinated

Cervical cancer can be prevented by taking the HPV vaccine. Vaccinating everyone helps to stop transmission of HPV and even reduces the risk of several cancers among vaccinated people, including certain cancers of the cervix, anus, throat, penis, skin, and vulva.

Experts recommend it for everyone between 9–27 years if it’s available. Years ago, the vaccine was only recommended for girls because there were questions of availability. Even now, where resources are scarce, research suggests 9–14-year-old girls should still get it first.

Get Screened

“Prioritize your smear! It’s easy to put off a cervical screening if you have no symptoms, struggle to get a doctor’s appointment, or are anxious about the procedure. But screening saves lives”, Dr Sarah Welsh, the co-founder of HANX, a sexual wellness brand, told me.

If you live in a country with limited guidance, seek out cervical screening tests every three years when possible. Screenings help your doctor detect abnormal changes in your cervix before they become cancers. The abnormal cells can be removed, reducing your likelihood of having cervical cancer.

If you experience symptoms, experts recommend seeking medical advice early—before the cancer spreads and when treatments are more likely to work. Even so, it’s a good idea to seek care no matter what stage of the process you may be in. Cancers in their late stage can  be treated and symptoms alleviated.

In addition to vaccination and screening, experts also recommend you quit smoking and avoid secondhand smoke, use condoms, and limit your sexual partners.

Now is the time

In May 2018, the World Health Organization Director-General made a global call for cervical cancer elimination. By August 2020, the World Health Assembly adopted a cervical cancer elimination global strategy. 

The strategy is clear, simple, and doable. For cervical cancer to be eliminated, we have to reduce incidence to less than 4 per 100 000. To do this, we have to meet targets from the three pillars of vaccination screening and treatment. They are:

  • Vaccination: 90% of girls fully vaccinated by age 15.

  • Screening: 70% of women by 35 and again by 45 using a high-performance test.

  • Treatment: 90% of women with pre-cancer treated and 90% 9f women with invasive cancer managed.

Every country has to meet these 90-70-90 targets by 2030 if we are to eliminate cervical cancer within the next hundred years.

This will only happen with more funding, collaboration, and support for cervical cancer elimination programs worldwide; especially in the regions with the highest burden of the disease.

Now is the time for local, national, regional and global task forces on cervical cancer prevention. It’s time for more funding to support cervical cancer awareness and prevention efforts by organizations like the Medical Women’s Association of Nigeria. It’s time for corporate organizations to sponsor mass HPV vaccination campaigns for girls and screening for women and treatment for people with this disease.

We can eliminate cervical cancer within a generation. We can place the heartbreaking stories of women like Eno permanently in the history books where they belong. Just like we did for smallpox and rinderpest before it. All we need is to act now.