Could little brush bring down cases of this killer cancer?

Less than 10 per cent of Kenyan women aged 15 to 64 have ever been screened for cervical cancer, yet the disease claims up to eight lives every day. ILLUSTRATION| FILE| NATION MEDIA GROUP

Carol Ng’ang’a, a cervical cancer survivor, and a volunteer educator on sexual and reproductive health, recalls how she always avoided pap smears because people had described it to her as painful, horrifying and scary.

At her Pap smear ever, and at only 27 Carol Ng’ang’a didn’t think anything could go wrong.

She had mustered the courage and put aside her fears of pain and discomfort to face the “dreaded” speculum, a medical tool put into the vagina to part the walls for examination.

The test itself went without much incident. She had been on phone with a friend during the entire procedure to calm her nerves.

The friend was a Pap smear veteran of sorts, having taken advantage of free tests during their university years, when everyone else gave the tests a miss, with various excuses on their lips.

Carol had also told the nurse who was collecting the sample for testing that she was scared, and that might have helped a bit.

The results were due in a week’s time, but Carol took a month to fetch them. It was just a routine test, so the results could wait. And when she did get round to picking them, she was told she had Stage 1 cervical cancer, setting her on a medical journey involving surgery and hormonal therapy  to beat the tumour.

Five years later, she is doing her bit to inform women about the need for screening, through her non-governmental organisation, HELD Sister Foundation, that organises medical camps offering cancer and general health screening for women (and men) especially in rural areas and informal settlements.

FEARS

The same fears she had back then before her very first Pap smear, are the same fears the women she meets during the medical camps face.

“Why should I bare my private parts to a stranger?

“How much pain will I feel?”

“What will happen if the test turns positive?”

And they form part of the reasons women fail to seek early screening for the second-most frequent cancer in women in Kenya, and the leading cause of death among women of reproductive age. The cancer caused by the human papilloma virus, is sexually transmitted, and can be prevented by vaccinating girls before they become sexually-active.

It can also be prevented by practising safe sex and early intervention by catching abnormal changes in the cervix through screening and treating them before they turn into cancer.

Unfortunately, screening rates remain low, and diagnoses are often made when the cancer has advanced.

According to the Kenya Aids Indicator Survey of 2012, when women aged 15 to 64 were asked if they had ever been screened for cervical cancer, only 7.8 per cent said yes. Women in the 40 to 49 years age group and HIV-positive women were more likely to have been screened.

Women living in urban areas were also more likely to have been screened, than women in rural areas.

For those who were screened, five per cent were found to have abnormal cells and 55 per cent of those were referred for cancer treatment.

Further, according to the Kenya Demographic Health Survey of 2014, almost 5,000 women are diagnosed with cervical cancer every year, and there are about 2,500 deaths from the disease every year.

Could a little-known screening method help change the numbers of women progressing to full cancer and dying from it?

The method in question is the Cobas HPV, that was introduced to Kenya slightly over a year ago.

It gives women the option of collecting their own samples from their vaginal canal using a soft brush in the comfort of their homes, and dropping it off to the lab for testing or having it picked by a courier.

At the lab, the sample is tested for strains of HPV that cause almost all cases of cervical cancer. Cobas HPV testing differs from Pap smear in that the latter only looks out for abnormal changes on cervical cells and tissues associated with the cancer but not HPV itself.

Just before the launch of the brush, a survey of 327 women in Nairobi, Mombasa and Kisumu aged between 18 and 60 years by research firm Consumer Options in October 2016 showed that majority (87 per cent) would be more likely to screen for cervical cancer if the screening method did not involve exposure of private parts to health workers.

Margaret Njoki, a lab pathologist & CEO of Medi-hub Healthcare in Nairobi, a centre that offers wellness check-ups and health screening such as Pap smears, says that most women procrastinate going for Pap smears because they are “invasive and embarrassing.”

FRIENDLIER OPTION

When offered the V-Brush, many find it friendlier, and as a result they have screened 300 women using that method since last year when they started offering it as an option.

“The only problem is that cost may be a limiting factor because many women cannot afford it,” she says.

The brush is also said to be more accurate than Pap smears.

Dr Rabia Mukadam, a molecular scientist who is in-charge of the Cobas HPV screening method at Lancet Laboratories in Nairobi says that since the test is DNA-based, the accuracy of the test is not compromised even if the brush does not reach the lab on the same day.

Dr Rabia says Cobas HPV testing allows women to accurately know their risk of developing cervical cancer unlike Pap smear.

“Women found positive with high-risk HPV sub-types are at higher risks of cervical cancer while the HPV negative ones are deemed at low risk. This means only those at high-risk need monitoring and not every woman,” she says.

Meanwhile, it remains to be seen if the growing popularity of Cobas HPV screening using the self-collection method among Kenyan women will help turn the tide against cervical cancer.