Cancer Control in Africa: ACS Recognizes International Nurses Day with Frontline Report on Zambia Nurses Treating Tens of Thousands With Cervical Cancer

On Saturday, May 12, International Nurses Day is celebrated around the world to mark the contributions nurses make to society.  In honor of this year's theme “Closing the Gap from Evidence to Action” — ACS invites you to read about cervical cancer screenings and life-saving follow-up services underway in Zambia's capital. 

Lusaka, Zambia — Down a dirt road in Lusaka that snakes through makeshift hawker stalls lies the Zambia Ministry of Health George Clinic. Patients crowd waiting areas, sitting on thin benches sometimes for several hours waiting to be seen by a nurse. What makes this clinic unique is that it is one of only a handful of places in a city of 1.7 million where women are screened for cervical cancer. It is at full capacity every day, as it serves a neighborhood of more than 30,000 women.

The clinic uses the VIA (visual inspection using acetic acid) method to screen for cancer of the cervix. If suspicious lesions are found and can be removed by the nurse by cryotherapy, this is done immediately. Once a patient leaves, clinic staff may never see her again, as most patients do not have a formal address. More than 80 percent of the women agree to be treated on the spot. The nurses’ role as a counselor is crucial, as most patients have never had a simple pelvic exam.

Cervical cancer is the leading cause of cancer death among women in sub-Saharan Africa, due to a high prevalence of human papillomavirus (HPV) infection, which causes cervical cancer, coupled with a lack of screening services and early detection. In Zambia, the impact of the disease is catastrophic, as it accounts for up to half of all female cancer cases. Eight out of 10 patients die from the disease. Health authorities in countries like the US recommend women get their first screening in their 30s. Yet, in Zambia large numbers of women in their early 20s already have signs of the disease, and many suffer from advanced-stage cervical cancer.

Women are the backbone of Zambia; besides being the mothers, family managers, and caretakers, they are breadwinners as well. The death of even one woman is devastating to a community, as they must now take in the children from her family with the few economic resources that they have available, further straining an already fragile situation.

As bleak as the situation seems, progress is being made in the fight against the disease. The Centre for Infectious Disease Research in Zambia, in association with the Ministry of Health, began the first program to screen for cancer of the cervix in 2003. From a shoebox of a room in the University Teaching Hospital, the program has grown and has rolled out to a handful of places that includes the George Clinic. The program has successfully screened more than 72,000 women in nearly a decade. Still, in pilot stage the program will expand nationally if funding becomes available.

Expanding cervical cancer screening to all the districts in Zambia is easier said than done. Roads are ruined in the rainy season. Communications and infrastructure are addled year round. Myths about illness abound. Many believe cervical cancer is a "curse" or a "hexe." Many women seek treatment from traditional healers rather than going to a local health post. There is a strong role for awareness, education, and advocacy in this fight.

In the end, this battle will be won by two people — women entering the clinic and the nurses performing the screening. Their 20-minute interaction is what will bring more women into screening clinics. If patients feel that they are in a secure environment where they are respected and valued, they will spread the word in their communities and more women will come to be screened. Our role as NGOs, donors, researchers, and administrators is to make sure that nurses and their patients have the resources and support they need.

 — Jay Evans, Director of Business Planning, ACS Global Health Programs 

Global Cervical Cancer Headline Facts

• Cervical cancer was the fourth leading cause of cancer death in women worldwide, and the leading cause of cancer death among women in sub-Saharan Africa and South Central Asia in 2008. That year, cervical cancer caused an estimated 275,100 deaths.Ninety percent of these deaths occurred in developing parts of the world, where access to screening and treatment are often non-existent and adolescent girls are not receiving vaccination for the human papilloma virus (HPV), the primary risk factor for cervical cancer.
• The HPV vaccine can prevent up to 70 percent of cervical cancer cases, and cost-effective procedures are available to detect and treat cervical pre-cancer.
• To redress the rise in cervical cancer, the Society has spearheaded programs in India, Latin America, Southeast Asia, and sub-Saharan Africa. We aim to promote public awareness about cervical cancer, educate health professionals, and improve access to screening. We collaborate with PATH and the Cervical Cancer Action Coalition with a shared goal of preventing cancer globally.

Source:  Global Cancer Facts & Figures, 2nd edition

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