Eliminating cervical cancer in Nigeria

By Adeyinka Adeosun

It has been 10 months since 42-year-old Maria Ishaku received a cervical cancer diagnosis. “Will the pain ever go away? It is better to die than to live like this; the pain is too much for me to bear,” She mutters at intervals, tears rolling down her face as she talks about her cancer journey.
 
“It started with what I thought was normal waist pain. Routine visits to hospitals in my state always ended with being prescribed painkillers. As time passed, the pain became almost unbearable, so I travelled to Abuja and visited Gwagwalada Specialist Hospital. There, I was told I had a disc degenerative disease. The painkillers and drugs I was given did not seem to do much as the condition became worse.
 
Then one morning, I woke up screaming in pain; it was as if I was about to die. I was then rushed to the same hospital where I was being managed. This time, I saw another doctor who asked me to carry out some tests. About three weeks later, I received a diagnosis — I had stage 2 cervical cancer. The doctor said that the pain I felt in my waist and legs was due to the pressure of the enlarging tumor. I was told that I needed to start chemotherapy immediately and I was referred to National Hospital in Abuja for further treatment.”
 
The diagnosis disrupted Maria’s life in unimaginable ways. She had taken too many days off from work and was eventually let go. She moved from her home in Keffi, Nasarawa State to Abuja — leaving behind her husband and six children — to access the recommended treatment. Her husband started seeing another woman. “He barely cares about me nor supports me with funds for treatment. I am now left alone to bear the financial, emotional, and psychological burden of treating cervical cancer, to stay alive.”

According to the United Nations, cervical cancer is the third most common cancer and the second most frequent cause of cancer deaths among women aged between 15 and 44. It begins in the cervix of the female. It is, however, one of the most successfully treatable types of cancer if detected early and treated appropriately.

Cervical cancer has such a high death rate in spite of being one of the most treatable types of cancer.  One word can sum up the chief reason for this, and that is access. There is poor access to prevention (vaccination and screening), as well as treatment services through the primary health care system. Because women lack access to testing facilities, cancer frequently remains undiagnosed until it has progressed and symptoms appear. If they are diagnosed, they may not have access to treatment choices. Moreover, lack of education (awareness) and poverty are critical risk factors that must be addressed in order to successfully reach every girl-child.

According to studies, cervical cancer is most frequently diagnosed in women between the ages of 35 and 44 with the average age at diagnosis being 50. It rarely develops in women younger than 20.

According to the World Health Organisation, in 2020, the latest year for which data is available, Nigeria recorded 12,000 new cases and 8,000 deaths from cervical cancer.

Across the world, cervical cancer is a public health concern, and Nigeria is not immune from its crushing effect. HPV is a common sexually transmitted infection that is a silent forerunner of several types of cancers, including cervical cancer.

Many Nigerians are not aware of the link between HPV and cervical cancer. Some are just hesitant to vaccinate their daughters against the virus. Working in partnership with the various State Primary Health Care Development Agencies (SPHCDA), the federal government, through the NPHCDA, is working tirelessly in creating the required landscape for improved acceptance and adoption of HPV vaccines in communities across the country.

Under the leadership of the former Executive Director and Chief Executive Officer of the National Primary Health Care Agency, Dr. Faisal Shuaib, the Federal Government secured over six million doses of the Human Papillomavirus Vaccine and essential supplies for the rollout of the vaccination for girls aged nine to 14 years. He disclosed this on Oct 17 at a press briefing in Abuja. He said the vaccine will help to prevent HPV infection and reduce the risk of cervical cancer.

As part of initiatives to provide universal access to HPV vaccines for adolescent girls in the country, the National Primary Health Care Development Agency (NPHCDA) is coordinating the national introduction of the HPV vaccine into the routine immunization schedule from November 2023.

“Nigeria will introduce HPV vaccine using a phased approach based on lessons learnt from other countries and previous new vaccines introduced in the country.

“In each phase, we will initiate a five-day campaign encompassing schools, communities, marketplaces, government-owned health facilities, and other public places, targeting girls aged nine to 14. Subsequently, we will continue routine vaccination within health facilities for the same age group. By 2025, we anticipate transitioning to full routine Immunization with the HPV vaccine, focusing on girls aged nine.”

The phase one states are Abia, Adamawa, Akwa Ibom, Bauchi, Bayelsa, Benue, Enugu, Jigawa, Taraba, Kano, Kebbi, Lagos, Nasarawa, Ogun, Osun and FCT, while phase two states are Anambra, Borno, Cross River, Delta, Ebonyi, Edo, Ekiti, Gombe, Imo, Kaduna, Katsina, Kogi, Kwara, Niger, Ondo, Oyo, Plateau, River, Sokoto, Yobe and Zamfara.

Speaking on the HPV vaccine, Prof Mojisola Adeyeye, the Director General of the National Agency for Food Drug Administration and Control (NAFDAC) stressed that the agency is committed to ensuring the safety, quality, and efficacy of the Gardasil vaccine in the country.

The NAFDAC boss said Gardasil is a vaccine that protects against HPV and it is recommended for girls and boys aged 11 to 12 years, but it can be given as early as nine years or as late as 26 years.

She further added that the decision to deploy Gardasil as a single dose schedule is based on the scientific evidence that shows that a single dose of Gardasil vaccine can provide solid protection against cervical cancer caused by human papillomaviruses.

With a successful flag-off on October 24, 2023, in 15 states and the Federal Capital Territory, the HPV vaccine has commenced targeting girls between the ages of nine-14 through in-school and outreach vaccination models. A single dose of the Gardasil HPV vaccine was approved for the rollout of the vaccination by the NPHCDA.

In her address at the flag-off of the introduction of the human papilloma virus vaccine into routine immunization in Abia state, the Acting Executive Secretary of the Abia State Primary Health Care Development Agency, Mrs Ike Gladys said a single dose will be administered for girls 9-14 years in schools and communities.

“Nigeria is introducing HPV vaccine using Gardasil which is pre-qualified by WHO to prevent cervical cancer and other HPV-related cancers. A single dose of Gardasil will be administered by injection to girls 9-14 years old in schools and communities to protect them against cervical cancer and other diseases caused by HPV. Abia state is blessed to be among the 16 selected states in phase 1 to implement the HPV vaccine introduction to routine immunization in Nigeria.”

Before now, there was no tailored cervical cancer control policy or population-based screening programme in the country. Consequently, existing screening services were opportunistic, and sparingly distributed, thereby making it accessible to less than 9% of eligible Nigerian women.

Under the new immunisation protocol, however, girls aged nine-14 will receive a single dose of the vaccine, which is highly effective at preventing infection of HPV types that are known to cause at least 70% of cervical cancers.

The vaccination, in combination with other strategies including screening, early diagnosis, and treatment, will drastically reduce the incidence of cervical cancer.

HPV is mainly transmitted through sexual contact with someone who has the virus. It is the most common sexually transmitted infection (STI) across the globe. It can be spread through vaginal, oral, or anal sex with someone who has the virus.

In addition to sexual contact, HPV can be transmitted through other forms of skin-to-skin contact, such as during childbirth or through sharing personal belongings like razors, scissors, or towels with someone who has the virus.

Dr Faisal, however, noted that while vaccination is the most potent prevention measure against HPV, women are encouraged to undergo regular screening tests for early detection and treatment.