CERVICAL CANCER CERVICAL CANCER PREVENTION PREVENTION STRATEGIESSTRATEGIES

Z Mike Chirenje MD FRCOGZ Mike Chirenje MD FRCOG

Department of Obstetrics and Department of Obstetrics and GynaecologyGynaecologyUniversity of Zimbabwe, Harare University of Zimbabwe, Harare ZimbabweZimbabwechirenje@uz-ucsf.co.zwchirenje@uz-ucsf.co.zw

Problem in Zimbabwean Problem in Zimbabwean women:women:

Female cancers registered in 2002 by site:Female cancers registered in 2002 by site: Cervix uteri (771)Cervix uteri (771) 25.9%25.9% Kaposi sarcoma (478)Kaposi sarcoma (478) 16.1%16.1% Breast (304)Breast (304) 10.2%10.2% Ovary (74)Ovary (74) 2.5%2.5% Cervix corpus (40)Cervix corpus (40) 1.3%1.3%

Zimbabwe cancer Registry (2006).Zimbabwe cancer Registry (2006). Therefore 1 in every 5 women diagnosed Therefore 1 in every 5 women diagnosed

to have cancer had cervical cancer.to have cancer had cervical cancer.

Cervical cancer is often slow growing, Cervical cancer is often slow growing, with progressive generalised wasting with progressive generalised wasting for several months that creates for several months that creates difficult home care in low resources.difficult home care in low resources.

Family members complain about the Family members complain about the unbearable smell that is socially unbearable smell that is socially embarrassing and impossible to embarrassing and impossible to eradicate (unresponsive to antibiotics).eradicate (unresponsive to antibiotics).

Epidemiology and Treatment of Epidemiology and Treatment of Cervical Cancer :Cervical Cancer :

Cervical Cancer Cervical Cancer PreventionPrevention

Primary (e.g. delayed intercourse)Primary (e.g. delayed intercourse)Secondary: = Pap smearSecondary: = Pap smear =Visual Inspection with acetic acid (Chirenje =Visual Inspection with acetic acid (Chirenje

et al Lancet 1999) et al Lancet 1999) = Lugol’s Iodine= Lugol’s Iodine = HPV vaccination (Merck covers HPV types = HPV vaccination (Merck covers HPV types

6,11,16 and 18 and GSK covers types 16 and 6,11,16 and 18 and GSK covers types 16 and 18).18).

HPV types 16 and 18 cause 70% of cervical HPV types 16 and 18 cause 70% of cervical cancer casescancer cases