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Combating Cervical Cancer in Sub-Saharan Africa

According to the Centers for Disease Control and Prevention, about “93% of cervical cancers are preventable.” Unfortunately, however, the rates for cervical cancer, as well as the number of deaths from it, continue to remain high in many of the poorest areas of the world. This is especially the case in sub-Saharan Africa, most notably in East Africa. In order to reduce incidences of cervical cancer in sub-Saharan Africa, targeted human papillomavirus (HPV) vaccine rollouts are necessary.

Cervical Cancer Rates in Sub-Saharan Africa

Sub-Saharan Africa notes a significant number of cervical cancer cases. In East Africa specifically, cervical cancer is “the leading cause of cancer-related morbidity and mortality, with one of the incidence rates above 40 cases per 100,000 of the population,” according to a study based on surveys conducted between 2014 and 2017. The World Health Organization (WHO) reports that, in 2018, Africa accounted for 19 of the 20 countries with the highest rates of cervical cancer.

A study published in 2020 by Elima Jedy-Agba and others says cervical cancer is also “the most common cancer in half (23/46) of the countries of sub-Saharan Africa,” with women in these countries noting the highest cervical cancer incidences and mortality rates globally. The cervical cancer survival rate is also very low in sub-Saharan Africa as only about 33% of those with this form of cancer survive five years after diagnosis. Additionally, cervical cancer was responsible for 21.7% of all cancer deaths in women in sub-Saharan Africa in 2018, “making it the most common cause of cancer death in the region.”

Cervical Cancer Risk Factors

Cervical cancer rates are high in sub-Saharan Africa primarily due to a prevalence of various risk factors, many of which tend to be associated with poverty. University of Cape Town gynecology professor Lynette Denny asserts that the increased risk of cervical cancer in sub-Saharan Africa has “a very strong connection with poverty, with high numbers of people living in unsatisfactory conditions, as well as fragile health care systems that tend to focus on curative rather than preventative interventions…”

Denny also cites women’s lack of access to health care and successful screening programs in Africa as other potential causes. This lack of access contributes to 90% of deaths from the illness.

Lower levels of education, which ties to poverty, also play a role. In a study published in July 2021, Abila and others found that among a group of participants from Uganda, Burundi, Rwanda, Kenya and Tanzania, “having a complete secondary education was associated with the lowest number of risk factors for cervical cancer compared with women with no education” in each country.

Furthermore, most of the respondents in the study “started sexual intercourse at 17 years or younger with the highest proportion among women from Uganda (72.38%) and the lowest among women from Burundi (52.3%).” The women also first gave birth at tender ages, with the mean ages ranging from 18.67 in Uganda to 21.71 in Rwanda.

HIV and HPV Risk Factors

Such trends are common in poor regions as various studies in Africa reveal that “poverty is a risk factor for early sexual debut.” For instance, sub-Saharan African countries typically note higher rates of transactional sex (exchanging sexual acts for basic necessities such as food and money) among young women due to economic insecurity.

Although these young women can meet certain short-term needs by engaging in transaction sex, this practice typically involves multiple sexual partners, which increases the risk of contracting HPV and/or HIV, both of which cause a bulk of cervical cancer cases globally. This shows how poverty in sub-Saharan Africa can directly result in higher rates of cervical cancer.

Treatment Options/HPV Vaccinations

Expanding access to HPV vaccinations is a solution that could greatly reduce the incidence of cervical cancer in sub-Saharan Africa. According to a research article by Christine Muthoni Karanja-Chege, “HPV vaccination provides protection against HPV types 16 and 18 which are responsible for approximately 70% of cervical cancer cases.”  Karanja-Chege also notes that the best age for vaccination is during the early adolescent years before an individual’s first sexual encounter as children in developing countries are more prone to becoming sexually active at an early age.

Karanja-Chege cites Australia as an example of a country in which widespread HPV vaccination has succeeded. As of 2019, 80% of Australian females eligible for the HPV vaccine have received it, which has greatly reduced HPV infection in the country. Furthermore, this increase in HPV vaccination rates is expected to reduce the cervical cancer rate in the country in the near future. The example of Australia demonstrates that nations can achieve considerable success in preventing a major risk factor associated with cervical cancer, which is what African nations such as Kenya hope to do.

HPV Vaccination Rollout in Kenya

Kenya has also attempted to deter cervical cancer through HPV vaccination. In 2019, Kenya’s Ministry of Health rolled out a “routine HPV vaccination” program for 10-year-old girls in the country. With the support of Gavi, the Vaccine Alliance, public health organization John Snow, Inc. (JSI) helped introduce the vaccine in Kenya.

Despite these efforts, vaccine misinformation spread throughout the country, discouraging many parents from bringing their daughters for vaccinations. Furthermore, the COVID-19 pandemic disrupted health care services in the country and forced the government to delay many immunization campaigns, including the HPV immunization campaign.

Nevertheless, the introduction of the HPV vaccine in Kenya has seen some success. The 2019 program also provides valuable lessons that health ministries in Africa can take into account to ensure greater success in future programs. JSI notes that “HPV vaccine introduction requires tailored approaches to reach preadolescent/adolescent girls. Countries that are introducing HPV vaccine are learning that these lessons also offer an innovative blueprint for future life-course vaccinations.”

– Adam Cvik

Photo: Flickr

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New Cancer Therapies Bring Ray of Hope 

Cancer TherapiesIn 2020, the estimated number of cancer cases of all sexes and ages was 19,292,789 and the number of cancer-related deaths was approximately 10 million. Data suggests that about 400,000 children procure cancer on an annual basis. This goes to show that cancer is still a leading global health problem that has an economic cost of trillions of dollars. According to the World Health Organization (WHO), about 30-50% of cancers can be prevented simply by early detection, correct diagnosis and avoiding risk factors such as tobacco, alcohol, UV radiation and more. Although basic cancer treatments such as radiotherapy and surgery exist, recent advancements show that a number of new cancer therapies developed can significantly increase the survival rate of patients.

A Panacea for Rectal Cancer

On June 5, The New York Times published a piece about a small clinical trial conducted at New York’s Memorial Sloan Kettering Cancer Center. In this trial, 18 patients with stage three rectal cancer were given a drug called Dostarlimab “every three weeks for six months.” Dostarlimab is an immune checkpoint inhibitor. This means that the drug itself does not attack the cancer cells. Dostarlimab instead exposes the cells and allows the patient’s immune system to then “identify and destroy them.”

All 18 patients were miraculously cured of their cancer, leaving no trace of tumors to be found in any physical examinations or body scans. Scientist Dr. Luis A. Diaz Jr stated that “I believe this is the first time this has happened in the history of cancer,” in regards to this study.

The reason why this experiment is so revolutionary in the field of cancer research is because of its implications. According to Dr.Hanna Sanoff of the University of North Carolina’s Lineberger Comprehensive Cancer Center, rectal cancer patients traditionally have to bear severe consequences after surgeries or chemotherapy.

Sanoff stated in an NPR news interview, “I have had patients who, after their rectal cancer, have barely left the house for years – and in a couple of cases, even decades – because of the consequences of incontinence and the shame that’s associated with this.”

Side Effects and Effectiveness of Dostarlimab

In contrast, this new cancer immunotherapy didn’t bring with it any significant clinical complications for patients. The side effects, if any, were sparse and less in intensity.

However, this study has proven to be useful for only a “subset of patients” who have a specific gene mutation known as mismatch repair gene deficiency. About 5% of cancer patients have such gene abnormalities and they are the ones who will respond well to the Dostarlimab drug.

To gauge the true effectiveness of this research study, a more broad and diverse sample needs to be experimented upon. Nonetheless, this is a hopeful beginning that shows that cancer therapies can cure cancer for good.

New Drugs Synthesized treat Hard-to-Cure Breast Cancers

A new study published on July 5 in the New England Journal of Medicine focused on treating cancer patients with low levels of HER2, a protein “which is a common villain in breast and other cancers.”

Previously, it was found that drugs attacking HER2 only worked for patients who had high levels of the protein. However, 80–85% of breast cancer patients have low levels of HER2 (“a condition known as HER2-low”), making the usage of these drugs unhelpful.

In this clinical trial, 557 patients with HER2-low metastatic breast cancer were divided randomly into two groups. Two-thirds of patients were intravenously injected with a drug called trastuzumab deruxtecan (T-DXd) every three weeks. The rest received standard chemotherapy.

The results showed that patients who had taken T-DXd “survived for a median of 23.4 months overall, while those in the chemotherapy group survived for a median of 16.8 months.” The unique thing about T-DXd is that it contains an antibody attached to a chemotherapy drug. When T-DXd finds a cancer cell with HER2 on it, “the chemotherapy drug separates from the antibody and kills the cell.”

The Impact of T-DXd and Foundation of ERX-41

Breast cancer specialist Jane Meisel, M.D. of Emory University’s Winship Cancer Institute, who was not part of the study, believes that the findings will “change how metastatic HER2-low breast cancer is treated, and are ‘a huge win for [the] patients.’”

In another experiment published on June 9,  UT Dallas associate professor Dr. Jung-Mo Ahn synthesized a new compound called  ERX-41, which helped in destroying tumor cells in the breast. This compound proved especially effective in treating patients with triple-negative breast cancer (TNBC) and is novel because traditionally, there have been “few treatment options for patients with TNBC.”  ERX-41 also proved to be helpful in treating pancreatic, ovarian and brain cancers.

A New WHO Initiative

On June 4, WHO announced its collaboration with the American Society of Clinical Oncology, Inc. (ASCO). The primary goal of this partnership is to reduce inequalities and improve the quality of cancer care, both globally and locally. The emphasis is on low-income countries where “comprehensive treatment” is found in less than 15% of places.

Through innovation, network-building and pooling of resources and tools, the WHO and ASCO will lift the cancer burden on many patients and provide them with effective treatment.

A Look Ahead

Much progress has been made in developing new cancer therapies that would have been unfathomable even a few years back. The road ahead is long and yet there is light at the end of the tunnel.

–Anushka Raychaudhuri
Photo: Unsplash