Detection and treatment of cervical cancer in Africa

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Published: 14 Dec 2011
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Dr Chibuike Chigbu - University of Nigeria Teaching Hospital, Enugu, Nigeria

Dr Chibuike Chigbu discusses screening for and treatment of cervical cancer in in Africa. Visual inspection with acetic acid (VIA) is a simple, cheap and practical alternative to standard screening techniques. Where cancer is detected, cryotherapy can be used to effectively freeze and kill cancer cells. Although this technique is currently prohibitively expensive, Dr Chigbu explains that the use of carbon dioxide rather than nitrous oxide could solve this problem. A BIG CAT (Beginning Investigators Grant for Catalytic Research) grant has been awarded to fund this work and Dr Chigbu’s group have successfully screened over 13,000 women. The key to this high recruitment rate has been respect for the traditional system and consultation with tribal elders. 

AORTIC 2011, Cairo, Egypt 30 November–2 December 2011


Detection and treatment of cervical cancer in Africa


Dr Chibuike Chigbu – University of Nigeria Teaching Hospital, Enugu, Nigeria


The BIG CAT is essentially about screening for cervical cancers. What works for the developing countries, not just what works, what is also practicable based on the economy, based on the social infrastructure and then based on the culture of the people. That’s exactly what we’re trying to do, we have said, OK, what happens in developed countries where you use what we call cytology-based screening? It might not effectively work in Africa; in fact, to date, no single African country has been able to implement that successfully. So that made us start looking at what are the alternative means of doing this in Africa. And fortunately we have so far… science has so far succeeded in doing that, we’ve got what we call VIA which is visual inspection with acetic acid. What it entails is that you simply paint the cervix, the cervix is the neck of the womb of a woman, just paint it with acetic acid and then look. Now the bad ones will turn white and anybody can see and say, “Look, this is not good,” and they will treat. We are still doing the very complex laboratory tests that requires a lot of infrastructure, letters will go and come back, follow-up and all that. That we have been able to do, but in terms of treatment we have also been able to know that what are called cryotherapy, using gas, cold gas, to freeze those cells and kill them. Now when you do that you stop those cells from developing into cancer. So if we are able to do that in a population setting, that means we are going to stop that population from having a lot of cervical cancers and that’s just what the project is all about. That’s why we are looking at the fine print, the questions we have not been able to answer based on studies from developed countries. And then also seeing how we are going to be able to integrate that within the culture of our people that don’t like coming until they’re very sick and all that. So essentially that’s what we are doing and we have been able to really, at this moment, screen about 13,000 women in six months and that’s just a whole lot of… surpasses what we thought we could achieve. We were able to do that because we involved the traditional system, we had to go through the established traditional system there, talk to the elders, the village heads. Then they talk to their wives and it was easy because there is this patrimonial system in Africa, unfortunately, the women don’t have a say, they have to… before they can take water they have to get permission from their husbands. So it’s a problem but we are living with it until we are able to get our women emancipated, for them to come up to say, “Look, this is what I want to do.” We have to really go through the traditional system to get them well. It’s exactly what we’re doing and it’s working fantastically.


What percentage of people are being screened?


We have been able to screen 13,000 women. Now refusals to screening are almost rare. The problem that we’re having now is screen all who come out to be screened, it’s just a problem. We have limited health workers, I usually go to about thirty health workers and the problem is not even the number, the problem is that we are using the existing healthcare system where you have the primary health clinics in the villages. You discover that they have about five beds, eight beds, ten beds, so if you have thirty workers coming to use eight beds, that means only eight will be working, 22 won’t be working, and that’s a problem. So we now have to… so in villages we have to spend three or four days in those villages so we can screen everybody. We’ve not really had issues with people refusing to be screened, that’s the funny thing, once the traditional system was involved. Because when they go home, the husband will ask them, “Were you screened?” and then she has to say yes. If she says no, she has to tell her husband why she wasn’t screened and if it is her fault then she’s got a whole lot of problem on her hands. So everybody was struggling to be screened. And that’s the whole thing about the community participation we’re talking about.


Are there any problems with this treatment?


We have a problem with our freezing gas, that’s the big thing now, it’s very expensive. When we started this project we thought we could, from what we got from the website of the suppliers, we thought it was that easy. But we discovered that a 30kg gas is about $1,200, that’s to buy 30kg gas. And with that you could treat about 100 – 120 persons. So by Nigerian standards that is expensive. But again, there is also hope along the line. We’re using nitrous oxide, I understand that carbon dioxide is far cheaper to use so we’re maybe thinking that along the line nitrous oxide might not necessarily work. In Nigeria we just have one supplier, Air Liquide, from France and they import this gas and they sell it at $1,200 for a 30kg cylinder, and that’s a problem. Then, again because it’s 30kg, it’s very huge, you have a problem with transporting it to the villages. So we have to get it up on pickups, a van and all that and take it to the villages. But if we can deal with the cost issue then the logistics of taking it to the villages won’t be a problem because we have a lot of second-hand approved vans imported from Europe in Nigeria. So the issue is the cost, but I think carbon dioxide, we may have to change to that, carbon dioxide, it may be better for us.


Is there any funding potential for the gas?


No, we’ve not. Everything we’ve got for now is from the BIG CAT, AORTIC, NCI collaboration. We’ve not been able to get anything from any other group. Though we’ve not tried, anyway, we’ve not tried. We may think about that.