When Talent Yakado was diagnosed with cervical cancer in 2004 after giving birth to her third child, she feared that the diagnosis would be a death sentence. Despite having been screened twice before, she realized she still had very little information about the disease.
After an initial test came back as inconclusive, she had a repeat test six months later. “This time, the results came back as I had dreaded – I had cancer. From that point on I was numb with fear,” she says. “Fortunately, my husband did not panic much. After the first result, he decided to find out as much as he could about cancer, and he assured me we stood a better chance because of the early detection.”
Yakado, 37, got treatment and is now cancer-free. And she has dedicated her life to ensuring that more women in Zimbabwe are able to detect, fight and survive a cervical cancer diagnosis. Through her Tanyaradzwa Cancer Trust, she educates women on the importance of screening for cervical cancer, helps them find places to get tested and, if they are diagnosed, suggests where to get treatment.
“The challenges I faced prior to my treatment prompted me to form the trust,” she says. “The challenges being the lack of knowledge, financial constraints, and lack of proper counseling.”
Yakado’s survival story is a rarity in Zimbabwe, where the 2015 Zimbabwe Demographic Health Survey revealed that although nationally 79 percent of women had heard of cervical cancer, only 13 percent of them have had a test to screen for the disease. This despite the fact that the World Health Organization (WHO) has identified cervical cancer as the leading cause of female cancer in the country.
According to the most recent WHO statistics, about 2,270 new cervical cancer cases are diagnosed annually in Zimbabwe, and 1,451 women are estimated to die of cervical cancer each year. Cervical cancer accounts for about 23 percent of cancer deaths among women in the country.
According to experts, the Zimbabwe’s cervical cancer disease burden is intensified by the high prevalence of HIV and Human Papilloma Virus (HPV). The 2016 HPV and Related Cancers report from the HPV Information Centre emphasized that 24.7 percent of women in Zimbabwe’s general population are estimated to be HPV-positive, while 17.7 percent of women are estimated to be HIV-positive.
Cervical cancer is caused by certain types of sexually acquired HPV and does not present any signs and symptoms until it reaches an advanced stage. Women are encouraged to go for regular cervical cancer screening exams, which can be done through the Papanicolau (Pap) test or the Visual Inspection with Acetic Acid and Camera (VIAC). Both tests are effective for detecting early abnormal or cancer cells in the cervix and uterus and are recommended for women from the time they become sexually active.
Sukoluhle Nkomo is one of the many women in Zimbabwe who has never had a cervical cancer screening test. Though the 25-year-old waitress has heard of the disease, she says she was not aware that cervical cancer kills more women in the country than any other cancer and doesn’t know of any screening options available.
“I have heard of cervical cancer, but have never been tested for it,” she says. “I actually would not know where to go for testing. I don’t think there are any centers just for testing for cervical cancer, like the ones that are there to test for HIV,” she says. In fact, VIAC screening for cervical cancer is now available at district hospitals in all 10 provinces in Zimbabwe, and some New Start Centres that are dedicated to HIV testing and counselling now also provide cervical cancer screening. But the fact that so few Zimbabwean women know about the availability of screening options is a major reason behind the country’s high cervical cancer rates, say health experts.
Jane Ndlovu, a 30-year-old pharmacist living in Bulawayo, says she had her first pap smear in October 2016 when she went to see her gynecologist regarding a cyst in her uterus. “He encouraged me to do the test and I got it done because I was already there,” she says.
Before then, Ndlovu had not seen any campaigns encouraging women to go for screenings. “If so many women are dying from this disease, then we need to know about it,” she says. Ndlovu also had to pay for her cervical cancer tests, something that many women can’t afford to do. “I was screened through a private doctor and it is expensive,” she says. “I had to pay consultation fees, a fee for a collection of the sample to be taken to the lab, plus the fee for the laboratory too.”
Zimbabwe’s National Cancer Prevention Strategy 2014- 2018 acknowledges that cancer has remained low on the government agenda, with diseases such as cholera, HIV/AIDS and malaria being prioritized over non-communicable diseases. The report adds that this has resulted in a lack of resources and shortages of essential chemotherapy, pain control drugs, and cancer diagnostic and treatment machines.
The report goes on to say that a possible solution to the lack of funding is partnerships with aid agencies and NGOs. That’s already happening. Better Healthcare for Africa (BHA) is one of several organizations working to provide cervical cancer screening options for women in Zimbabwe. Since 2013, the NGO has been supporting VIAC programs at St. Albert’s Mission Hospital and Karanda Mission Hospital, in the Mashonaland Central Province. It also helps those hospitals provide community cancer awareness and education programs.
According to BHA spokesman Darrell Ward, VIAC programs can be effective. “This screening method is endorsed by the World Health Organization for low-resource countries,” he says. “The programs have been used in India, where studies have shown that they reduce the incidence of cervical cancer,” he says.
But Ward says screening for cervical cancer only works if women get tested. And that means focusing on community education to encourage women to get screened and to eliminate the stigma associated with the disease. “Stigma and shame can prevent women from seeking screening and treatment early, when cancer is most easily and successfully treated and sometimes cured, and when care is less costly,” he says.
“Local beliefs that a woman is less of a person because surgery has removed her uterus or a breast is another form of stigma that must be countered. Cancer causes enough suffering without additional suffering due to ridicule, shame or embarrassment.”