Director of the Institute for Women’s Health at UCL and Co-Director of
the Department of Health Policy Research Unit in Maternal Health and
Care, University of Oxford. I spent 100% of my time on academic
How the Project Began
The idea of setting up a project for cervical screening in Nigeria began when the newly formed Institute for Women’s Health received a donation of £500,000, which was to be spent on new projects in LED countries. Adeola Olaitan, Consultant Gynaecologist at University College London Hospital saw an opportunity to use her skills and those of her colleagues to help prevent cervical cancer in Lagos and in November 2005 the project was allocated £50,000.
Cervical cancer is the second commonest cancer in women world wide, second only to breast. It accounts for ½ a million cases/year and approximately 80% of these occur in the developing world. 300,000 women die of cervical cancer per annum, more than die of complications of childbirth.
Nigeria, a West African country is the 9th most populous country in the world, ranking just above Japan. Almost 10% of its estimated 126 million population reside in Lagos, a small state on the western coast.
There are multiple reasons why cervical cancer is so common in Nigeria. There is no effective screening program and awareness of cervical cancer even among healthcare workers is low. In addition, the HIV epidemic has contributed to the incidence of this disease. The majority of women present late and as there is little opportunity for curative treatment and no access to palliative care, most women die a miserable death.
Thus a small, inexpensive intervention such as cervical screening could potentially save numerous lives. It is estimated that screening in the United Kingdom saves 2000-4000 lives per year.
The Objective of the Project
The objective of the project is to determine the feasibility and acceptability of screening in sexually active women up to 70 years by using visual inspection techniques to detect signs of cancer or pre-cancer and to remove any pre-cancerous cells with cryotherapy. This technique has been extensively validated in India and South Africa and found to be an effective means to detect and treat pre-cancerous lesions.
It is possible to be screened privately in Lagos, but this costs at least 1,500 Naira (£12.50) in a country where many people earn just 6,000 Naira (£50) per month. Screening is usually done by cervical cytology which requires a sophisticated infrastructure. The cytology samples, once obtained, have to be sent to the laboratory for a qualitative analysis. Interpretation of smears thus depends on expertise and strict quality control. There must be facilities in place for communicating the smear result to the patient and a repeat visit is then required for further evaluation and treatment if the smear is abnormal.
Visual inspection techniques avoid the need for repeat visits as abnormalities on the cervix can be recognised by the application of specific solutions (visual inspection with acetic acid (VIA) and visual inspection with Lugol’s Iodine (VILI))and immediate treatment offered, thus ensuring better compliance.
Page last modified on 17 jun 09 14:36 by Vijay Devineni