I’m presenting cervical cancer in southern Malawi, the presentation, management and outcome. I looked at 300 women which was all the patients presenting to the main tertiary hospital in southern Malawi, which essentially worked out at one new case of cervical cancer every single day. Seven out of ten of those cases presented at an incurable stage so I was looking at what reasons were there that these women are presenting late? Why are they getting there at an incurable stage? And when they get there what management are we doing to them and their outcomes.

What were the reasons for late presentation?

The key things identified were that there’s a severe lack of knowledge about cervical cancer so women don’t know about this disease. Even our oncology nurses on the oncology unit, I asked them about cervical cancer screening, none of them had been. I asked them if they knew about the cervical cancer vaccine which can prevent 98% of cases of cervical cancer and none of them had ever even heard of this. So how can we expect the people in the villages and people all over Malawi to know about this if our oncology nurses don’t know? So there’s a severe lack of awareness about cervical cancer. Other more practical issues such as transport, getting to the hospital, even when they do recognise there’s a problem, and very poor access to screening. 98% of the women that I saw presented with symptoms of bleeding or pain and at that time it’s definitely too late, the cancer has progressed too far for us to do anything about. So the only way to prevent it is to come before you get symptoms and for that to happen women have to know about screening.

What treatment options are available?

In Malawi we only have chemotherapy and palliative care, so symptom control, to treat patients with an advanced stage of cervical cancer. Radiotherapy can melt away cervical cancer and can catch those cases which haven’t progressed too far and can still maintain some women being curable but there is no radiotherapy in Malawi whatsoever. So we manage to initiate about 10% of patients on chemotherapy, which controls their symptoms, and surgery did happen for some of the earlier stages. But, again, there are many reasons for delay in surgery such as poor pathology services and simple things in theatres – not having water, not having staff.

What can we do to improve screening and prevention in Malawi?

First things first, prevention is better than cure. As I said, cervical cancer, 98% of cases are preventable. There are small areas in Malawi where the vaccine is being rolled out but essentially if we could vaccinate every girl at the age of 11 in the whole country against the HPV virus then we could prevent the vast majority of cervical cancer in the whole country. Before we get to that stage we can improve screening and the first thing is to educate the women in Malawi about screening and try and improve access to get to the screening, so transport services, going into the community and putting more trained professionals in the community to do the screening.

How can this become a reality?

Once we manage to accurately highlight how many women it is affecting, which we’re doing, and many of the research talks today have done that, so we need to present this data in a clear fashion to the government, highlight this problem and ask for more funding from the government to provide screening services.

Is there anything else you would like to add?

Vaccinate your daughters against cervical cancer with the HPV vaccine wherever you are in the world.