In Malawi, where radiotherapy does not exist and access to anticancer drugs varies, Doctors Without Borders is treating patients with chemotherapy and surgery. And the focus is on HPV screening and vaccinations
Cervical cancer is the second deadliest cancer in low- and middle-income countries. In Malawi, East Africa, more than 4,000 women get this type of cancer every year (37% of new cancers affecting women). With 2,905 deaths related to this cancer in 2020, the country has also recorded the second highest mortality rate. Since 2018, Doctors Without Borders has developed a project to reduce incidence and mortality among women in Blantyre and Chiradzulu districts. Doctors Without Borders’ interest in cancer is the result of a combination of factors. In low-income countries, epidemiological projections indicate a decline in infectious diseases and a concomitant increase in chronic diseases such as cancer. There lack of resources they late stages thewhere tumors are diagnosed in sub-Saharan Africa, for example, suggest that in the end they will make more victims of infectious diseasesas is currently the case in high-income countries.
Mortality doubling by 2040
The World Health Organization (WHO) estimates that Cancer mortality will double in Africa by 2040. In Malawi, where MSF has been providing medical care to HIV/AIDS patients for many years, we discovered that many of our patients also had cervical cancer. Women with HIV are six times more likely to get cervical cancer than women without HIV. This prompted us to carry out a comprehensive evaluation of this cancer in MalawiThat it has the second highest prevalence and mortality rates in the world. In 2020, 4,145 new cases of cervical cancer were detected and 2,905 women died from this disease. L’access to anticancer drugs very variable, the non-existent radiotherapy and underdeveloped surgery. We want to support vaccinations to protect against cervical cancer, extend screening programs and develop new treatment plans.
There radiotherapy the classic first-line treatment for cervical cancer, but currently not available in Malawi. Over the past two years, MSF has developed a model of care that combines chemotherapy and surgery. After three to six cycles of chemotherapy, the tumors have shrunk and can be operated on, saving the patients’ lives. We do not yet have data to evaluate the two-year survival rate, but the treatment shows satisfactory results and can be expected to guarantee a life expectancy close to that of radiotherapy treatment. In resource-limited countries, this type of treatment could be considered a serious alternative to radiotherapy, provided there are well-trained surgeons. For this reason we have paid particular attention to the training of surgeons who perform advanced surgeries such as hysterectomies, in which the uterus is partially or completely removed. Every month, in our project, surgeons perform an average of 14 hysterectomies and 40 surgeries. These are highly specialized surgeons who have acquired a high level of expertise in the field of onco-gynecological surgery.
Also, the quality of treatment guaranteed by multidisciplinary work, involving pathologists, oncologists, surgeons and supportive care teams, who provide social and psychological support, physiotherapy or palliative care. There is also another category of women who come identified at a more advanced stage and for which we organize and finance the transfer to Kenya to undergo radiotherapy. But these transfers require significant support and resources, and few patients can benefit from them on a large scale. By the end of 2023, we should be able to access radiotherapy in Malawi, which should facilitate the management of these late-identified patients.
The role of vaccination
Vaccinations are essential because the easily preventable cervical cancer. one of the few cancers associated with a virus, human papillomavirus (HPV), and there is an effective vaccine against some HPVs. The other way to protect yourself from cancer is screening, either as a means of prevention or as an early stage of treatment, as precancerous lesions can be treated at this stage. The HPV vaccine available through international schemes such as GAVIbut the routine vaccination in health centers does not reach easily the target population in Malawi, i.e. land girls between 9 and 13 years old. They don’t come to health centers because they generally don’t get sick, which is why they have to be vaccinated at school or in the villages. These systematic prevention programs in schools and communities require additional resources. We will continue to support these vaccination programmes, in partnership with the Malawi Ministry of Health, as we have in Januarywhen we have vaccinated 17,000 teenage girls in Phalombe district.
* Head of Mission of Médecins Sans Frontières in Malawi
February 4, 2023 (change February 4, 2023 | 09:29)
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