Cervical cancer

Cervical cancer is a major health issue for women around the world, particularly in the developing world where cancer treatment is limited. 

For countries like Zimbabwe, with fewer resources, a number of simple, safe and effective methods are now recommended by the World Health Organization (WHO) that could offer protection for millions of women against the devastating effects of the disease.

MSF obstetrician-gynecologist Severine Caluwaerts describes three methods that MSF is delivering on various projects in southern Africa, including Zimbabwe.

HPV vaccine (9-13 years)

“Over 70% of cervical cancer is caused by persistent infection with the human papillomavirus (HPV), the most common sexually transmitted infection. There are two vaccines endorsed by the WHO which protect against HPV, both of which are safe and effective and the WHO recommends vaccinating all girls aged 9-13 years. It’s generally believed that the vaccine is more effective if given before the first sexual encounter, but new evidence shows that vaccinating after exposure to HPV is still beneficial.

However, while preventing cervical cancer equals exponential savings in the long run globally, there are only two manufacturers which produce the HPV vaccine – GlaxoSmithKline and Merck – so market prices for these vaccines are too high for wider roll-out because of lack of competition.”

In February 2017, MSF launched a vaccination campaign against cancer-causing HPV, human papillomavirus, in three Manila districts where there are lots of slums. In August, the team had to find the 25,000 girls to give the second dose. Find out how we did it in this video.

Visual inspection with acetic acid and cervicography (VIAC) plus cryotherapy (ages 18 and older)

“This is a safe, effective way to identify pre-cancerous or cancerous cells early, which gives immediate results and could prevent a large proportion of cancers. Nurses and midwives can be trained to do it, and you don’t need a laboratory. Visual inspection involves swabbing the cervix with a dilution of acetic acid – ordinary vinegar – for a few minutes and observing under light or on a screen. If the clinic has the resources, a digital photo is taken for patients’ files to follow progress, which is called cervicography.

White patches indicate HPV infection or pre-cancerous cells. If the lesions cover less than 75% of the cervix, cryotherapy can be done immediately. Here, liquid nitrous oxide, is directed through a small probe onto the cervix to freeze and destroy infected patches of cells. Women should come back to the clinic six months later to see if the cryotherapy has worked.

The technique is pain-free, heals quickly and is around 80% effective in stopping lesions developing further. In Zimbabwe, HIV-positive women are screened once a year, while HIV-negative women come once every three years for screening.”

MSF, Doctors Without Borders, Cervical Cancer Zimbabwe
Tracy (left) testing for VIAC, with MSF nurse & mentor Tendai Chigurah. Photo: Melanie Wenger 

Loop electrosurgical excision procedure (LEEP) (ages 18 and older)

“When visual inspection shows lesions on more than 75% of the cervix, patients can be referred for LEEP. Here, patients are given local anaesthesia before an electrical current is passed through a wire loop to remove or cauterise more advanced lesions from the cervix. Samples can then be sent for biopsy. LEEP takes just 5-10 minutes to do and heals quickly. LEEP is around 90% in stopping further development of lesions.”

How is cervical cancer caused?

Cervical cancer is a disease which develops slowly, sometimes taking up to 20 years to appear. The most common cause is persistent infection of the cervix by the human papillomavirus (HPV), the world’s most common sexually transmitted infection.

Nearly four in five women will contract HPV in their lifetime, mostly through sexual intercourse, but will clear it naturally. However, repeated exposure or lowered immunity may cause infection. For women living with HIV, the risk of infection is 2 to 22 times greater, as they have weaker immune systems.

Repeated infections cause a spectrum of tiny cellular changes in the epithelial cells in the mouth of the cervix, which eventually grow into invasive cancer. 

Read more about MSF's work related to cervical cancer in Zimbabwe.