The Week Of The Cervix

Hello from Bungoma. We're in a medium sized Kenyan city located about half an hour east of Uganda and a little more than an hour west of Eldoret, the area of Kenya where most of the amazing long-distance runners come from. Svjetlana, Mimi, and I have joined up with a group called PINCC, Prevention International: No Cervical Cancer, this week to help train Kenyan health workers to screen for and treat pre-cancerous disease of the uterine cervix. Cervical cancer is a big deal. It's the main cause of cancer-related death among women around the world, and it's almost 100% preventable. With relatively simple examinations to detect pre-cancerous changes of the cervix and fairly straight-forward procedures to either freeze or cut out the abnormal cells, women can avoid the slow and painful death caused by cervical cancer. Cervical dysplasia, the term used to describe when normal cervical cells turn into abnormal cells, is caused by HPV, the human papilloma virus. HPV is very common around the world, and depending on the subgroup, up to 75-80% of people will have been exposed to it over their lifetime. Some people never have problems from it, some develop genital warts, and others - predominately women - have pre-cancerous disease and thankfully, much less commonly, cancer. In the US, we screen women for cervical dysplasia caused by HPV by using pap smears. Abnormal pap smears require women coming back for a longer examination with a magnifying instrument called a colposcope. During colposcopy, biopsies are taken of abnormal appearing tissue, sent to a pathologist, and if they are minimally abnormal, the patient is just watched with serial examinations. If the tissue changes appear more advanced, then an office procedure called a LEEP is necessary to remove the cells before they become cancer. This process doesn't work so well in countries such as Kenya, since it is expensive and requires women to return for several visits. We are teaching a procedure used more and more commonly in the developing world called VIA, where the cervix is swabbed with a 5% solution of acetic acid (household vinegar), examined for dysplasia that is highlighted by the vinegar, and then the abnormal cells are either frozen with a technique called cryotherapy, or cut out with a LEEP. This requires fewer visits than the typical US approach, and the results have been very good.

It's been a psychologically tough two days. We've seen several cases of probable cervical cancer and one case of probable advanced breast cancer. Due to financial reasons, these women, unlike their counterparts in the US, will likely never see the medications, radiation, and chemotherapy necessary to either cure them or at least extend their lives. It's hard to watch. But we soften the blow by reminding ourselves that we are here to strengthen these clinicians' ability to prevent more cases of cervical cancer. That, at least, is some solace. We'll be here through Friday, when we return to Sagam. Stay tuned for more updates.