Use of Appropriate Technology to Improve Cervical Cancer Prevention and Early Detection: Experience in Jos, Nigeria

Abstract

PURPOSE In absolute numbers, Nigeria is one of the countries with the highest burden and mortality as a result of invasive cervical cancer (ICC), with more than 53 million women at risk. The coverage for available cervical cancer screening by conventional cytology is less than 9% of the population. Also, the lack of a national human papillomavirus vaccination program and organized cervical cancer screening services could partly be responsible for the more than 14,000 new ICC cases and 8,000 deaths attributable to ICC in Nigeria every year. Furthermore, the prevailing challenges of diagnosis at advanced stages in more than 80% of ICC cases with a paucity of trained oncologists and poor treatment infrastructures often result in high death rates. These problems make the use of appropriate technology to improve screening, early detection, and treatment of precancerous conditions a novel strategy for achieving quality cancer care in our setting. The objective of this study was to discuss our experience with use of available and resource-appropriate technology to improve cervical cancer care and outcomes in Jos, Nigeria. METHODS A critical review of cervical cancer prevention, diagnosis, and treatment facilities and outcomes in Nigeria was done. This background information provided justification for the use of resource-appropriate technology for improving quality of cervical cancer prevention and treatment outcomes in resource-limited settings. We also gleaned from specific experiences of cervical cancer screening, follow-up, and treatment of both precancer and early invasive cervical cancer in Jos, Nigeria. RESULTS The main factors responsible for increasing burden and poor cervical cancer outcomes in Nigeria and other resource-limited settings in sub-Saharan Africa include: HIV infection; lack of organized cervical cancer screening programs, with poor coverage even when opportunistic screening is available; weak health care system; illiteracy; and poor human papillomavirus vaccination coverage. Some of the major challenges in treatment of cervical cancer include: late presentation, with poor treatment infrastructures; paucity of trained gynecologic oncologists, medical oncologists, and other disciplines needed to improve quality of cancer care; and poor access to available prevention and treatment services, with limited/no health insurance coverage. CONCLUSION Resource-limited settings should leverage the widespread availability of mobile phones to improve cervical cancer education and scheduling for screening, follow-up, and treatment of precancerous conditions. Also, the use of radio talks can reach women in remote locations. Adoption and use of novel testing technology, such as self-sample collection for human papillomavirus DNA testing, is also advocated. Our team in Jos, with collaboration with Northwestern University, is also looking ahead through molecular research on how epigenetic and microbiome biomarkers could improve prevention and early detection of precancer and ICC as a strategy for improving outcomes in our population. Also, the utility of low-cost treatment modalities, such as battery-operated thermocoagulation, could improve coverage for treatment of cervical precancer. Finally, resource-limited settings should train general gynecologists with interest in oncology to acquire specific competencies for locoregional surgical control, particularly for early-stage cervical cancer. Given the identified challenges, the judicious use of these resource-appropriate technologies may improve quality of cancer care and outcomes in resource-limited settings.