CANCER CONTROL PROGRAM
Our desire as a ministry is that people will have access to all the information they need to maintain good health. We have introduced a new program (Cancer Control Program) that focuses on cancer prevention especially in rural communities where the incidence is too high.
Burden of cervical
cancer in Uganda
Cervical cancer—which can be prevented with timely screening
and appropriate treatment—is the most common form of cancer and the leading gynecological
cause of death among women in Uganda. It accounts for 40 percent of all cancers
recorded in the Kampala cancer registry with an incidence rate of 45.6 per
100,000 women (WHO, 2006). More than 80 percent of women are diagnosed with
late-stage disease, when it is problematic or impossible to treat.
The National Cancer Control Program emphasizes the
importance of early detection and treatment. But the country has no organized
screening program, and many women lack both awareness about the disease and
access to prevention and treatment facilities. These factors put poor and rural
women at heightened risk for cervical cancer. Evidence shows that the disease is
more common among the lower economic strata
Cervical cancer is the uncontrolled growth of cells on the
cervix. It is unique because it can take 10 to 20 years for invasive cancer to
develop after mild dysplasia is identified (WHO, 2006). This slow progression
from early lesions to overt cancer provides the basis for early screening,
detection, and treatment.
Cervical cancer’s main underlying cause is the human
papillomavirus (HPV), a sexually transmitted and largely symptomless infection
for which there is currently no cure. Many young people contract HPV, but the
infection may remain stable or become undetectable.
In some cases, however, HPV leads to abnormal cell changes
that can progress to cancer over many years. Around the world, this cancer is
most common among women 35 years and older.
A number of factors indirectly heighten the risk of cervical
cancer by increasing the likelihood that a woman will contract an HPV
infection. These factors include early age at first intercourse, early age at
first birth, having many births, tobacco use, prolonged use of hormonal
contraceptives, an impaired immune system, particularly related to HIV
infection and multiple sex partners. Several other factors may influence
whether women with abnormal cervical-cell changes develop cancer.
The Vulnerability
of Rural Ugandan Women
With a greatest percentage of Uganda’s population living in
rural areas where measures of health and living standards are low, rural women
are vulnerable to many of these risks.
For instance, rural women tend to marry earlier and have
more children than urban women. Although the legal minimum age for marriage is 18 in Uganda, roughly
one-half of rural women ages 45-49 married before age 15.
A reliance on indigenous cures in some rural Ugandan
villages and a traditional reluctance among many villagers to seek medical
assistance for gynecological and other matters may also heighten women’s
vulnerability to infection and disease. People have fear about cancer especially
with women, whose health is not a priority in the family. Many Ugandan women
seek care only when the cancer is advanced and difficult to treat.
While the mass media can play an important role in spreading
critical information in poor communities, many rural women in Uganda lack any
meaningful exposure to the media (newspapers, magazines, television, radio, or
cinemas) compared with urban women.
FoHA; Cancer Control
Program
As a ministry, we have launched a Cancer Control Program
(CCP) in response to the increasing incidence of various cancers affecting
women and men especially in rural communities. The program’s goals include the
primary prevention of cancers through health education; secondary prevention
through early detection and diagnosis and palliative care for patients with
advanced cancer.
Cancer Control
Program Objectives
- Raise awareness around and advocate for cervical cancer prevention and treatment in Uganda
- Decrease cervical cancer incidence through screening of all eligible women and treatment of cervical precancerous lesions.
- Increase access to cervical pre-cancer screening and treatment services amongst eligible women ages 25–49 years by providing visual inspection
- Improve the quality of life of patients with cervical cancer and their families through management of pain and other physical, psychological, social, and spiritual problems.
Implementation
strategy
- Training of health care providers, which will begin with a training-of trainers course for all Village Health Teams/Rural Health Evangelists who will then provide local training in VIA. The trainings will use lectures, demonstrations, audio/video presentations, and hands-on practice in screening. Pre/post-test evaluations will assess performance. Sites will be trained in the order in which implementation will occur.
- Cervical pre-cancer screening short term missions to provide screening services in a phased manner by region. Mission protocol will include community mobilization; health education; we will work with regional Health centers to carry out VIA and then refer clients with cervical precancerous lesions to the nearest district or regional referral hospital for further care.
- Implementing an effective communication and mobilization strategy for both women and men. This strategy will be developed before commencement of screening and improved upon thereafter. The community mobilization strategy will be implemented at the community level for all women and their spouses. Other avenues to reach women will include campaigns involving local community leaders, churches, women’s groups, radio messages, and/or the use of film vans or public address systems at the community level.