More
often than not, on Tuesday and Thursday mornings, a line of women wraps around
the building of the women’s health clinic at the Sihanouk Hospital Center for
HOPE seeking free cervical cancer screening.
On a
recent Tuesday, a 36-year-old from Kampong Speu, who asked to remain anonymous,
was one of them. She had been enduring abdominal pain for the past three
months, with severe pain up to three times a week.
“I want
to find out what the problem is,” the woman said.
Cervical
cancer is not only the most common kind of cancer among Cambodian women, it’s
the most prevalent cancer in the Kingdom. Cambodia’s cervical cancer rate is
also among the highest, if not the highest, among Southeast Asian countries,
doctors say.
However,
research on the topic remains sparse, and the availability of prevention
services, screenings and adequate treatment remains severely limited, creating
a high burden on the country, causing hundreds of preventable deaths every year
and making younger-than-usual women more susceptible to the deadly disease,
medical experts say.
Data from
February show that the country’s cervical cancer rate stands at 20.5 for every
100,000 women, according to the HPV Information Centre in Spain, which
compiles, processes and disseminates country-specific information on HPV and
cervical cancer.
Rates in
neighbouring Vietnam, meanwhile, are just over half that, at 11.3 for every
100,000 women, while Laos’s rate is just 9.8 for every 100,000, data show.
The
Kingdom has a population of about 5.56 million women, aged 15 and older, who
are at risk of developing cervical cancer, according to the data, and the
country sees about 1,512 new cervical cancer cases and about 795 deaths every
year.
Cervical
cancer, however, is preventable, doctors say, and with more preventive
resources – such as those provided by the women’s health clinic – the country
could one day reverse those dismal statistics.
Screenings key
Screening
makes an important difference by detecting cancer at an early stage, when it
can still be cured, said Dr Thay Sovannara. Sovannara’s research, recently
presented in Australia, found that out of 1,000 women, there was an estimated
11 per cent prevalence of cervical abnormalities that can be indicative of
cancer, most of which were in the early stages.
Although
several medical professionals are helping train their counterparts in the
provinces and informing the public about the deadly disease, as Sovannara
notes, “Education is still low.”
What’s
more, in Cambodia, detecting cervical cancer at an early stage is not always a
victory in itself. Even with a diagnosis, many women lack the financial means
to pursue treatment options, Sovannara said.
“They
decide to take the traditional medicine,” she said.Most women with diagnoses,
she added, “are from the provinces”. Currently, however, both primary national
hospitals in the country offering oncology treatment – Calmette Hospital and
Khmer-Soviet Friendship Hospital – are located in Phnom Penh.
Why the high rates?
Dr Eav
Sokha, head of the Onco-Hematology department at Calmette Hospital, said there
are several factors contributing to the high rate of cervical cancer in the
Kingdom.
For
starters, there’s no HPV vaccine in the national immunisation program; pap
smear screening, which has drastically curbed cervical cancer in developed
countries, is not well established in Cambodia; and cultural norms often
prevent women from speaking up or seeking treatment if they don’t have any
symptoms, Sokha explained.
According
to Sokha, Cambodian women are also often unfamiliar with preventative measures,
such as not smoking, using protection when sexually active, limiting the number
of sexual partners and practising proper hygiene.
For
example, he added, he once met women in Kampong Chhnang who, during
menstruation, used dirty pieces of fabric as a substitute for sanitary pads.
“The young girls are now being educated, but there’s still the traditional
ways,” Sokha said.
One
notable difference in Cambodia is that women suffering from cervical cancer are
younger compared to patients in other countries, said professor Kouy Samnang,
chief of oncology services at the Khmer-Soviet Friendship Hospital. While the
culprit behind the phenomenon remains unknown, Samnang suggested early marriage
could be a factor.
“We need
to do a research study,” he said. “It’s in the vision of the hospital and the
department to do the study.”
Alternative options
While
there are several screening methods for cervical cancer, medical professionals
have come to learn that a visual inspection with acetic acid, known as VIA, is
both affordable and effective, said Dr Khin Sam Ath, with WHO Cambodia.
There are
currently pilot projects for screening and treating cervical cancer in the
provinces, Sam Ath said, but treatment remains concentrated at the district
hospital level.
Under the
pilot programs, women get a VIA screening at local health centres, but must be
referred to a district hospital for cryotherapy treatment, Ath said.
While
cryotherapy, which destroys abnormal tissue by freezing it, is performed in
some countries by nurses, Cambodian nurses and midwifes at the health-centre
level are not trained in the use of the equipment.
According
to Sam Ath, local treatment would be ideal, as those referred to district
hospitals might not follow up.
WHO
Cambodia is supporting the development of the national action plan for
prevention and control of cervical cancer, which would include primary
prevention – such as the HPV vaccination for girls 9 to 13 years old – and
secondary prevention – such as the VIA. Officials hope to have a draft
completed this year.
HPV
vaccination can help prevent 70 per cent of cervical cancer cases, Ath said,
while VIA screenings can theoretically catch the other 30 per cent.
“If the
country starts providing primary prevention and secondary prevention today, we
will see the results in the next 20 years, almost 100 per cent of women can be
prevented from [having] cervical cancer,” Sam Ath said.
Rob
Kelly, spokesman for pro-vaccine non-profit GAVI, said the organisation will
provide just over $500,000 to support Cambodia’s two-year HPV pilot program.
During that period, the country will receive more than 60,000 doses of HPV
vaccine for use in two selected provinces – Kampong Thom and Svay Rieng.
Dr Chhun
Loun of the Ministry of Health confirmed that the ministry would be cooperating
with GAVI to roll out the program. Other ministry officials did not return
numerous calls seeking comment for this story.
A plan of attack
The
availability of treatment options for those already diagnosed with cervical
cancer remains limited, though may soon start to change.
Sokha,
Calmette’s head of onco-hematology, said by next year, Cambodia’s first
national cancer centre will be operational. It will offer sophisticated
treatment and medical procedures, such as nuclear medicine and bone marrow
transplants.
“These
are new technologies for Cambodia,” he said. “The government in Cambodia is
still very poor. Investment for health is still very low, compared to our
neighbours, but for this project, they made a great effort.”
The
International Atomic Energy Agency, Sokha said, will help with fellowships,
scholarships and training in hopes of developing the cancer centre into a
teaching facility. Cambodia needs “[to] produce our own oncologists,” he said.
Two more
regional cancer centres are planned to be built by 2025, Sokha said, with the
centre in Phnom Penh to cover about 60 per cent of the population, another in
Siem Reap to cover 30 per cent, and a third in Kratie to cover 10 per cent.
“The aim
is to create a triangle for a national cancer centre network,” he said, adding,
however, that he wasn’t sure if the plan could be completed by 2025.
Khmer-Soviet
Friendship Hospital alone gets about 350 cervical cancer cases a year, said
Samnang, the oncology chief, and 60 per cent of those are already at an
advanced stage.
On
Wednesday afternoon, Phoung Sokhom, 38, from Kandal, was waiting in
Khmer-Soviet’s radiation department.
Sokhom
was diagnosed with stage-2 cervical cancer in February of 2015, and was scheduled
yesterday to go in for her 28th day of radiation and chemotherapy, the last of
her treatment.
Seated in
the waiting room, Sokhom closed her eyes and slowly reopened them. “I don’t
have much hope,” she said. Sokhom, who had already paid more than $1,000 for
her 28 days of radiation, said that her condition may require surgery or more
treatment, but she doesn’t have the money to pay for it.
“I’m not
sure yet,” she said of what might happen next.
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