 Good evening and thank you for joining us on Y254 News Updates and tonight we talk matters health. We are going to be talking about cervical cancer treatment and management. We seek to understand what really is the HPV, which is the human papilloma virus all about. We try to look at the risk factors of cervical cancer. We try to look at treatment screening. That is how often as a woman should you go for screening for cervical cancer. We are also going to talk about getting checked for other cancer diseases that are there. To help us talk about this topic tonight we have Benda Enkidaka, who is a co-founder for Women for Cancer. She is going to be talking about everything about cervical cancer tonight. So please if you want to be part of this conversation share your views and comments on all our social media platforms. That is on Y254 channel and you can also reach me at Patricia Moriuki. As we start off the broadcast or like us to start off with some statistics, we are globally cervical cancer ranks in both incidents and cancer related deaths among women with an estimated of 569,847 new cases and 311,365 deaths annually. It accounts for that 10.1% of all new female cancers globally. In Eastern Africa alone we have cervical cancer remains the most common cancer in women with estimated age, standardized incidence and mortality rates of 40.1 and 30.1 per 100,000 respectively. And then in Kenya we have currently Kenya is ranked top 20 countries with the highest rates of cervical cancer in women of reproductive age. The country also has the highest number of cancer related deaths across East Africa with cervical cancer accounting for 3,286 deaths annually which is a very sad story but today we are talking about cervical cancer which is a disease that can be prevented and it can also be treated. So Benda thank you very much for finding the time to join us on Y254. I'm sure this is a topic that is going to inform and educate a lot of young girls and also young men watching tonight. So thank you very much. Welcome. As we start off our leg first to ask you what inspired you to start or to be an advocate for cancer and why did you start the women for cancer? So that's an interesting question you should ask me. Each one of us sometimes is faced with a life changing decision and when that happens then you have to decide what you want to do with that. For me in 2010 I was in corporate Kenya. I was working in corporate marketing and being a communication person at that time I was faced with the decision where my younger sister was going through a cancer diagnosis and it was in cancer. It was pre cancer of the cervix. I knew very little about cervical cancer let alone pre cancer and at that time I knew if I don't know and I'm fairly well educated and I'm working in corporate Kenya and I don't know how many women out there don't know. So that's where my journey started. Since then I met women who are equally as passionate in different fields and we got to talking and decided that this is the one cancer that we can do something about. When we started there were 2,500 cases of cervical cancer annually and about 1,500 dying every year. By today we are talking about the 5,200 women being discovered early and another 3,000 dying 3,286. So in our advocacy work one of the things that we've categorically called on women to do is go get screened early and also policy advocacy to ensure that we can get the preventative measures as early as possible so that we can prevent this disease that's preventable. And my inspiration is knowing since when we started when many women were not going out and that's why the numbers were so low that we have more women coming out now. We also have the vaccine that was launched and therefore we know we are on the right path towards early detection and towards prevention for our girls. Okay, I've heard you. You've actually mentioned that if probably did not happen to your younger sister you would not have the interest to want to know what cervical cancer was all about. So for people watching us tonight would you tell us what is cervical cancer? Cervical cancer is a disease that affects women because women have cervixes. It's a disease that affects the opening of the uterus which is the door to the womb. And the cervix being as women are the ones who have the cervix it affects women and takes a period of time, a disease that develops over a period of time caused by a virus called HPV, human papillomavirus, which is caused by persistent infection with the high risk HPV. Now that sounds like a lot of technical jagon, but if I can simplify it human papillomavirus has been found to be the cause of cervical cancer. Cervical cancer takes time 5 to 20 years before it develops. We have pre-stages of the cancer which is called the pre-cancer where the cells are changing with continuous persistent infection of the human papillomavirus and in that period if caught early it is treatable. So when somebody asks me what is cervical cancer I like to say it's the one cancer that gives us time to act. Before we talk about the HPV that is a human papillomavirus I would like us to talk about what are the risk factors because when we talk about the courses we know the course is HPV and what are the risk factors for cervical cancer? Okay and the very first risk factor is that you're a woman. If you're a woman chances are you will get cervical cancer by virtue of having a cervix. The second one is persistent infection with HPV, high risk. If I can explain that a little bit HPV, human papillomavirus there are so many strains of 150 different types of HPV to have been proven to be the risk factors for cervical cancer that strain 16 and 18. I didn't know that before I got into this field and knowing that it is so common anyone who has had any intercourse has caught it at one point or another and if you have caught HPV and you don't know which one it is 16 or 18 therefore we can't tell who is at risk or who is ignored at risk and that's why we say screening is imperative so that we can be able to catch early before it develops into cervical cancer and there are even modernities now of knowing which HPV type it is between 100 and 1 to 150 16 and 18 being the ones that cause cervical cancer we are able to tell. The other risk factor is multiple sexual partners HPV is sexually transmitted the more the number of partners the higher the chances that someone is picking as many from out there and this is not just about women this is also relating to men when men have multiple sexual partners and then they bring them back because once they have engaged with someone chances are they will bring that virus back home also prevalent on both men and women and so multiple sexual partners is yet another and the age of sexual debut the younger the girl the more at risk she is of developing cervical cancer because then there will be more HPV in the system for a longer period of time and the body also the mechanism for fighting for itself which is why we say if we want to stop cervical cancer we then need to be aware that we first of all keep to faithfulness secondly get screen so that we know as early as possible when the cell changes are happening and thirdly is a woman just be self aware because as a woman you are at risk of cervical cancer Do you think there is enough awareness on the vaccine because the HPV vaccine can only be administered to maybe girls of the age of 10 Do you think we have enough awareness does a mother today in Turkana in the rural areas of this country know that there is a vaccine for cervical cancer do they know that? So it's a work in progress the vaccine was introduced in Kenya in 2019 October and before then we had engaged in various campaigns together with the Ministry of Health and other partners to be able to educate communities around HPV vaccination and cervical cancer prevention the key messages to get out there is that HPV vaccine is safe and it's also effective and has been tested and tried across the globe with over 115 countries having started HPV vaccination programs it is proven to prevent cervical cancer and therefore when we are introducing it now that it is locally available for all health facilities we men ought to take their daughters men ought to take their daughters who are eligible in Kenya for public health reasons the vaccine is being given to 10-year-old girls and therefore mothers of 10-year-old girls and fathers of 10-year-old girls and caregivers children who live with their grandmothers or live with their other relatives they ought to be taken for this vaccine it's free of charge nobody is being charged for it maybe someone 16 or 18 or 20 if all we are talking about is there is something here that can help us counter attack these diseases why can't this vaccine be administered to a young lady who is 18 or 19 or 20 okay so globally and this is good information for people to know out there globally the vaccine is available for girls ages 9 to 14 and ages so 2 doses and ages 15 to 26 they can get what is known as a booster vaccine 3 doses globally in Kenya we are administering to ages 10 because that's the routine immunization program with the Ministry of Health if a mother out there wants to protect their daughter who is older and they are able to pay for this vaccine they will not be able to access it for free because there is public planning and vaccine doses have been provided for for the 10 year old girls but if a parent is able to do so for their children who is older and they ought to at the age of 14 to 18 if a girl has not been introduced at 26 if a girl has not been introduced to HPV they ought to be vaccinated but because the government is not providing for that right now then somebody would need to pay for it if they are safe and effective I would like us to talk about screening that is where to be screened we get to talk about how our systems really promoting screening because I think sometimes you need to show up in a hospital and I have no idea that screening can help you and a nurse or a medical practitioner is going to encourage you to do so and also how often should screening be done okay so you raise some good points and I'll start with where is the screening being done according to the Ministry of Health all public health facilities ought to have screening for women who are eligible the ages that are being advocated for is ages 25 through to 49 this is available in facilities but you see so if this service is being delivered if women don't demand for it so from a health advocate perspective my sense is women need to be demanding for these services because our government should be providing this service to the women for the health of the population the government has gone ahead and launched last year the screening guidelines which standardize service across the country they have also rolled it out so for us to make it easier for our women to be screened it's the woman to present themselves and then get screened and if the service is not available let them then ask for that service the health care worker could come in and also give that service but you and I know our health care system is quite stretched between dealing with no issues no issues between dealing with non-communicable diseases diabetes, hypertension BMI weight having to deal with cancer and it's not just cervical cancer dealing with communicable diseases malaria we have TB so when the health care system is that strained and stretched and we don't have as many health care workers as can be the challenge is that the health care worker is dealing with the issue at hand not necessarily recommending the service that could prevent so there is a need for that paradigm shift for our health care system also to start recommending preventative health but again power to the people we keep saying the youth are the future of this country we forget the future is now and the future of health is protecting who is healthy to remain healthier and preventing that which is preventable for girls and young men to remain healthy and for that to happen we cannot wait 10 years from now to start telling them go get screened we need to sensitize now to start demanding for that service if they are eligible I would like to take something out here as is the case in many low and middle income countries most women are diagnosed in very advanced stages of the disease when treatment options are limited and it is very costly to treat as a result women in Kenya are 14 times more likely to die from cervical cancer than women in the United States we've talked about screaming I will walk in a facility a woman is going to walk in a facility get screened probably they have because I understand there is primary secondary in the tertiary that is the stages of cervical cancer when this woman now knows that I have cervical cancer probably they have no finances you find out maybe we don't have equipments whatever that is there is very expensive for these people to afford what do you think the ministry of health and the stakeholders can do to make sure that even as we talk about and preach about early screening and getting screened probably annually and all that we are not just pushing women to go and get screened and then when they know what they have a problem we cannot solve it I will take you back to 2010 when my sister was told she had cervical cancer and it was in cervical cancer it was pre-cancer at that time we were asking the same questions what if the cost of treatment is so high what if the chances of recovery are minimized what if what if what if we can never know until we have gone to the system the one thing that I have seen in this field is that technologies are evolving right now we have technologies to even screen for HPV risk type we are able to say you have HPV high risk and therefore you need to be observed further so that we can be able to diagnose way before the disease has kicked in we are able to tell the cervix is changing but right now we can treat it and the interventions are so cheap with 2500 shillings in the doctor's office they can be dealt with and they can be eliminated and in three months the woman has retained the fertility through a technology called thermoablation where the cells are burnt off and then clinically and then in three months the cells have regenerated but the cancerous cells the pre-cancerous cells have fallen off for this to happen women need to embrace that element of it's treatable if discovered early often with very minimal and with very little cost the misconception that treatment of cancer has to always be expensive is what is killing our people because then they are afraid to go because they are afraid of the cost they are afraid of what will it turn out to be yet majority could have been prevented if they were discovered early secondly we have NHIF and cover some of these procedures if only women presented early but somebody has to take charge and go and get screened one of the things that I have seen often when we go to medical outreaches and we tell someone we are seeing something changing there is always the fear but the moment we say these cell changes are such that we can arrest it early you will be treated the smile that comes on is that the woman is confident I am glad I came earlier because now we can deal with this we can't guarantee five years later it wouldn't be invasive cancer and so to go back to your question we find our women are found so late when the cost of treatment is high and the chances of recovery is very minimized it's because in Kenya and in African countries regrettably we don't follow the screening guidelines we don't have our women demanding for this service and our healthcare system does not call on them to go as early as possible in the US they are screened routinely and the standard is every five years somebody is screened if they go through HPV screening or if they do a pub smear or if they do a visual inspection every five years a woman should be screened if something is found they ought to be navigated to be treated referred to be treated if nothing is found there ought to be a follow up mechanism that five years later they are reminded to come for the second one and that's what we are working towards I hope you are going to manage to get there as a country so let's talk about treatment and management so how now do we treat what is the process of the treatment of cervical cancer before we can talk about treatment of cervical cancer because I'm hoping your viewership would be people who are at this point in time looking at preventative and people who would be looking at what do I need to do next I want to say this one, girls and women should not wait for signs and symptoms they should not wait for I want my body to tell me go get checked they should take it upon themselves we should all take it upon ourselves to go get screened as early as possible and the rule of the thumb is if you have been introduced to intercourse at the age of 21 for example or 24 for example 3 years after which you ought to go for your first screening don't wait until you are 35, 40, 45 go get screened it's a 15 minutes affair in the doctor's office it will take you 5 minutes to undress and I keep saying this and people think I'm juking 5 minutes to undress, 5 minutes to get dressed after 5 minutes to be checked and in that 5 minutes could determine the rest of your life if you are found early secondly, for those who are a bit advanced in age and probably are seeing signs and symptoms what to look out for we see women presenting with abnormal bleeding either in between periods or heavier bleeding than normal or women who have already reached menopause and they are bleeding that's not normal go get checked for women who get a discharge we all know our bodies clean themselves that's why we even wear this liners but for a discharge that's abnormal and that's smelly that you can feel flowing they ought to watch out for that but remember I said there are no signs and symptoms when it's early disease so they should not wait for these signs and symptoms lower back pain again severe lower back pain lower abdominal pain again it's your body screaming and saying something is not right don't wait for it go get checked why I said I don't want to concentrate so much on the treatment is because we cannot be able to cover the length of treatment options now but I can mention this at early pre cancer stages we have what is known as see and treat we see the cells as they are changing they are treated through cryotherapy or cryotherapy or tamoablation and in three months the cells have fallen off and in six months we can test again and we see that there is nothing going on there is brachy therapy which is introducing radiotherapy through the canal the bath canal and again this is targeted treatment for invasive cancer there is chemotherapy and radiotherapy and there is also what we call hysterectomy when the cells have started changing but it has not gone invasive around the other areas and therefore we can surgically remove the diseased part why I am saying go back to screening is because we need not wait for this by the time we are seeing science and symptoms we are seeing invasive disease when we could have stopped it way before it started at pre cancer level and when we could have stopped it for the young girl at the vaccination level when the body is building its own immunity we focus on prevention for cervical cancer as opposed to so much of treatment actually we are running out of time but what do you think is the role of the society what is the role of what now can the society come and contribute in making sure that as we fight cervical cancer we not only get to fight it for people who are either infected or affected even for someone probably who has not had a relative cervical cancer but they can understand that we are doing this together to fight these menans so with cancer the first part of call is awareness as a community we need to be aware that cancer is not a death sentence and therefore the stigma that accompanies a cancer diagnosis the fear that accompanies a dimension of the word cancer we need to demystify that we need to demystify that all cancer skill no we need to talk about prevention some cancers are preventable cervical cancer is one of them it has a vaccine liver cancer is also vaccinatable people don't know this hepatitis B is a vaccine HPV vaccine is a vaccine to prevent cancer people need to be aware of this screening for early detection when we can downstage the disease and get it treated earlier more effectively it's important then we go to treatment and again different treatment for different stages of cancer which often can result to better quality of life or even better treatment options and sometimes 100% cure people need to take charge and it's not just about the woman the man in recommending that the woman gets screened the man in having fewer no, actually remaining faithful the man recommending the vaccine to their daughter the community the church community talking about it at the pulpit talking about prevention the community itself attending public health facilities and also attending community awareness and education so that we can know how to beat cancer early each one of us has a role to play and for the younger generation you are the ones who can guarantee us a cancer free society a cervical cancer free society you are healthy and you have the mechanism to prevent for yourselves help make this job easier by preventing as we close up maybe you could share platforms for the view of social media platforms for the women for cancer just in case someone has watched us tonight at women for cancer women and then digit 4 cancer at benda k2 at kenko network that's the larger network of cancer organizations all these are on my social hurdle and I can be able to do so let's keep the conversation going let's prevent cervical cancer it's doable thank you very much benda for finding the time to talk about it I'm sure people have learned something because honestly I have learned something I take home today and I'll make sure that my friends and my siblings also understand that so if you've watched us tonight you're a young lady, you're a young man you're a father, you're a mother make sure that if you're a father may you motivate your daughters your partner to go and get screened if you're a young girl you should not wait any longer as you've heard from benda don't wait to be 35 my name is patricia budyoki thank you