Self-care could break barriers to cancer screening
By PD columnist, October 19, 2022Self-care is not a new term or concept. It has become a word used to promote caring for oneself, especially where mental health is concerned.
But self-care is much more than that and has to do with holistic personal health.
For instance, an activity as ubiquitous as brushing teeth serves as an illustrative example of a daily self-care activity in which individuals are in control of their dental health. Going deeper, an intervention such as a pregnancy test, which previously was only available through facility-based healthcare providers but can now be accessed and used at home, is another good example.
According to the World Health Organisation (WHO), self-care is “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider.” Individuals choose a self-care health intervention plan for many reasons including convenience, cost, empowerment and a better fit with values or lifestyle. Proven efficacy and endorsement by a health provider or health system may be another reason to choose self-care interventions. Self-care interventions have the potential to increase choice and can also provide more opportunities for women to make informed decisions regarding cervical cancer.
Cervical cancer is the leading cause of all cancer-related deaths and the second most common cancer among females in Kenya, according to 2020 GLOBOCAN, an online database providing global cancer statistics and estimates of incidence and mortality in 185 countries for 36 types of cancer. This, however, should not be the case as cervical cancer is totally preventable if detected early through high-risk Human Papillomavirus screening tests.
The persistence of the infection, caused by one or several of the so-called high-risk Human Papillomavirus varieties associated with behavioural or person-related cofactors, is necessary for cervical cancer to develop. These small DNA viruses are resistant and highly contagious. Over 80 per cent of men and women are infected at some time in their sexual life. The infection is usually quickly self-limiting, but for a small percentage, the virus persists in the cervix leading to cellular changes in the cervical cells that progresses over five-15 years to become cancerous eventually manifesting as cervical cancer.
In 2020, WHO launched a global strategy to accelerate the elimination of cervical cancer with the primary prevention target being to vaccinate 90 per cent of eligible girls against HPV. Reaching more women who have never been screened, including women living with HIV, who have a higher risk of HPV infection and cervical cancer, is therefore critical.
High-risk Human Papillomavirus (hrHPV) testing is a relatively new, reasonably accurate method of secondary cervical cancer prevention recommended by WHO and the Ministry of Health. WHO’s latest guidelines on cervical cancer screening suggest HPV self-sampling should be made available as an additional approach to sampling in cervical cancer screening services.
The capacity and ability of an individual to make informed health decisions and make use of available health resources is an important component of the effective prevention and management of a health condition. Self-care is among the most promising and exciting new approaches to improving health and well-being utilising interventions that were previously available only through facility-based healthcare providers.
Cervical cancer screening has the potential to transition to self-care with the availability of HPV self-sampling and empower women to prevent cancer themselves, in the context of a safe and supportive enabling environment. HPV self-sampling does not replace the health care system, but provides additional choices and options for health care.
— The writer is the Chief Consultant Pathologist at Pathologists Lancet Kenya