Home > Health > Cervical Cancer Prevention in Nepal, by Dr David Nunns

A One-Stop Service for Screening and Treatment

Dr David Nunns is a Trustee of PHASE and Consultant Gynaecological Oncologist at Nottingham University Hospitals.

“Cervical cancer is a major cause of death in Nepal. Soon the global death rates from the disease will exceed that of maternal mortality.  Although the disease is one of the world’s deadliest – it is also one of the most preventable forms of cancer in women, cervical cancer is responsible for more than 270,000 deaths annually and 85% of these occur in developing countries. Treatment of precancerous disease can be treated simply and this saves lives – PHASE are supporting government organisations, Nepali doctors and local NGOs in Nepal to provide screening camps and simple treatment solutions so that women don’t die unnecessarily. 

On my most recent trip to Nepal in November I was pleased to present a thermocoagulator machine to Dr Mita Singh who is a gynaecologist working in Nepal, Radha Pyari Nakarmi from the Nepal Network for Cancer Treatment and Research and Amala Dave Manandha, the assistant programme officer for Nepal Australian Cervical Cancer Foundation.

David Nunns with the team in Nepal

Using this machine PHASE is pioneering a different approach to the treatment of cervical cancer in partnership with the Nepal Network for Cancer Treatment and Research (NNCTR).  The thermocoagulator is important as it enables simple, effective treatment of precancerous cells of the cervix. Previously when women who came along to be screened at camps needed additional treatment they had to travel to Kathmandu or a larger district centre but the thermocoagulator can provide treatment at the camps in a simple single visit.  This type of screening and treatment will result in more women being treated and a reduction in the number of deaths from cervical cancer in Nepal. An approach like this has not previously been used in Nepal.

This is approach is part on an ongoing programme to reduce deaths from cervical cancer in Nepal.  Over the last seven years PHASE has supported our local partners NNCTR to carry out hands-on workshops, exchange visits with UK hospitals, nurse training, screening camps, training for pathologists and biomedical scientists andquality assurance – ensuring the right patients are being treated. There are fully operational colposcopy clinics in the hospitals we work with thanks to this programme of work.

How we prevent cervical cancer

The cervix is situated between the vagina and the womb. A virus called the Human Papilloma Virus is common in the cervix, and this can lead to precancerous changes in a small number of women.  A proportion of these women can then develop cancer of the cervix. The good news is that the natural progress of the disease, from infection to the development of cancer can take years, making detection and treatment of precancerous cells possible. Lives can be saved through cervical screening. However, for screening programmes to be successful, access to regular screening and colposcopy (treatment of women who screen positive) is needed.

Many communities in Nepal live in very remote villages, making it difficult to screen and treat women. Women in remote areas struggle to access health centres that offer cervical screening and if treatment is required women have to travel to the nearest hospital. This can often take days and sometimes weeks and many women in isolated regions feel that they cannot not afford this amount of time away from their children or farm, or cannot cover the costs associated with the journey. This results in many deaths from the disease.

PHASE together with NNCTR are running camps in remote areas to reduce the impact of this.    Firstly, a screening test called Visual Inspection with Acetic Acid (VIA) (the western equivalent is called the cervical ‘pap’ smear) is carried out by health workers, this simple test can detect precancerous cells. The results from this test are available immediately.  5% of those screened require a colposcopy, a minor procedure which lasts around 10 minutes. During this procedure the cervix is viewed at high magnification by a trained health worker (doctor or nurse) and, in our new approach, treatment will be given at the same time using the thermocoagulator. This is known as the ‘Single-Visit-Approach’ and means that women do not have to wait for treatment. Treatment with a thermocoagulator is safe and effective and requires minimal health professional training, unlike other methods.

During each camp PHASE and NNCTR aim to screen 1000 women over 5 days. Approximately 50 women will screen positive and require a colposcopy and around 10-20 require treatment which could potentially prevent cervical cancer development.

The delivery of this work relies on governmental support, committed teams and close working between the all the stakeholders such as women’s groups, community leaders and screening groups – it is a long term approach to an important women’s health issue.  To fund this work PHASE have received support from the British Society for Colposcopy and Cervical Pathology and the Tropical Health and Education Trust under the Health Partnership Scheme provided by the UK Department for International Development.  I received a letter from Justine Greening the UK Secretary of State in December 2014 thanking our partnership for improving health outcomes in some of the poorest parts of the world – it is great that this work has been recognised by the UK government.  We are also supported by a network of UK gynaecologists who visit Nepal, provide technical advice and support the project financially.  We would like to thank all these groups for their ongoing support.”