Why cervical cancer screening matters even when you feel healthy

Jennifer Munai felt well when she walked into hospital for a cancer screening test in 2014. She had no symptoms and no reason to suspect she had cancer.

Initially, she had gone for breast cancer screening before deciding to have a Pap smear.

Her decision followed vigorous awareness campaigns and a conversation with a colleague who had undergone surgery to remove her uterus after it was found to be cancerous. That decision changed her life.

A doctor called her over the weekend with news she had never imagined receiving: she had cervical cancer at Stage 2B.

“I had no symptoms and would never imagine I had cancer. The news was shocking,” recalls the teacher.

The diagnosis left the mother of three stunned. She struggled to understand what was happening, feeling as though the world around her had come to an end.

“I was lost. It felt like the world was not there,” says Munai.

She had heard of people dying from the disease and knew of only one woman, a nurse, who had reportedly survived it.

But Munai resolved to remain positive and face treatment, even as she struggled to come to terms with the diagnosis. She chose to face the first battle quietly, sharing the news only with her husband.

She did not tell her mother or siblings, fearing the news would cause them pain when she was still trying to process it herself.

The gynaecologist who diagnosed her referred her to Nairobi for further tests and treatment. Her treatment involved five sessions of chemotherapy alongside radiotherapy.

She later underwent three sessions of brachytherapy, an internal form of radiation treatment used to treat cervical cancer. For about three months, her life revolved around hospital visits.

Throughout this period, she kept her children in the dark about her diagnosis, trying to protect them from the fear and uncertainty she was experiencing.

Months later, an MRI scan brought encouraging news: no residual disease was detected. After the financial and emotional strain of treatment, Munai began imagining life beyond cancer.

However, she still needed regular medical follow-up and continued undergoing MRI scans every three months.

The results were reassuring until a scan conducted in 2017 revealed a new growth. The cancer had returned.

Munai had endured treatment, struggled through its effects and received reassuring results, only to find herself confronting the disease again.

During her first treatment, she had read extensively about cervical cancer and knew it could recur.

“I felt so devastated. I thought it had come to swallow me,” she says.

This time, she opted for surgery to remove her uterus, cervix and ovaries.

“I did not have the strength to fight it through treatment, but I had three children, and I told doctors to remove my cervix and uterus,” she says.

A doctor had given her a grave prognosis of 90 days, but she did not want to wait.

After surgery, she underwent six cycles of chemotherapy, with each cycle administered every three weeks.

Recovery was difficult. She spent three weeks in a wheelchair, while chemotherapy brought severe side effects, including nausea, vomiting and diarrhoea.

She also developed peripheral neuropathy, a form of nerve damage that can cause numbness, tingling and pain. To date, she wears sports shoes because of the nerve problems.

In March 2018, a PET scan brought the news she had been hoping for: “no evidence of disease was detected”.

Once again, she had come through cancer treatment.

Munai now says surviving cervical cancer was not simply about getting through treatment; it was also about learning to live with the uncertainty that the disease could return.

She decided to use her experience to help other women avoid a similar ordeal. She established the Jennifer Cancer Foundation to raise awareness about cancer and encourage communities to embrace prevention and early detection.

Through partnerships, the foundation conducts community sensitisation activities, bringing together health professionals, including oncologists, doctors, nurses, laboratory technicians and counsellors.

Those found to have cancer are linked to treatment, while parents are encouraged to have their daughters vaccinated against the human papillomavirus (HPV), which causes most cervical cancers.

As a teacher, she is particularly concerned about the next generation.

“In future, I do not want to see my students suffer cervical cancer when they can get the HPV vaccine to prevent it. I encourage parents to have their girls take the vaccine,” she says.

Data from the National Cancer Institute of Kenya show that cervical cancer is the second most common cancer among women in the country, with at least nine women dying from the disease each day.

The high number of cases and deaths persists despite cervical cancer being largely preventable through HPV vaccination and screening.

Consultant clinical and radiation oncologist Dr Catherine Nyongesa says early cervical cancer and precancerous changes often develop without symptoms.

By the time warning signs appear, the disease may already be advanced.

“A woman can have early cancer or pre-cancer and feel well,” says Nyongesa, founder of Texas Cancer Centre.

“That is why screening is so important, not waiting for symptoms.”

She says women should seek medical attention if they experience abnormal vaginal bleeding between periods, after sex or after menopause; unusually heavy or prolonged periods; foul-smelling or bloody vaginal discharge; or pain during sex.

Other warning signs include persistent pelvic pain, pain or bleeding when passing urine or stool, unexplained weight loss and leg swelling.

“Screening of cervical cancer should not be left to chance,” says the specialist, who is also head of the cancer unit at Kenyatta National Hospital (KNH).

More than 70 per cent of cervical cancers are caused by persistent infection with high-risk HPV, particularly types 16 and 18, she explains. HPV is a common virus spread mainly through sexual contact.

Most infections clear naturally, but some persist for years and cause changes in the cells of the cervix. If these changes are not detected and treated, they can progress to cancer.

Other factors associated with an increased risk of cervical cancer include HIV, smoking and weakened immunity.

Dr Nyongesa says women living with HIV require more frequent screening.

Treatment, she adds, depends on the stage of the disease and the woman’s circumstances. For early-stage cancer, options may include surgery to remove a cone-shaped section of the cervix, removal of the uterus or, in selected cases, procedures that preserve fertility.

For locally advanced disease, including Stage 2B, treatment commonly involves chemotherapy and radiotherapy given together, followed by internal radiation treatment where indicated.

Women whose cancer has spread may require chemotherapy, targeted therapy, immunotherapy or palliative care to manage symptoms, depending on the extent of the disease and available treatment options.

The removal of the ovaries is not necessary in every case. For some younger women with early-stage disease, doctors may be able to preserve them. The decision depends on the cancer type, stage and risk of spread.

Citing Munai’s experience, Nyongesa says the return of cancer after several years meant confronting difficult decisions about treatment and survival.

Recurrence, she observes, requires careful assessment to establish where the cancer has returned and whether it has spread.

In selected cases where the disease is confined to the central pelvis, major surgery may offer a chance of cure.

If it has spread beyond the pelvis, surgery alone may not be sufficient.

The oncologist also recognises that fear, financial hardship and the prospect of a cancer diagnosis can keep women from seeking screening or treatment.

But she warns that poverty should not determine whether a woman receives care.

In Kenya, HPV vaccination is recommended for girls aged nine to 14, alongside screening for eligible women. The Ministry of Health has been working with the Rotary Club to step up efforts to increase cervical cancer screening, promote HPV vaccination and help women access early treatment.

The club is working with Kalebi Labs to promote portable diagnostic tests and self-sampling options that could encourage more women to get screened.

“Women are mostly scared of Pap smears because they are so invasive. With the self-testing option, we are getting more women undertaking the tests,” says Ruth Munyi, immediate former president of the Rotary Club of Thika.

So far, at least 100 women have undergone Pap smear screening. The initiative is also raising awareness in communities and promoting HPV vaccination in schools.