Nigeria walks a tightrope as far as meeting the 2030 cervical cancer elimination target is concerned. With significant gaps and the absence of a structured screening programme for at-risk women, concerns are mounting that the epidemic may not be contained until 2120 if HPV vaccination is not scaled up alongside increased cervical screening and treatment, IJEOMA NWANOSIKE reports.
The absence of systemic cervical cancer screening centres in Nigeria may have stalled the country’s ambition of screening 70 per cent of its women, and girls and eliminating the cervical cancer epidemic by 2030.
Findings by The Guardian showed that there are no designated centres for screenings; instead, occasional screenings are organised by non-governmental organisations (NGOs) like Rotaract, Lions Clubs, and others, with a target of barely five years.
The Guardian also found out that, aside from private diagnostic centres, cervical cancer tests are mainly available in public tertiary hospitals. Human Papillomavirus (HPV) tests cost an average of N30,000. Additional tests, such as the Pap smear, may be required at an average cost of N5,000.
Meanwhile, the age distribution data from Statista shows that approximately 17.2 per cent of Nigeria’s population, equivalent to about 40.6 million women, falls within the 25 to 64-year-old age bracket, the key demographic that requires screening.
To meet the 70 per cent target, Nigeria needs to screen at least 28.4 million of this group of women.
A survey by The Guardian of this demographic found that, on average, only one out of every 25 women had been screened at least once in their lifetime through NGO-organisedprogrammes. Further investigation revealed that many women, especially those in remote areas, face significant challenges in accessing cervical cancer screening.
The survey also found that over 55 per cent of women who attempt to get screened independently often encounter financial constraints or are discouraged by cost and long distances to the nearest tertiary hospital, which remains a major barrier to access.
While the federal government launched the HPV vaccine rollout in 2023 for girls under 15, the elimination programme has not adequately addressed the screening and treatment of cervical cancer.
The National Primary Healthcare Development Agency (NPHCDA) reported an 89 per cent vaccination rate by the end of 2024, yet a randomisedGuardian survey in Lagos, Ogun, and Bayelsa states found that only three in every 12 eligible children had been vaccinated with most parents citing concerns over vaccine safety, or a lack of information on where to get children vaccinated.
Schools visited also reported that less than 25 per cent of the age group got parental approval for the vaccination.
However, available reports indicate that 13 million girls have received the vaccine so far, with little or no information on screening and treatment, which are both crucial for the country to meet the World Health Organisation (WHO) target by 2030.
The WHO global strategy to eliminate cervical cancer as a public health problem by 2030 requires countries to vaccinate 90 per cent of women and girls with the HPV vaccine, attain 70 per cent of cancer screening, and have 90 per cent of women and girls with cancer on treatment.
The Elimination Planning Tool (EPT) for Nigeria, developed by the International Partnership for Resilience in Cancer Systems (I-PaRCS), in collaboration with the International Agency for Research on Cancer (IARC), warned that cervical cancer would not be eliminated until 2120 unless HPV vaccination is scaled up alongside increased cervical screening and treatment.
They also highlighted that the healthcare system is inadequate to provide timely treatment for 90 per cent of women diagnosed with cervical disease.
Cervical cancer screening is a medical test, either a Pap smear and/or HPV Test, used to detect abnormal changes in the cervix that could develop into cancer.
According to the WHO, this cancer became the second most common cancer among Nigerian women after breast cancer, despite its preventable nature. Nigeria recorded about 12,000 new cases, which led to over 8,000 deaths in 2020.
It is caused by persistent infection of the cervix with the human papillomavirus (HPV), which when left untreated, causes 95 per cent of cervical cancers. HPV is a common sexually transmitted infection, which can affect the skin, genital area, and throat.
The WHO report explained that almost all sexually active people would be infected at some point in their lives, usually without symptoms. While the immune system clears HPV from the body in most cases, persistent infection with high-risk HPV can cause abnormal cells to develop, which go on to become cancer.
Experts noted that even though some progress has been made, expanding screening and treatment services remains critical in ensuring that Nigeria meets the 2030 cervical cancer elimination target.
The Executive Director of End Cervical Cancer Nigeria Initiative, Dr Ishaq Lawal, in an interview with The Guardian, warned that the unavailability of screening centres in the country could hinder the country’s ability to meet the global target for cervical cancer elimination by 2030.
Speaking on cervical cancer prevention efforts, Lawal, who also heads the Department of Obstetrics and Gynaecology at the Federal Teaching Hospital, Birnin-Kebbi, acknowledged the government’s efforts in vaccination, but stressed that without accessible screening centres, Nigeria might fall short of its goal.
“The government is doing a lot on the vaccination front, but the absence of screening centres would likely make Nigeria miss the target,” he said.
Lawal emphasised that screening alone was not enough, adding that women are often discouraged when they test positive but are referred to hospitals where they have to pay significant amounts for treatment.
“Screening without treatment should be discouraged. If a woman goes for screening, tests positive, and is immediately placed on the right treatment at little to no cost, she will understand that she has just been saved. When she gets home, she will become an advocate, encouraging others to get screened and treated,” he explained.
Lawal highlighted the need for dedicated screening centres, noting that the current system forces women who want to get themselves checked out to go through the same hospital process as sick patients, which can take longer waiting periods, often discouraging them from following through.
He further stated that awareness efforts must be matched with access to screening availability, arguing that informing people about the need to go for the test without providing accessible facilities renders awareness campaigns ineffective.
He called on the government to ensure free and accessible cervical cancer screening in all 774 local councils, as well as free treatment for pre-invasive lesions or pre-cancerous developments, stressing that early treatment is significantly more affordable than managing invasive cancer.
“The worst case of a pre-invasive lesion can be treated for about N50,000, but treating invasive cancer costs nearly N500,000. So, the government should ensure that free screening and pre-invasive lesion treatment services are available in all 774 local councils,” he urged.
Echoing similar sentiments, a Professor of Obstetrics &Gynaecology and a Consultant Gynaecological Oncologist at the University College Hospital, Ibadan, Akinyinka Omigbodun, expressed concern over the absence of a systematic cervical cancer screening programme in the country.
He explained that current methods, such as sentinel and opportunistic screenings, are inadequate to reach the 70 per cent needed for effective prevention.
He also highlighted that the healthcare system is not equipped to promptly treat 90 per cent of women diagnosed with cervical disease, allowing it to progress to full-blown cancer.
“There is no systematic screening programme for women who are at risk. What we have are sentinel and opportunistic screening. These will be insufficient to reach the 70 per cent of the female adult population that needs to be reached to get the desired population effect. Finally, the health system is not sufficiently developed to treat the 90 per cent of women who are found to have cervical disease promptly. Without this, the cervical disease will develop into full-blown cancer,” he said.
Speaking on the prevalence of the disease, Omigbodun told The Guardian that around 1,100 Nigerian women are diagnosed with cervical cancer each month, and more than two-thirds of them will not survive beyond five years largely because most present with advanced stages of the disease. The gynaecologist explained that the significant delays in diagnosis and treatment are often caused by ignorance and fatalism within the population as many women initially seek treatment from traditional healers or patent medicine dealers before eventually presenting to formal healthcare services.
“For those who present with early disease, the proportion that gets effective treatment needs to be increased by ensuring that radiation treatment facilities in the country are kept in a state where they are ready to treat patients. Right now, many of them break down frequently, and repairs are often delayed for many reasons. Hence, many patients do not get the full treatment that they need, or get no treatment at all,” he noted.
He also noted that women who begin sexual activity at an early age, have multiple sexual partners, or experience early pregnancy are more vulnerable to the HPV virus.
A Director of Research at the Nigerian Institute of Medical Research (NIMR), Prof. Oliver Ezechi, warned that certain behaviours, such as oral sex, the use of sex toys without proper hygiene, and the use of herbal sexual concoctions, may indirectly contribute to the development of cervical cancer.
According to him, while persistent infection with high-risk HPV types is the primary cause of cervical cancer, certain sexual practices could increase the risk of infections that might lead to HPV persistence and, consequently, cancer.
To enhance the country’s approach to elimination, Ezechi called for more public awareness campaigns to emphasise the importance of regular screening and vaccination, as well as the training of healthcare providers to better detect and manage cervical cancer in its early stages.
A Consultant Clinical and Radiation Oncologist and Head of the Brachytherapy Unit at NSIA-LUTH Cancer Centre, DrBolanle Adegboyega, pointed out that cervical cancer, although the second most common cancer in Nigeria, following breast cancer, is particularly prevalent in the northern part of the country, where it can even surpass breast cancer in frequency.
According to her, in some developed nations, the incidence of the disease has drastically reduced, with some countries implementing policies where women are given a paid day off each year for medical check-ups, including cervical screenings.
The oncologist suggested that Nigeria could adopt similar measures to reduce the prevalence of cervical cancer, calling for such policies to be considered for legislation by the National Assembly.
