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Ajah LO. Colposcopy and its challenges in Nigeria. Ann Trop Med Public Health 2016;9:379-80
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Ajah LO. Colposcopy and its challenges in Nigeria. Ann Trop Med Public Health [serial online] 2016 [cited 2017 Nov 14];9:379-80. Available from: https://www.atmph.org/text.asp?2016/9/6/379/193936
Cervical cancer is responsible for the death of many women globally and it is estimated that about 80% or more of the world burden of cervical cancer is in the developing countries., About 50.33 million Nigerian women are at risk of cervical cancer and the crude incidence rate per 100,000 population is 17.1 while the age standardized incidence per 100,000 population is 29.0. The annual number of cervical cancer cases in Nigeria is 14,089 and the annual number of cervical cancer deaths is 8,240. This is a major public health challenge and the number may increase if the effort toward its reduction is not put in place. The high cervical cancer burden in our environment has been ascribed to ignorance, lack of resources, and unavailability of nationally organized screening programs.
Colposcopy is one of the cervical cancer screening procedures aimed at early detection and treatment of cervical epithelial abnormalities. A colposcope is a binocular microscope used for direct visualization of the cervical, vaginal, vulval, and anal epithelia. It was produced by Hans Hinselmann, a German gynecologist, in 1925. Since then, it has undergone some modifications aimed at improving the accuracy of its results. Colposcopy complements the Papanicolaou (Pap) smear and human papillomavirus (HPV) deoxyribonucleic acid (DNA) test, especially when the client has abnormal cervical cytology or is HPV positive. However, there are some challenges associated with colposcopy in Nigeria. These challenges comprise the sociodemographic characteristics of Nigerians and the issues related to the procedure, itself.
Nigeria does not have an organized cervical cancer screening program. What is currently obtainable in Nigeria is opportunistic screening by using mainly Pap smear cytology and visual inspection with acetic acid or Lugol’s iodine. HPV DNA screening test is available in very few centers in Nigeria. Even with opportunistic screening, the acceptance is very poor. This may be responsible for the paucity of clients that need colposcopy services. More so, there are very few colposcopy service centers in Nigeria. The reason may be due to the paucity of qualified colposcopists and the facilities in Nigeria. The cost of this colposcopy service may additionally hinder its uptake by the Nigerian clients. However, there was a significant default in uptake of these services even when they were provided free., The main reason adduced to the poor uptake by the women was fear of the possible outcome.
Nigeria currently does not have any guidelines on cervical cancer screening. Most of the centers that have colposcopy service rely their screening on World Health Organization (WHO) guidelines. Therefore, the formulation of national guidelines may consider the local peculiarities and help strengthen the colposcopy services in Nigeria. When compared with Pap smear screening, colposcopy takes more time. Even in experienced hands, colposcopy does not take less than 5 min. Type 3 transformation zone leads to unsatisfactory colposcopy with its drawbacks. Even though endocervical curettage is done in such situations, it causes more painful discomfort and adds extra cost to the clients. Despite that, the accuracy of colposcopy on the detection of the preinvasive and invasive cervical lesions depends on the experience of the colposcopist; the gold standard is the histologic verification of the lesions. Another area of controversy is the mode of anesthesia during colposcopy and biopsy. Some colposcopists feel that it is not necessary, but others prefer local infiltration with xylocaine during biopsy. Some even prefer cervical blocks, while general anesthesia is used in extensive surgeries such as cone biopsy. Some centers in Nigeria use xylocaine infiltration in minor biopsy and cervical block in more extensive surgery. Xylocaine infiltration is cheaper, done in the cervical cancer screening clinic and ensures faster recuperation by the clients.
In conclusion, colposcopy services are very important in stemming the tide of high cervical cancer burden in Nigeria. The challenges militating against the achievement of this goal have been discussed. There is a need to have an effective national society of coloposcopy and cervical pathology in Nigeria. This will help engender training and retraining of members as well as create public awareness on the importance of cervical cancer screening among the target population. The men have to be involved in this sensitization, because a previous study has shown that Nigerian women are more motivated to accept cervical cancer screening by their husbands and the community leaders. All the stakeholders need to collaborate and formulate a policy aimed at starting an organized cervical cancer screening program. Free colposcopy services should be provided in every state of the federation and more colposcopists need to be trained in order to bridge the manpower gap in this subspecialty. If a quarter of the effort put by the stakeholders and the Nigerian community in the Ebola epidemic eradication in Nigeria can be applied in the reduction of cervical cancer, it will drastically reduce the high cervical cancer burden in our environment.
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Source of Support: None, Conflict of Interest: None