- Dilmah, Rotary, and Health Ministry collaborate to increase screening
Cervical cancer, a preventable and curable cancer, is the fifth most common cancer among women in Sri Lanka. According to the 2021 National Cancer Incidence and Mortality Data, 1,238 cases were detected that year, which is 6% of all cancers detected among women.
Globally, cervical cancer is the fourth most common form of cancer among women, with the disease claiming the lives of almost 350,000 women in 2022. Cervical cancer is caused by persistent infection with the human papillomavirus (HPV), with the World Health Organisation (WHO) stating that prophylactic vaccination against HPV and screening and treatment of pre-cancer lesions are effective strategies to prevent cervical cancer and are very cost-effective.
WHO is determined to eliminate cervical cancer within the next century. To do this, every country needs to meet the 90-70-90 targets by 2030, whereby 90% of girls must be fully vaccinated with the HPV vaccine by the age of 15; 70% of women must be screened using a high-performance test by the age of 35, and again by the age of 45; and 90% of women with pre-cancer must be treated and 90% of women with invasive cancer managed.
Given that January was Cervical Cancer Awareness Month, an awareness programme held on 30 January at Genesis, Dilmah Centre for a Sustainable Future was of immense importance. Organised by Dilmah’s MJF Charitable Foundation together with the Health Ministry and the Rotary Club of Colombo, the discussion shed light on Sri Lanka’s progress towards the 90-70-90 targets as well as challenges to cervical cancer prevention in Sri Lanka.
A vital collaboration
The event gave the organisers the opportunity to discuss a vital collaboration between them. Dilmah and the MJF Foundation is collaborating with the Government through the Health Ministry and the Rotary Club of Colombo to fund vital HPV DNA testing kits required for screening and early detection of cervical cancer.
A statement issued by Dilmah noted that in 2019, the Rotary Club of Colombo, recognising the critical need for a comprehensive solution, partnered with the Government of Sri Lanka to direct the country towards combating and ending this highly preventable disease. They had a vision of ending cervical cancer as a public health problem by 2030. The overall initiative had a two-fold mission: The vaccination of school-aged girl children and the screening and early detection of the target group of 35- and 45-year-old women.
The Rotary Club of Colombo and Dilmah’s MJF Charitable Foundation are driving this prevention action plan through donations of HPV DNA testing kits, which are a highly accurate and efficient test capable of identifying the cervical cancer-causing HPV virus strain compared to traditional pap smears.
HPV DNA testing was first introduced by Rotary at its Cancer Early Detection Centre in 2016. In 2020, the project was scaled up with the donation of a high-performance Cobas HPV DNA testing machine and kits to the Health Ministry. This initiative included capacity-building training for public health nursing staff and a comprehensive public awareness campaign to encourage women to undergo screening, the statement read.
On 23 January 2024, Dilmah and the Health Ministry signed a memorandum of understanding, where Dilmah Chair and MJF Foundation Managing Trustee Dilhan Fernando pledged a contribution of Rs. 75 million and the Government of Sri Lanka committed Rs. 35 million annually to fund the necessary HPV DNA testing kits.
Rotary, meanwhile, committed an additional Rs. 26 million to support this public-private partnership.
Partnerships that make a difference
At the awareness event held last month, Fernando reflected on these efforts, urging collaboration between the private and public sectors. He pointed out that more screening machines were required, saying: “There is a lot more effort required if we can genuinely embrace the target of eliminating cervical cancer in Sri Lanka by 2030. We will work towards it.”
Fernando explained that there is a school of thought where any complicated issue is seen as the Government’s responsibility. However, these are collective issues, he said, adding that any business should see that education, health, quality of life, and the environment all contribute towards its success.
When you accept this reality, he said, you will understand that there’s a fundamental obligation to embrace situations like this. Fernando emphasised that it was the responsibility of the private sector too, to address these problems.
Rotary International Past President K.R. Ravindran echoed these thoughts, saying their involvement in projects like this came from an understanding that what was difficult for an individual or a small group of people to do was possible through collaboration. He pointed out that such collaboration was possible through the work of ordinary people, extraordinary businesses, and governments that were willing to work with them to achieve goals.
Health Ministry Secretary Dr. Anil Jasinghe addressed the gathering, saying a system was in place to reduce the number of cervical cancer cases in the country. It is State resources as well as those from the community and supporting organisations that enrich health promotion and prevention, he said, adding that equipment was an area that needed further improvement.
He emphasised the importance of screening, saying early detection of cervical cancer leads to prevention. Sri Lanka mainly uses pap smears for testing, he said, but pointed out that the HPV DNA method had higher specificity and sensitivity. It was also required once in ten years, while a pap smear was recommended more regularly.
Cervical cancer causes and prevention
Educating the audience on cervical cancer were Dr. Nadeeja Herath from the Family Health Bureau and Dr. Hasarali Fernando from the National Cancer Control Programme. According to Dr. Fernando, cervical cancer for a long time was the second most common cancer among women in Sri Lanka. However, for the past five years or so, cervical cancer has gone down the list, taking up the space as the fifth most common cancer among women.
“According to the latest available data, which is in 2021, it’s the fifth most common cancer among females, and is no longer the second most common. That is mainly because other cancers, like thyroid cancer, colon and rectum cancer, and ovarian cancer, have come up. Number wise, cervical cancer remains the same,” she pointed out.
Cervical cancer is caused by HPV, which is a sexually transmitted disease. This means that cervical cancer is usually seen among sexually active women. “Cervical cancer has a precancerous stage. Once you are infected with HPV, by natural immunity, your body will reject the illness. So, all people who are infected with HPV will not develop cervical cancer,” Dr. Fernando said.
However, 10-15 years later, there is a possibility of developing cervical cancer provided that the individual’s immunity is weak. Cervical cancer is mostly seen among those from a low socioeconomic status, she added.
In order to prevent cervical cancer, HPV vaccination is carried out. “HPV vaccination is a very successful programme. Through the school health sector, vaccination is carried out very successfully in Sri Lanka. Parents are keen to get the vaccination,” she said, pointing out that Sri Lanka had reached the first of WHO’s goals, with HPV vaccination coverage exceeding 90% among school-age children.
The importance of screening
A challenge to screening, Dr. Fernando said, is the stigma associated with the disease. However, the health sector was determined to address this through education, convincing women to get screened.
According to Dr. Herath, screening was important as it would allow health workers to identify those in the precancerous stage and intervene. “Screening is carried out among the 35-45 age group women. We are carrying out this activity at the Well Woman Clinics. There are about 1,500 clinics in the country, carried out by the Medical Officers of Health (MOH),” she said.
According to her, over 60% in the 35-year age group has been screened and 43% of the 45-year age group has been screened. This includes both the pap smear and the HPV DNA test.
“The main challenge is that women are reluctant to come and get themselves screened, because there are no symptoms associated,” Dr. Hearth said, pointing out that not everyone shows symptoms during the early stages of the disease. However, the State health sector had a MOH-level system that was taking the message to the grassroots level. This added a positive note to Sri Lanka’s path towards achieving WHO’s 90-70-90 targets and eliminating cervical cancer.