Cervical cancer: signs, risks and when to get checked in Kenya

Cervical cancer starts in the cervix, the opening of the womb. Almost all cases are caused by long-lasting HPV infection, and regular screening finds changes years before cancer develops.

Bleeding after sex. Bleeding between periods, or any bleeding after menopause. A watery, bloody or foul-smelling vaginal discharge. Pain in the pelvis, lower back or legs. Pain during sex. Tiredness, weight loss or swollen legs in later stages.

Long-lasting infection with high-risk HPV, especially types 16 and 18. Living with HIV, which raises the risk about six times. Never having been screened, or a long gap since the last screen. Smoking. A weakened immune system. First sex or first pregnancy at a young age, and many full-term pregnancies. Long use of the combined contraceptive pill.

Bleeding after sex, between periods or after menopause should be checked by a clinician promptly, whatever your last screening result. These signs have many causes, most of them not cancer.

With HPV test, VIA/VILI or Pap smear. Women under 25: routine screening is not recommended.

A positive HPV test usually leads to a VIA check to look at the cervix. Abnormal cells can often be treated the same day with cryotherapy or thermal ablation. LEEP or a referral to a gynaecologist if the area is larger. A repeat test at the interval your clinician sets. A risk result is not a diagnosis.

Is an HPV test available here, or will I have VIA or a Pap smear? When should I come back for my next screen? If my result is positive, can I be treated the same day? I am living with HIV: how often should I be screened? Should my daughter get the HPV vaccine, and where?

The Social Health Authority benefit tariffs list an HPV test at KES 3,600 and cryotherapy or thermal ablation at KES 3,000, at facilities that offer them. Screening is also often free during county campaigns.

The cervical cancer risk assessment asks about 38 questions: HPV vaccination and test results, past treatment of abnormal cells, HIV status, sexual and pregnancy history, contraception and screening history. It flags warning signs at once and tells you which test is due: an HPV test, VIA or a Pap smear. It costs KES 300. A care navigator calls you back within 2 hours (Monday to Saturday, 8am to 8pm) to book what you need at a facility that suits your budget and location.