Over 3,600 Malawian women fall sick with cervical cancer every year and two thirds of them die from the disease. It’s the most common type of cancer among the female population in the country, affecting the cervix of the uterus (accounting for 45.4% of all cancers among women) and resulting from infection by Human Papilloma Virus (HPV). This heavy toll results from a combination of many factors: limited availability of the vaccine against HPV infection, which is at the origin of the cancerous lesions; high rates of HIV coinfection, which exponentially increase the risk of HPV infection turning into cancer; late diagnosis due to limited awareness and inadequate organization of screening; limited options for treatment (only two hospitals in the country offer cervical cancer surgery and there are no options for radiotherapy); and financial barriers to care.

As well as the obvious clinical impact (the median survival rate from the time of diagnosis has been estimated to be 10 months), women affected by cervical cancer face devastating social, familial and financial consequences. They become progressively unable to work due to increasing pain and reduced mobility, facing poverty as well as the disease; they experience marginalisation and sometimes abandonment by close family members who see them as a burden for the family.

MSF opened a cervical cancer programme in Blantyre district in 2018, beginning with screening, treatment of pre-cancerous lesions and early cancerous lesions. By late 2019 the activity had developed to include specialised surgery and palliative care for patients with late-stage cancer; activities are anchored by the “hub” of Queen Elizabeth Central Hospital in Blantyre but include support to several health centres in the district, community awareness sessions and home-based support for palliative care patients with reduced mobility. Earlier this year we supported the Ministry of Health in the HPV vaccination campaign. This activity is both a much-needed response to a major public health issue and a significant step in developing MSF’s range with oncological care.