Sisters fight cervical cancer together and urge women to go for regular screening

In January 2015, Alrita, then six months pregnant, complained to her gynaecologist of excruciating back pain. Four days after her daughter Mila's birth on 17 April 2015, she collapsed in agony. After being rushed to hospital, Alrita agreed to exploratory surgery. She woke up to the news that a biopsy had revealed Stage 2B cervical cancer.

"I was so shocked. I thought, how can I be given the miracle of a new-born baby girl and then find myself on death's doorstep," says Alrita.

What is cervical cancer ?

Cervical cancer is a cancer that starts in the cervix. The cervix is the lower part of the uterus that connects to the vagina. "Some strains of the Human Papilloma Virus (HPV) are a leading cause of cervical cancer, and responsible for more than 95% of cervical cancers," explains Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health.

Denial set in, followed by fear and uncertainty and lastly, determination to overcome with faith and positivity.

On exposure to HPV, the body's immune system will prevent the virus from doing harm. However, there is a small percentage of chances that the HPV survives in the body and causes some cervical cells to become cancer cells.

Smoking tobacco, a weakened immune system, sexually transmitted infections and increasing number of sexual partners are risks factors that can lead to cervical cancer.

"Cervical cancer is very prevalent in South Africa. According to CANSA, 11 000 women are diagnosed with cervical cancer annually in South Africa, making it the second most common cancer among women. Cervical cancer claims the lives of more than 3 000 women in the country each year."

Detecting cervical cancer

"It is tragic that so many women die from cervical cancer because it is a highly preventable disease and treatment is very effective."

"According to the World Health Organization, it takes 15 to 20 years for cervical cancer to develop in women with normal immune systems and 5 to 10 years in women with weakened immune systems, such as those with untreated HIV."

"To reduce the risk of developing cervical cancer, a vaccine that protects against HPV can be given to young girls from the age of 9. Women from the ages of 25 should have screening tests including HPV testing or pap smears. Pap smears detect abnormal cells before they become cancerous. Screening can be performed by a nurse, a GP or gynaecologist."

"It is recommended that women, from the age of 25, have a pap smear once every three years or an HPV test once every five years," explains Dr Nematswerani. "Those that have a high risk of cervical cancer (such as people living with HIV) should have an annual pap smear or HPV screening every three years."

"Early detection allows for early intervention, lowering the complications related to late diagnosis and improving the outcomes of treatment."

Alrita survives aggressive treatment and kidney removal

Alrita received aggressive chemotherapy and radiation treatment.

"Not only did the treatment ravage my body, but cancer can wreak havoc with your mind too. I found myself in a black hole."

She barely remembers the first few months of Mila's life.

Further tests revealed that the cancer had progressed to a Stage 3B diagnosis (the cancer having grown into the walls of the pelvis and/or blocking one or both ureters, causing kidney problems).

Eventually, on 21 July 2015, Alrita received test results showing that the treatment had been successful. She was cancer-free, but her left kidney had suffered irreparable damage and had to be removed. Despite this, today Alrita is fighting fit.

Tessa's silent cancer journey

While Alrita was receiving cancer treatment and fighting for her life, Tessa was also diagnosed with cervical cancer. She chose to silently carry the burden of her diagnosis, sharing it only with her husband and daughter.

Tessa's surgery on 20 August 2015 - on her birthday and four months after her sister's surgery - included a radical hysterectomy. The oncologist she shared with her sister, confidentially reassured her that her outlook was more positive than Alrita's.

"We only shared my cancer news with everyone else when the final lab results arrived after the hysterectomy." That took eight weeks. Her all-clear came one month after her sister's.

Pandemic causes women to defer cervical cancer screening - what will the outcome of this be?

"Discovery Health Medical Scheme (DHMS) data show that scheme members as young as 25 are being diagnosed with cervical cancer," says Dr Nematswerani.

Between 2019 and 2022, we saw a 5.8% increase in members being treated for cervical cancer. More than 100 Discovery Health Medical Scheme members were diagnosed with cervical cancer in 2022.

The COVID-19 pandemic period (2020 to 2022) caused serious disruption to all health screening checks, cervical cancer screening tests included. This means that cervical cancers detected in the time to come, may be at an advanced stage."

Compared to the pre-pandemic period (2019), the first year of the COVID-19 pandemic (2020) saw the biggest drop in pap smears with a 19% decline in recorded screenings. Fortunately, in 2021 and 2022 members began to resume their cervical cancer screening checks. However, cervical cancer screening rates had, by 2022, not recovered from the decrease experienced through the pandemic period (2020 to 2022) and have remained below pre-COVID-19 levels at 12.5% lower than 2019 screening rates. [Source: https://www.discovery.co.za/corporate/health-insights-types-of-cancer-screening-rates]

The sisters are passionate advocates for regular screening

As South Africa commemorates cervical cancer awareness month this September, Tessa and Alrita reflect on their journey and urge women to get screened regularly for cervical cancer.

Alrita regrets not consulting her gynaecologist more regularly before her last pregnancy. "I felt absolutely fine, so for nearly eight years I did not go for gynaecological examinations. For years I did not realise the importance of having a pap smear to detect pre-cancerous cell growth," she says.

"I ask the women in my life every year if they've been for their check up and I get angry with them if they haven't because cervical cancer can be prevented."

Tessa adds: "My oncologist says it takes more than 10 years for cervical cancer to develop. You can have three or four pap smears in that time. It's very important that you don't get lulled into thinking that you're okay and skip appointments. If you leave it, you'll end up where we did and that's an unnecessary journey to take. Cervical cancer is one of those cancers we can detect the warning signs of, and prevent and so it makes absolute sense to keep our regular screening checks up."