A new tool to end cervical cancer

Rotarian brings promising screening technology to Kenya

By Dr. Richard Godfrey

I'm parked on the side of the road in western Kenya in pitch-black darkness, completely lost. Kevin, my local friend, lent me his car, but in remote Siaya County, there are no road signs, lights, or any sure way to locate his house, and taking a dirt-road detour can deliver one into a ditch deep enough to swallow a car. So I wait for him to find me.

As a retired surgical oncologist, I’m in the region to deliver a new screening program that detects cervical cancer in its early stages and to perform surgery at Matibabu Hospital in the Lake Victoria region. My visit is part of a Rotary project to prevent cervical cancer, the most common cause of mortality for women throughout Sub-Saharan Africa.

While I have removed some 10,000 cancers in 35 years as a surgeon in busy California hospitals, I know that early detection is crucial in controlling cancer of all types. And cervical cancer is the one cancer we can eliminate globally. Why? Like polio, it’s caused by a virus, the human papillomavirus (HPV). An active immune system can clear the virus, but a weak one fails to prevent HPV from causing cancer. Women with HIV face a sixfold risk of cervical cancer, and in Kenya both HIV and HPV are widespread. 

When I was in Kenya two years ago, I learned of a 32-year-old widow, the mother of five children, who was diagnosed with cancer. Her chances of survival were slim, and I fear her children are now orphaned. Women are often their families’ primary support system, and the consequences for children are terrible when they lose their mother.

On another visit, I was approached by a 29-year-old woman with Stage 4 cancer who had four children. She had walked miles to get to our rural hospital and was bent over in pain, but we could only offer morphine and hospice care. Why, I wondered, should a preventable disease cause such suffering?

Without testing, a woman usually doesn’t realize she has cervical cancer until she develops bleeding, loses weight, or has more advanced signs of disease. Once cervical cancer spreads, it is rarely controlled even with surgery, radiation, and chemotherapy — treatments rarely available in low-income countries.

With Ampfire, the new genetic testing system I’m delivering, patients can test themselves at home using a brush to swab fluid and cells from the cervical surface. They then place the tip of the brush in a tube that gets transported our laboratory at Matibabu Hospital, which has a machine that can test up to a thousand samples per day. It takes only two days to set up the equipment, and the lab technician can manage testing independently.

The clinic staff communicates the results to patients through WhatsApp, and makes appointments for those who test positive, around 20%, to undergo further screening. Those who test negative are asked to return in three to five years, a major advantage of this method over the less accurate pap smears. Grants from the Rotary clubs of Merced and Oakland, California, made it possible to purchase the equipment. As many as a million women ages 30 to 60 need testing in the region, so we are just getting started.

When I first came to Matibabu Hospital in 2012, it was a very simple rural clinic. Rotary has contributed to the hospital since its inception, and with every visit, I’ve seen modern additions and updates. The hospital is now a welcoming, bright yellow state-of-the-art clinic with three primary doctors, including an obstetrician-gynecologist, and 10 nurses.

In the past, we used cryotherapy (cold therapy) to destroy abnormal tissue as an early-stage cancer treatment. Since 2020, we’ve used thermocoagulation, delivered through a small battery-powered instrument. This handheld device costs about $1,​5​00, but it has a powerful impact, delivering 100-degree Celsius heat to the cervix to eliminate abnormal cells in just 20 seconds, while causing minimal pain. If the hospital staff discovers advanced disease, they biopsy the cells and send the patient to a large regional hospital for surgical treatment. It’s easy to train doctors and nurses to use thermocoagulation, which is less complex than cryotherapy equipment that costs more and breaks down often. Our aim is to “train the trainers,” so we can move to the next site, enabling us to rapidly expand these programs in Kenya, Guatemala, Bolivia, Nepal, India, and soon Baja California.

We also work on cervical cancer prevention. Ideally, girls get vaccinated against HPV between age 9 and 13. In the U.S. where vaccines and screenings are widely available, only four out of 100,000 women get cervical cancer, whereas in Kenya, the rate is ​six​ times higher. By offering more vaccines along with the new screening methods, Kenya can become a leading example for East Africa. 

Fifteen minutes go by, then half an hour, and I’m still waiting in the dark. I watch as cars, motorcycles, bicycles, and pedestrians pass by. How the bicyclists, with no reflectors or lights, dare to travel on this dark and dangerous highway amazes me. I still hope Kevin will find me and take me to his house.

And finally, he does. He leads me to the hidden dirt passage between the car-swallowing ditches and guides me to a wonderful meal of rice, chicken, and Sukuma wiki (mustard greens). Next year, I will return to Kenya to see how many women have benefited from our new screening program, hoping we have made a difference.

Richard Godfrey is a retired surgical oncologist, aspiring apiarist, and published novelist. He is a member of the Rotary Club of Niles (Fremont), California.