🎀 Men's Health

Cervical Cancer & HPV in Nigeria

The cancer that kills 22 Nigerian women every day — and how to prevent it

Cervical cancer is the second most common cancer in Nigerian women, causing an estimated 22 deaths per day — one of the world's highest cervical cancer burdens. Nigeria has the additional risk factor of very high HIV prevalence (HIV-positive women have 5-10x higher cervical cancer risk). The tragedy is that cervical cancer is almost entirely preventable — through HPV vaccination before sexual debut and regular cervical screening (Pap smear or VIA — visual inspection with acetic acid). Yet vaccination coverage is low and screening is non-existent for most Nigerian women.

Signs and Symptoms

✓ Early stage: often NO symptoms — this is why screening is critical

✓ Unusual vaginal bleeding: between periods, after sex (post-coital bleeding), or after menopause

✓ Unusual vaginal discharge: watery, bloody, foul-smelling

✓ Pelvic pain or pain during sex

✓ Advanced disease: back or leg pain, swollen legs (lymphoedema), difficulty passing urine or stool, fistula (hole between vagina and bladder or bowel — a devastating complication)

Risk Factors

HPV infection: virtually all cervical cancer (99%) is caused by Human Papillomavirus — particularly HPV types 16 and 18
HIV infection: 5-10x higher risk of cervical cancer
Multiple sexual partners — increases HPV exposure risk
Early first sexual intercourse
Not being vaccinated against HPV
Smoking: doubles cervical cancer risk in HPV-infected women
Long-term oral contraceptive use: modestly increases risk

When to Seek Help

HPV vaccinationGirls aged 9-14 should receive HPV vaccine before first sexual exposure — the most effective prevention; Gardasil-4 or Gardasil-9 available at private hospitals; Nigeria's expanded immunisation schedule includes HPV vaccine

Cervical screeningAll sexually active women from age 25 (or 3 years after first sex) should have cervical screening every 3-5 years; VIA (visual inspection with acetic acid) is practical and available at many Nigerian PHCs

Investigate post-coital bleedingAny woman with bleeding after sex, between periods, or after menopause — see a gynaecologist for cervical examination; do not assume it is 'hormonal'

Tests & Diagnosis

🧪 VIA (visual inspection with acetic acid)

Acetic acid (vinegar) applied to the cervix — abnormal cells turn white; cheap, immediate result, no laboratory needed; widely available at PHC level in Nigeria through PEPFAR-supported programmes

🧪 Pap smear (cervical cytology)

Cells scraped from the cervix sent to laboratory — takes days to weeks for result; requires trained cytologists; available at major hospitals

🧪 HPV DNA test

Tests directly for high-risk HPV DNA in cervical cells; highly sensitive; WHO recommends as preferred primary screening tool; becoming available in Nigeria

🧪 Colposcopy and biopsy

Magnified examination of cervix after abnormal screen — directed biopsy confirms diagnosis and determines severity (CIN 1, 2, 3 or invasive cancer)

🧪 MRI pelvis and CT chest-abdomen-pelvis

Staging of confirmed cervical cancer — assesses spread to lymph nodes, bladder, and distant organs

Treatment Options

CIN (precancer) treatment

LEEP (loop electrosurgical excision procedure) or cryotherapy — removes or destroys precancerous cells; prevents progression to cancer; curative in >90% of cases; available at gynaecology departments of teaching hospitals

Early stage cervical cancer

Radical hysterectomy (surgical removal of uterus and surrounding tissues) + lymph node dissection; or definitive chemoradiotherapy — equivalent outcomes

Advanced stage cervical cancer

Concurrent cisplatin chemotherapy + external beam radiotherapy + brachytherapy (internal radiotherapy); significant limitation in Nigeria due to limited radiotherapy availability

Palliative care

Pain management, fistula repair, psychological support for advanced disease; palliative care teams at some teaching hospitals

Screen and treat

VIA-positive women can have cryotherapy or LEEP at the same visit — 'screen and treat' approach reduces loss to follow-up; widely implemented in Nigerian PEPFAR-supported programmes

Frequently Asked Questions

Is HPV vaccination only for girls?

No — boys also benefit from HPV vaccination (prevents penile, anal, and throat cancers, and reduces HPV transmission to partners). However, female vaccination prioritised first due to the cervical cancer burden.

Can HPV be treated?

There is no specific treatment for HPV infection itself. The immune system clears most HPV infections within 1-2 years. The precancerous changes that some HPV infections cause (CIN) can be treated with LEEP or cryotherapy.

Where can I get cervical screening in Nigeria?

VIA screening is available at PEPFAR-supported health facilities across Nigeria (particularly in states with high HIV burden). Pap smears are available at gynaecology departments of all teaching hospitals and many private hospitals.

Does cervical cancer affect HIV-positive women differently?

Yes — HIV-positive women develop cervical cancer at younger ages, with more aggressive disease, and have a 5-10x higher overall risk. All HIV-positive women should be screened every year rather than every 3-5 years.

Can cervical cancer be prevented completely?

HPV vaccination before first sexual exposure combined with regular cervical screening reduces cervical cancer risk by over 90%. Countries with high vaccination and screening rates have seen dramatic reductions in cervical cancer — Nigeria could achieve the same.