Control of cancer of the cervix: feasibility of screening for premalignant lesions in an African environment.

Cancer of the cervix is a common disease in sub-Saharan Africa and tends to be diagnosed later than in the developed countries. The disease is therefore associated with a high mortality under African conditions. In addition, it occurs at a much earlier age in Africa than in Europe and North America. The etiology is unknown, but early adolescent sexual exposure has been shown to occur more frequently in cancer patients than in controls. Child marriage, found in many African countries, may therefore be a contributing factor. In contrast, the suggestion that male circumcision reduces the incidence of cancer of the cervix has not been confirmed by studies of different ethnic groups in Kenya. Since cervical intraepithelial neoplasm may develop in African women before the age of 20, screening must be started as soon as women become sexually active, and early diagnosis of invasive disease must be the first aim. As the number of gynaecologists available is small, nurses and midwives must be instructed in examination of the cervix. In Kenya, a cytology research department was established in 1981 and has carried out three surveys of asymptomatic women. The survey data suggest much higher prevalence rates of abnormal cytology than those reported in the developed countries.