Cervical cancer in Tanzania: A systematic review of current challenges in six domains

Abstract

Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a priority for the Tanzanian government. In this systematic review of 39 peer-reviewed publications that appeared in the PubMed/MEDLINE (NCBI) database from 2013 to 2018, we synthesize the growing body of literature to capture current trends in Tanzania's evolving cervical cancer landscape. Six domains were identified, including risk factors, primary prevention, barriers to screening, treatment, healthcare worker education, and sustainability. In addition to traditional risk factors associated with sexual behavior, acetowhite changes observed during visual inspection of the cervix with acetic acid, lower education, rural setting, and HIV positivity also have a noteworthy clinical impact.

Keywords: Cervical cancer; HIV; HPV; Tanzania; VIA; Visual inspection with acetic acid.

Fig. 1

Visual inspection with acetic acid charts for healthcare provider training. Prepared by the World Health Organization's International Agency for Research on Cancer (IARC) and made available by the Bill & Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention (ACCP).

Fig. 2

Cervical cancer screen-and-treat in Northern Tanzania. A. Women in line for VIA screening at Buzuruga Health Centre in the Mwanza metropolitan area of the Ilemela District of northern Tanzania. Photograph taken with permission on July 4, 2018 during the University of California, Irvine-led cervical cancer screen-and-treat workshop. B. UCI medical students Elizabeth Crawford and Megan Bernstein with CDM high school student Sujata Tewari, together with Buzuruga Health Centre nurse Suzie and Brother Erick Oguta. C. University of California, Irvine Class of 2021 medical students on the ground in Mwanza, Tanzania for the July 2018 cervical cancer screen-and-treat workshop at Buzuruga Health Centre: From left to right: Justine Maher, Emma Cooper, Alexa Lucas, Danielle Zezoff, Elizabeth Crawford, Ariana Naaseh, Kevin Bera, Justine Chinn, Kayla White, Ava Runge, Andreea Dinicu.

Fig. 3

Some of the first girls to receive the HPV vaccine following the campaign launch in Tanzania during April 2018. Here they pose with their vaccination booklets. Source: Jhpiego.

Fig. 4

Map of the Republic of Tanzania indicating medical centers where cancer care is provided. Designed by Ava Runge.