More than 600,000 women have been screened for cervical cancer under Rwanda’s nationwide drive to expand early detection and move closer to its 2027 elimination target, according to the Rwanda Biomedical Centre (RBC).

The country aims to screen 70 per cent of women aged 30 to 49 by 2027, with current coverage standing at 37 per cent.

Dr Theoneste Maniragaba, Director of the Cancer Programme at RBC, told The New Times that the screening campaign is being expanded across districts, alongside efforts to maintain high human papillomavirus (HPV) vaccination coverage, which stands at about 93 per cent.

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The Eastern Province has completed the current screening exercise, with Gatsibo the latest district to finish.

In Kigali, Kicukiro and Nyarugenge have also been covered, while Gasabo is yet to be reached.

"We are running too fast to make sure that the South and Western provinces can be reached in the short period coming. The focus now is on reaching more women with screening and ensuring those with precancerous lesions receive treatment,” Maniragaba said.

Rwanda has set 2027 as its target for eliminating cervical cancer, three years ahead of the World Health Organisation’s 2030 target.

The country is targeting about 1.5 million women for screening as it scales up the programme nationwide.

Maniragaba said population data is being used to determine the number of eligible women in every district, sector and cell, with community health workers playing a central role in identifying and mobilising them.

"Population data is being used to identify the women to be screened in each district, sector and cell, with support from the National Institute of Statistics. Community health workers are helping find women in their communities and homes,” he said.

Bringing screening closer to communities

One of the approaches being used is community-based self-sampling, where women are taught how to collect their own samples and return them for testing.

Community health workers collect the samples and deliver them to health centres, from where they are sent to laboratories.

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Women who test positive for HPV undergo further examinations, including visual inspection with acetic acid, commonly known as VIA.

Those found to have precancerous lesions can be treated at health centres, district hospitals and other health facilities.

Women suspected of having cancer are referred to specialised centres for biopsy and pathology tests.

They can also undergo CT scans and MRI tests at teaching hospitals, which Maniragaba said are covered under the community-based health insurance scheme (CBHI).

Patients diagnosed with cancer can access treatment, including surgery and chemotherapy.

More cases detected early

Maniragaba said the expansion of screening is contributing to more cervical cancer cases being detected at stages one and two, when treatment is more effective.

"We are seeing an increase in cases diagnosed at stages one and two as more women are reached through awareness and screening. When the disease is detected early, patients can be treated with surgery and, where necessary, chemotherapy,” he said.

Cervical cancer is the second most prevalent cancer among women in Rwanda after breast cancer, but carries the highest cancer burden among women.

Rwanda records about 600 cervical cancer cases annually, with about 70 per cent diagnosed at an advanced stage, according to Maniragaba.

He said the disease is receiving particular attention because its main cause is known, vaccination can prevent most cases and screening can identify precancerous changes before they develop into cancer.

"If we know how many people need to be screened, we know the cause, we have an affordable vaccine and screening is possible, why can’t we do it?” he said.

Community health workers at the centre of the drive

Kwizera Matabishi, a community health worker in Kicukiro, said community health workers go door to door to raise awareness, encourage women to get screened and explain the importance of early detection.

"Those found with HPV or cancer are advised to go to health centres for treatment. We also make sure that people living with cancer can live in the community without stigma,” Matabishi said.

Alain Fabrice Mizero, Executive Director of Rwanda Cancer Relief, an organisation that supports improved cancer care, said increased awareness, easier access to screening and the availability of treatment are encouraging more women to participate.

"The government, NGOs and other partners are raising awareness about cervical cancer and encouraging women to get screened. Screening services are also being brought closer to communities through primary healthcare, with RBC and the Ministry of Health training community health workers to provide the service,” he said.

Mizero said the priority should be to strengthen existing programmes and ensure they reach more women across the country rather than introduce new approaches.

"The Ministry of Health has provided the framework under Mission 2027, and we need to make sure it delivers the target. That requires everyone, not only the government, but also NGOs, partners and philanthropists, to put in the resources needed to reach more women and achieve the mission,” he said.

Challenges slowing expansion

Despite the progress, Maniragaba said limited access to testing and laboratory services, implementation gaps and coordination challenges continue to slow the programme.

Other constraints include high screening costs, procurement delays, a shortage of trained health workers and limited equipment.

He said more health workers need to be trained at health centres, district hospitals and other facilities to expand screening capacity.

The programme also plans to have testing machines in every district, reducing the need to transport samples from one district to another.

Rwanda has largely relied on schools to reach girls aged 13 to 15 with the HPV vaccine, with vaccination coverage standing at about 93 per cent.

Maniragaba said efforts are now being made to reach girls who are out of school so they can also receive the vaccine.

How HPV spreads

Maniragaba said cervical cancer itself cannot be transmitted from one person to another, but HPV, the virus responsible for most cervical cancer cases, can spread through intimate skin-to-skin contact around the genital area.

He said HPV transmission differs from HIV because sexual intercourse is not required for transmission.

The virus can be present on the skin around the vagina or penis and can be passed from one person to another through close skin contact.