Doctoral Defence of Nontuthuzelo Somdyala online on Friday May 6th

The doctoral dissertation of MSc in Development Studies (MDS) Nontuthuzelo Somdyala in the field of epidemiology entitled Reducing the Burden of Cervical Cancer in a Rural Setting of South Africa: Understanding the Incidence of this Disease and Building Infrastructure towards Intervention will be publicly examined on 6 May 2022 at Faculty of Social Sciences starting at 12 o'clock. The venue is Arvo building auditorium F114, address: Arvo Ylpön katu 34. The Opponent will be Professor Claudia Allemani, London School of Hygiene and Tropical Medicine. The Custos will be Professor Anssi Auvinen, Tampere University and Finnish Cancer Registry. The dissertation was supervised by Professor Nea Malila.

The power of consistent counting has great impact on understanding the burden of cancer even in marginalized communities, where counting has many challenges. One of the main outcomes of the dissertation was that through the data collection we were able to quantify the number of cases with cervical cancer in the target population. This information significantly impacts decision making and the statistical infrastructure for health information. A more targeted control program to reduce cervical cancer is needed.

The doctoral dissertation of MSc in Development Studies (MDS) Nontuthuzelo Somdyala highlights the importance of cancer registration which tracked the high cervical cancer incidence experienced by women in the rural Eastern Cape Province that progressively increased over time. Important suggesting pointers of the low or non-existence of screening in this population include low survival to this cancer due to an advanced stage at diagnosis that many women present with, showing that clinical signs and symptoms made diagnosis rather than prompt screening.

Non-communicable diseases (NCDs) currently in low-middle-income countries (LMICs) account for 40% of the total burden of disease. They are recognized as a significant threat to health and the economy. Cancer is among NCDs challenging the LMICs today with projected trends that are continuously increasing. Cervical cancer is estimated as the fourth cause of global incidence and mortality. Women experience high incidence and mortality rates due to this cancer in LMICs, with the highest burden borne by countries in Sub-Saharan Africa (SSA).

The problem of cervical cancer was elevated to a severe level of the SSA region by the onset of the Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In addition, many women are unscreened or under-screened because there are no organized screening programs for the early detection of pre-cancerous lesions.

South Africa is the only country in the SSA region that offers the national cytology-based screening. Yet, cervical cancer is ranked the second most common cancer and cause of death among women and 8th of the top 10 contributors to Disability Adjusted Life Years (DALYs). Poor screening performance is one of the reasons for the high invasive cervical cancer, which remains a health challenge. Given South Africa’s disparate distribution of public healthcare resources, it is essential to know whether the mass population-based cytology screening program is available to the rural population of the Eastern Cape Province of South Africa.

The research aims to understand the burden of cervical cancer in this population. The objectives include describing the incidence of cervical cancer, investigating geographical differences, assessing screening coverage, and examining the survival rate using collaborative studies results in the region and internationally to develop an appropriate intervention program.

LMICs struggle to generate historical cancer incidence data over a period due to little investment committed to sustaining this critical infrastructure needed for cancer control in these countries. There are also many competing health demands in SSA that cripple the establishment and maintenance of PBCRs, the source of these historical cancer incidence data. Hence, notably in SSA, only a few cancer incidence data are reported. Despite the challenges, SSA faces in cancer registration compared to other LMICs, directed investment towards staff training and infrastructure limitations can improve the current situation.

The new information derived from Nontuthuzelo Somdyala’s dissertation significantly impacts decision-making and a statistical infrastructure for health information. It is also essential to inform the national government about a more targeted control program to reduce cervical cancer burden, improve survival, and review the current cytology-based screening program policy rolled out more than 20 years ago in South Africa.

The event can be followed also via remote connection.

The dissertation is available online at