Cervical Cancer Awareness Month – update from the MALSCOT programme

26 January 2024

Malawi has the highest mortality rate from cervical cancer in the world, with families and communities hugely impacted by mothers’ deaths at relatively young age.

As January is Cervical Cancer Awareness Month, we are very glad to be able to share this positive update from the MALSCOT programme on their great progress and targets for the future, Cervical Cancer having the potential to be the first cancer with the possibility of global elimination by 2030.

The MALSCOT programme and its predecessor, funded by the Scottish Government International Development Programme for Malawi over 8 of the last 11 years, has enabled a number of volunteers from different NHS Health Boards and different professional groups to train and support Malawian providers to deliver a same day cervical ‘screen and treat’ programme for a large number of rural women who have never before had access to screening, let alone treatment. This competence assured programme has impacted the lives of thousands of women and would not have been possible without the passion and commitment to the partnership between our Malawian provider colleagues and our Scottish volunteers.

In that time the programme has:

  • Raised community awareness of cervical cancer, its association with the virus HPV, and the preventable nature of the cancers through screening
  • Provided cervical screening services on a daily basis in 8 hubs across all three regions of Malawi and on a weekly basis in 35 ‘spoke’ health centres, some of them at great distance from the hub
  • Provided ‘outreach’ clinics to the most inaccessible areas where women could not reach a health centre
  • Trained >100 providers of VIA screening (visual inspection with acetic acid) and same day treatment (by thermal ablation) of early lesions. While this is different from the screening programme in the UK, it is affordable and scalable, as shown during the interval between our two large grants
  • Screened >140,000 women, offered same day treatment where relevant, biopsies of suspicious cancers, follow-up where needed, referral to secondary/tertiary level services where appropriate and access to palliative care for women with frank cancers.
  • Created a database which will allow expansion to other centres and collection of national data to inform future policies.

There is much still to do! Cervical cancer is the first cancer with the possibility of global elimination by 2030 through:

  • 90% vaccine uptake in girls over 9 years of age, preferably through a schools-based programme
  • 70% screening up take at least twice between ages 30-50
  • 90% access to treatment for those with early and treatable lesions.
  • Cervical Cancer Elimination Initiative
The UK does not yet hit these targets, although Scotland achieved >90% uptake of vaccine in the first few years, the highest in UK (2008 onwards, but slipping annually), does reach 70% screening coverage in some age groups but not across all and should be able to access to 90% of those who need it. There are many challenges for Malawi in reaching these three WHO goals, but we hope, with on-going support and advocacy and the lasting friendships and partnerships which have developed with colleagues, that we can help establish a nationwide screening programme.
Cervical Cancer Awareness 5

The programme has been called MALSCOT since 2018 and was first led by Professor Heather Cubie (Consultant Clinical Scientist in Virology, NHS Lothian) from 2013-2018 and by Dr Christine Campbell (Reader, Usher Institute, University of Edinburgh) since 2018. In the early years, Dr Graeme Walker (Consultant Gynae Oncologist) and Sr Hilary Walker (Consultant Nurse Colposcopist), NHS Lothian) and Dr Miriam Deeny (Lead Colposcopist, NHS Greater Glasgow and Clyde) contributed hugely to the development and training of the clinical programme. Laboratory training and support for HPV testing was delivered by Professor Cubie with a self-sampling project by Dr Grazyna Stanczuk (Consultant Gynaecologist, NHS Dumfries and Galloway, 2015) and advanced HPV testing by Dr Ramya Bhatia (Clinical Scientist, NHS Lothian, 2017). From 2016 both Dr Deeny and Dr Wendy McMullen (Locum Consultant in O&G, NHS Tayside) have provided clinical support and education in Malawi and regular CPD sessions both in person and on-line with Dr Campbell being responsible for development of Mentoring and Safeguarding toolkits.

MALSCOT and the UN’s Sustainable Development Goals (SDGs)

MALSCOT contributes to three Sustainable Development Goals – Good Health and Wellbeing; Reduce Inequalities; and Partnerships for the Goals.

The focus and direct beneficiaries include women of all ages:

  • Young women with little knowledge and understanding of the burden of cervical cancer and the benefits of preventative measures.
  • Older women within the Ministry of Health age range for cervical screening who will benefit from access to same day ‘screen and treat’ services.
  • Women living with HIV who are at significantly greater risk of developing cervical cancer.
  • Vulnerable and disadvantaged women, including those with disabilities who find access to clinics difficult and those in prison/young offenders’ institutions who are often forgotten in the development of new services.