Cervical Cancer in Liberia: Identifying Existing Gaps in Infrastructure and Treatment Availability

Research Article

Ann Carcinog. 2018; 3(1): 1015.

Cervical Cancer in Liberia: Identifying Existing Gaps in Infrastructure and Treatment Availability

Beddoe AM¹*, Jallah W², Pereira E¹, Dottino A³, Lieber MLMSW¹, Rehwaldt L¹, Solomon E4, Harris S4 and Dottino P¹

¹Department of Obstetrics and Gynecology, Icahn School of Medicine at Sinai, USA

²Hope for Women International, Monrovia, Liberia

³Georgetown University School of Nursing and Health Studies, USA

*Corresponding author: Beddoe AM, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, USA

Received: May 03, 2018; Accepted: June 27, 2018; Published: July 04, 2018


In Liberia, cervical cancer is the most common cause of cancer related death among women. The lack of prevention, screening and follow up programs, have made cervical cancer public health urgency. We reviewed charts on 157 women who presented for a treatment in Monrovia between 2008 and 2013. The objective of the review was to determine overall survival from cervical cancer based on current treatment strategies and to identify those factors that impact survival. The majority of women, >70% presented with advanced stage disease and 1/3 of women succumbed to their disease within 3 months if no treatment was given. Treatment with only chemotherapy or chemotherapy given in the neo-adjuvant setting followed by surgery increased overall survival to 6 and 9 months respectively. Patients who presented early in the course of their disease and were eligible for primary treatment with surgery survived the longest highlighting the need for awareness and early diagnosis. Given the identified infrastructural and human capacity deficits treatment options are limited. A comprehensive treatment strategy is necessary to demonstrate improvement in addressing the full spectrum of cervical cancer management in this resourceconstrained country.

Keywords: Cervical cancer; Cancer care; Liberia; Advanced staging; Chemotherapy


OS: Overall survival; IARC: The International Agency for Research on Cancer; FIGO: (The International Federation of Gynecology and Obstetrics; NACT: Neo-Adjuvant Chemotherapy; CINV: Chemotherapy Induced Nausea/Vomiting; SSA: Sub-Saharan Africa


In most developing countries, the absence of organized cervical cancer screening programs has contributed to a high disease burden and increased mortality from cervical cancer [1,2]. The introduction of the Papanicolaou smear as a screening test in the 1940s, led to dramatic improvements in prevention with over 75% reduction in incidence in developed nations and lifetime risk reductions of 25-35% with a single screening using varied non-cytology based methods for detection and treatment [3,4].

In low and middle income countries where implementation of sustainable screening programs is often not feasible, there is a high burden of cervical cancer. The International Agency for Research on Cancer (IARC) has estimated that of the 528,00 new cases of cervical cancer worldwide in 2012 over 85% occurred in LMICs [5]. In Liberia, a country that has seen its health infrastructure and capacity to respond to health emergencies compromised by war and the recent Ebola outbreak, cervical cancer is the leading cause of cancer related deaths and the second most common cancer among women [6]. With no options for comprehensive management of cancer in Liberia, and no in-country gynecology oncologists, women with cervical cancer often stay at home and succumb to their disease without seeking medical care, or they self refer to the only clinic in Monrovia that offers chemotherapy services.

To better assess the management of cervical cancer in Liberia we reviewed the charts of women presenting to this center for treatment between 2009 and 2013. The primary objective of this review was to determine the overall survival (OS) of patients with cervical cancer during that period. The secondary objectives focused on the infrastructural and treatment gaps that need to be addressed in order to provide cancer care to women with cervical cancer in Liberia.


A chart review of cervical cancer patients treated at the only clinic in Liberia providing cervical cancer care was undertaken. Of 185 women who presented for treatment of cervical cancer during the time period from March 2008 to July 2013, 157 had data that could be retrieved for analysis. Records were reviewed for basic demographic information, presenting symptoms, method of treatment and clinical status. Barriers to treatment-outcomes are additionally reported.


All patients had a diagnosis of cervical cancer made by visualization of lesions on speculum examination without pathologic confirmation.

Average age at presentation was 51 years (mode 48 years, range 30-87 years). Almost all patients presented with one or a combination of the following symptoms: weakness and lethargy, pain, nausea, vomiting, diarrhea, abnormal vaginal/heavy vaginal bleeding requiring transfusions, foul-smelling vaginal discharge, and recto- vaginal and/or vesico-vaginal fistulae (Table 1).