Lynette Denny is the Chair and Professor of Obstetrics & Gynaecology and registered sub-specialist in Gynaecological Oncology at Groote Schuur Hospital and University of Cape Town. Her research interest for the past 15 years has been in preventing cervical cancer in low-resource settings and she has published over 100 peer-reviewed papers on the subject. She has been a keynote speaker at numerous international conferences. She was awarded the Distinguished Scientist for Improving the Quality of Life of Women by the South African Department of Science and Technology in 2006 and is a B2 rated scientist by the National Research Foundation of South Africa. She was the first recipient of the Shoprite Checkers SABC 2 Women of the Year award for Science and Technology in 2004. She was awarded the South African Medical Association award for extraordinary Service to Medicine (2012) and given a fellowship ad eumdem to the Royal College of Obstetrics and Gynaecology, United Kingdom (2012). Professor Denny was presented with the BSCCP Founders' Medal at the 15th World Congress for Cervical Pathology and Colposcopy in London, UK in May 2014. This award is in recognition of the outstanding contribution she has made to women's health and the prevention of cervical cancer in Africa. In October 2015 Professor Denny was presented with the International Federation of Gynaecology and Obstetrics (FIGO) Award in Vancouver, Canada. This award is in recognition of women obstetricians and gynaecologists.
Screening and early detection of cancer of the cervix in Africa
Sub-Saharan Africa (SSA) consists of 54 countries almost all of which have the lowest ranked Human Development Index (HDI) and highest Human Poverty Indices (HPI). With a total population estimated in 2008 of 812 million (404 million men and 408 million women), only 7.2% were covered by medically certified causes of death and 8.3% by population based registries. The African continent has 130 medical schools located in 41 countries, but facilities for training in cancer diagnosis and management are found mainly in North Africa and South Africa with limited facilities elsewhere. Adding to the complexity of the challenges facing SSA (ranging from environmental disasters, to competing health needs, endemic civil strife, war, lack of safe water and sanitation to name a few) has been the HIV/AIDS epidemic, where 70% of the world’s cases of HIV are diagnosed. It is well known that HIV infection increases the risk of developing certain cancers and Kaposi sarcoma, non-Hodgkin lymphoma and cervical cancer have been classified as AIDS defining diseases since 1993.
Women infected with HIV have an increased risk of being infected with HPV and are therefore considered at higher risk for cervical cancer. However, the expected increase in women diagnosed with cervical cancer in Africa during the HIV pandemic was not convincingly observed, most likely due to most at-risk women dying from other opportunistic infections prior to developing cervical cancer or its precursors. In the era of anti-retroviral medication, this scenario is expected to change.
One of the initial problems encountered in initiating screening programs in LMICs is the detection of a relatively large number of incident cancers. This poses an ethical and logistical dilemma as access to treatment in many developing countries is extremely limited. Most patients cannot afford to pay the costs of cancer therapy, even where it exists.