Reproductive tract cancers remain a major public health crisis globally, disproportionately affecting women in low- and middle-income countries like Nigeria. Cervical cancer stands out as the most frequent gynaecological malignancy locally, largely driven by persistent high-risk human papillomavirus infections and limited access to structured screening programmes. Ovarian and uterine cancers also contribute significantly to female morbidity and mortality. Unlike high-income nations where organised screening and widespread vaccination have sharply driven down cervical cancer rates, Nigerian women often present late with advanced-stage disease. This late presentation drastically reduces survival chances and places a heavy emotional and financial burden on families and healthcare systems.
Beyond viral causes, lifestyle choices, hormonal exposure, and genetics heavily influence uterine and ovarian malignancies. Obesity is a major risk factor for endometrial cancer because excess adipose tissue converts androgens into oestrogen, driving unopposed endometrial proliferation. Nulliparity, early menarche, and late menopause extend a woman's cumulative lifetime exposure to ovulatory cycles and oestrogen surges. Tobacco smoking specifically contributes to squamous cell cervical cancer by acting as a co-factor with human papillomavirus. Furthermore, inherited mutations in the BRCA1 and BRCA2 genes drastically elevate the lifetime risk of developing both ovarian and breast cancers.
Primary prevention aims to stop the disease before it ever starts. For reproductive cancers, particularly cervical cancer, vaccination against human papillomavirus is the cornerstone of this approach. Vaccines are most effective when administered to young adolescent girls before their first sexual encounter and exposure to the virus. Health education promoting barrier contraceptive use, delaying sexual debut, and smoking cessation also play vital roles. Midwives must actively advocate for school-based and community-wide immunisation programmes to ensure high coverage rates among pre-teens and teenagers across Nigeria.
Secondary prevention focuses on detecting precancerous lesions and early malignancies when they are most treatable. In low-resource settings where cytopathology laboratories for Pap smears are scarce, alternative screening methods are essential. Visual Inspection with Acetic Acid (VIA) allows immediate identification of abnormal cervical tissue by turning precancerous cells temporarily white after applying vinegar. Human papillomavirus DNA testing offers high sensitivity and can sometimes be done using self-collected samples. When abnormalities are found during visual inspection, healthcare providers can often perform immediate treatment using thermal ablation or cryotherapy, following a 'screen-and-treat' approach.
Midwives are often the first point of contact for women seeking maternal and reproductive health services. This position places them at the forefront of cancer awareness, screening, and referral. Midwives must debunk cultural myths, such as the belief that cancer is caused by spiritual attacks or that screening is painful and harmful. By offering opportunistic screening during antenatal, postnatal, and family planning visits, midwives catch many women who would otherwise never visit a clinic for screening. Training community health workers and running educational talks further extends this outreach, fostering a culture of proactive reproductive health.