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By Enyeribe Ejiogu
Stephanie Omoarebun, a medical laboratory scientist and Executive Director of The Labcoat Agency, has been engaged in healthcare outreaches, actively motivating residents of the Federal Capital Territory to adopt the life-saving and longevity enhancing practice of undergoing regular health checks, so that they know their vital numbers and health status. Such regular health checks will go give early indications of the formative stages of life-threatening disease conditions. In addition to her preventive health checks campaigns, Omoarebun devotes quality time as National Secretary to the running of the affairs of the Young Medical Laboratory Scientists Forum.
In this interview, she speaks on the increasing incidence of misdiagnosis as well as late diagnosis of cancer, and makes a call for strengthening systems for prevention, early detection and care for cervical cancer. As part of prevention, she advocates for increased vaccination against HPV infection, a predisposing factor for cervical cancer.
Pain a picture of the burden of cervical cancer in Nigeria.
Cervical cancer remains a major public health concern in Nigeria, despite being largely preventable. The 2020 estimates reported approximately 12,000 new cases and 8,000 deaths annually. These figures highlight persistent gaps in prevention, screening, diagnosis and treatment.
The tragedy is that cervical cancer often develops over several years, passing through precancerous stages that can be detected and treated. We have effective tools to prevent many of these deaths. The challenge is ensuring that women can access them early enough to make a difference.
Cervical cancer is now preventable. Why are many Nigeria women still being affected?
The existence of effective interventions does not automatically guarantee access to them. Many women face limited awareness, misinformation, stigma, financial constraints and inadequate access to screening services. Others may undergo screening but struggle to obtain their results or complete further investigations.
In my interactions around cervical cancer awareness, I have encountered experiences that illustrate why awareness alone is not enough. One woman who had previously undergone a Pap smear and received a negative result said she would not want to repeat it because she had heard that cervical cancer was associated with having multiple sexual partners. Another woman, despite receiving information about screening, explained why she had not gone for one: “The reason I have not gone for the Pap smear is because I feel like it’s invasive.” I also encountered a woman who was interested in getting screened but declined because the cost of a Pap smear, which ran into thousands of naira, was beyond what she was willing or able to pay.
These experiences reveal three distinct barriers: misinformation and stigma, fear of the procedure, and affordability. They demonstrate that the challenge is not simply convincing women that screening matters. We must also address their concerns, provide respectful counselling and make screening financially accessible.
Awareness must be matched with accessible, affordable and reliable services. Otherwise, we risk telling women to take responsibility for their health without ensuring they have a realistic opportunity to do so.
HPV vaccination has been incorporated into the nation’s routine immunisation programme. What is your general assessment of the programme, in terms of coverage and success? What would you say are the major challenges?
Nigeria’s introduction of HPV vaccination into its national immunisation programme in October 2023 was an important public health milestone. The initial rollout targeted approximately 7.7 million girls aged 9–14.
However, we must distinguish the number of girls targeted or reached during an initial campaign from sustained national vaccination coverage. Assessing measurable progress requires current, disaggregated data showing who has been vaccinated, which communities are being missed and whether coverage is being maintained.
Challenges include misinformation, vaccine hesitancy, difficulties reaching out-of-school girls, logistical constraints and the need for sustainable financing. The next priority is to strengthen routine immunisation, improve community engagement and ensure that missed populations are reached. Vaccination must also be complemented by screening and treatment services for women who need them.
How effective is the HPV vaccination programme in preventing cervical cancer and how can cervical cancer screening be expanded to rural and underserved communities?
HPV vaccination is highly effective in preventing infections caused by the HPV types responsible for most cervical cancers, particularly when administered before exposure to the virus. However, vaccination does not protect against every cancer-causing HPV type, so screening remains essential.
To expand screening in rural and underserved communities, Nigeria needs stronger primary healthcare facilities, community outreach, trained personnel and affordable services. Validated HPV self-sampling approaches, where appropriate, may also help reduce barriers to participation.
However, expanding screening must go hand in hand with reliable diagnostic services and referral pathways. Reaching more women is important, but ensuring that women with abnormal results receive further assessment and appropriate care is equally essential.
What are the major barriers to HPV vaccination among eligible girls in Nigeria?
Misinformation, parental concerns, inadequate community engagement and difficulties reaching out-of-school girls are major barriers. Some parents have concerns about vaccine safety or future fertility because of misleading information.
These concerns should be addressed respectfully through evidence-based communication involving healthcare workers, teachers and trusted community leaders. Even where vaccination is free, transportation costs and limited access to vaccination sites can prevent uptake.
We need a combination of school-based vaccination, routine immunisation, community outreach and reliable data to identify girls who have been missed. Building trust is just as important as making the vaccine available.
To reduce cervical cancer death, what the most urgent actions Nigeria should take?
Nigeria must strengthen HPV vaccination, screening and treatment as interconnected priorities. This requires investment in reliable diagnostic services, functional equipment, skilled personnel, affordable care and effective referral systems.
We must also monitor whether women with abnormal screening results complete further investigations and receive appropriate treatment.
A screening programme cannot be judged by the number of women tested alone. We must also ask whether the results are reliable, whether abnormal findings are followed up, and whether women receive treatment in time. Otherwise, we risk counting activities without measuring the lives actually protected.
This is the fundamental shift Nigeria needs to make: from measuring activities to measuring outcomes. A programme should not be considered successful simply because vaccination campaigns were conducted or screening targets were met. Success means preventing disease, detecting abnormalities reliably and ensuring that women receive timely care.
How can Nigeria improve HPV vaccination coverage and screening uptake?
Nigeria must make vaccination and screening accessible, affordable and acceptable to the populations they are intended to serve. School-based vaccination should be complemented by outreach to girls outside the school system, while primary healthcare facilities and community-based services can bring screening closer to women.
Communication must also address the concerns women actually have. My encounters with women who questioned the need for repeat screening after a negative result or felt that Pap smears were invasive demonstrate why generic awareness messages may not be enough.
Women need accurate information about HPV, clear explanations of what screening involves and reassurance that seeking screening is a preventive health decision, not a judgement of their sexual history. They should also understand that a negative result does not necessarily mean they will never need screening again; the recommended interval depends on the test used, age, individual circumstances and applicable guidelines.
Ultimately, uptake improves when people trust the information, can access services conveniently and know that they will receive their results and appropriate follow-up.
How can laboratory scientists and public health experts collaborate to improve early detection?
Medical laboratory scientists contribute to diagnostic reliability through appropriate testing, specimen quality, accurate analysis, quality assurance and timely reporting. Depending on the screening pathway, laboratory services may support HPV testing, cytology and histopathological assessment.
Public health experts contribute by identifying populations at risk, designing interventions, mobilising communities and evaluating programme outcomes. Working together allows us to connect population-level prevention with reliable diagnostic services.
This collaboration should extend to programme planning, policy development, monitoring and evaluation. Laboratory professionals should not be involved only after screening programmes have been designed; diagnostic capacity and quality must be considered from the outset.
What are the consequences of delayed diagnosis and inadequate follow-up?
Delayed diagnosis can allow precancerous changes to progress to invasive cancer, reducing opportunities for early intervention. Advanced disease may require more complex treatment, increase costs and cause significant complications, reduced quality of life or death.
Inadequate follow-up compounds the problem. A woman may receive an abnormal screening result but be unable to afford further investigation, travel to a referral facility or navigate a poorly coordinated health system.
This is why screening must be linked to a functional pathway of care. Results must be communicated promptly, referrals completed and patients supported through further assessment and treatment. Identifying a potential problem without ensuring access to the next stage of care leaves women vulnerable.
What strategies can improve access to diagnosis, treatment, and follow-up care for women with abnormal screening results?
Nigeria needs clear referral pathways linking primary healthcare facilities with centres capable of providing further investigations and treatment. Women should receive their results promptly, understand what those results mean and know where to go next.
Patient-tracking systems can help identify women who need further assessment but have not returned, provided confidentiality is protected. Public financing, subsidies and other measures to reduce out-of-pocket costs are also important.
Healthcare facilities need adequate staffing, functional equipment, reliable supplies and effective communication between laboratories, clinicians and referral centres. A referral should not simply mean that a woman has been told where to go; it should increase the likelihood that she actually receives the care she needs.
What practical steps can be taken to improve cervical cancer services in rural communities?
The starting point is to strengthen primary healthcare facilities and build functional links with diagnostic and treatment centres. Community outreach, trained health workers, women’s groups and local leaders can help improve awareness and participation.
Services should reflect the realities of the communities they serve, including transportation costs, staff availability and distances to referral facilities. Where it is appropriate, validated self-sampling approaches may offer another way to reduce barriers to screening.
However, outreach must be linked to follow-up care. The effectiveness of rural cervical cancer services should be measured not only by the number of women reached or screened, but also by whether they receive results, complete necessary investigations and access treatment.
How can Nigeria achieve the World Health Organization’s 90–70–90 cervical cancer elimination targets by 2030?
The WHO targets call for 90 per cent of girls to be fully vaccinated against HPV by age 15; 70 per cent of women to be screened with a high-performance test by ages 35 and 45; and 90 per cent of women identified with cervical pre-cancer to receive treatment, alongside 90 per cent of women with invasive cervical cancer receiving appropriate management.
Achieving these targets requires coordinated implementation, adequate financing, reliable data and accountability at national and subnational levels. Nigeria must track vaccination and screening coverage alongside diagnostic capacity, treatment completion and disparities between communities.
These targets must translate into funded programmes with clearly assigned responsibilities and measurable outcomes. We need to know not only how many girls were vaccinated and women screened, but also whether diagnostic and treatment services can meet the needs those interventions generate.
How does misdiagnosis contribute to late detection and poor outcomes in cervical cancer?
Diagnostic errors can delay appropriate care or give patients false reassurance. False-negative screening results, inadequate specimens, errors in processing or interpretation, and weaknesses in quality assurance can all affect diagnostic reliability.
It is important to distinguish screening from definitive diagnosis. An abnormal screening result does not automatically mean a woman has cancer; it indicates that further assessment may be necessary. Depending on the findings, this may involve clinical assessment, colposcopy or histopathology.
Reducing errors requires competent personnel, appropriate testing methods, effective quality assurance and clear communication between laboratories and clinicians. At the same time, not every late diagnosis results from laboratory error. Delayed presentation, lack of screening and barriers to follow-up also contribute.
We must strengthen the entire diagnostic pathway, ensuring that results are reliable and that clinical decisions are based on appropriate evidence.
How does inadequate diagnostic equipment affect cervical cancer detection and management in Nigeria?
Inadequate or non-functional equipment can compromise access, turnaround times and the reliability of diagnostic services. When facilities lack the equipment, reagents or consumables needed to provide appropriate testing, women may have to travel elsewhere, incur additional costs or abandon the process altogether.
Depending on the service, diagnostic requirements may include HPV testing platforms, cytology capacity, colposcopy equipment and histopathology services. But purchasing equipment alone is not enough. Equipment must be maintained, supplies replenished, quality assurance sustained and personnel trained to use it competently.
Nigeria needs needs-based investment in functional diagnostic capacity, supported by maintenance plans, reliable supply chains and appropriate quality management. A machine that cannot be operated consistently or produces results without adequate quality assurance does not provide dependable diagnostic capacity.
How serious is the shortage of skilled personnel in cervical cancer prevention and care?
Manpower shortages affect every stage of care, from community education and screening to laboratory testing, specialist assessment and treatment. In laboratories, inadequate staffing can increase workloads, delay results and limit the time available for quality assurance. Shortages of pathologists, clinicians, nurses and oncology specialists can create further bottlenecks.
The challenge is not simply how many professionals are trained, but whether they are adequately supported, retained and distributed across the country. Services concentrated in major urban centres leave women in rural and underserved communities at a disadvantage.
Nigeria needs deliberate workforce planning, recruitment, continuing professional development, supportive working conditions and equitable deployment. Equipment and policies cannot deliver their intended benefits without the skilled professionals needed to implement them. Nigeria must move from awareness campaigns and isolated screening exercises to a properly funded, accountable cervical cancer prevention system. That means strengthening HPV vaccination, expanding access to appropriate screening, investing in reliable diagnostic services and skilled personnel, reducing financial barriers, and ensuring that every woman with an abnormal result can access further assessment and treatment.
Nigeria does not have a knowledge problem alone; it has an implementation problem. We cannot claim progress simply because women have been sensitised or screened. Progress means that prevention reaches those at risk, results are reliable, and every woman who needs further care has a realistic pathway to receive it.
As a medical laboratory scientist and public health practitioner, I believe our measure of success must go beyond how many women we reach or screen. It must include whether women receive reliable results, complete follow-up and access timely treatment. Ultimately, the goal is not simply to run a cervical cancer programme; it is to prevent avoidable illness and deaths.
