While some people know very little about cervical cancer, it is very common to come across people who have never heard about it before. Cervical cancer is a leading cause of death in women (especially those living in developing countries) and is considered as a preventable as well as treatable disease. It causes death of over one-quarter of a million women every year and it is estimated that a woman dies of cervical cancer every two minutes. Over time, many cases of the disease discovered in later stages can be due to low level of awareness, poor knowledge of the risk factors, symptoms, screening methods and treatment options.
Cervical cancer occurs when there is an abnormal growth of cervical cells which commonly affects women above 30years of age. The cervix is the lower part of the womb (uterus) which has an opening through which a baby or blood during menstrual flow passes to the exterior. There are several risk factors for cervical cancer which includes having children at a very young age, having many children, being HIV positive, smoking and having multiple sexual partners. Symptoms of cervical cancer include increased vaginal discharge (usually foul smelling), post-menopausal bleeding, spotting or light bleeding between menstrual periods, low back pain, weight loss, reduced appetite among others.
Cervical cancer is mainly caused by persistent infection with high-risk types (16 and 18) of Human Papilloma Virus (HPV). HPV is a common viral infection of the reproductive tract and is primarily sexually transmitted as well as through skin-to-skin genital contact. Many people may not know they are infected with HPV as there is usually no discomfort. The risk factor for HPV infection, in both men and women, include having sexual relations at an early age as well as a high number of sexual partners. There are different types of HPV, some of which can cause other diseases like warts, as well as anal, vulva, oral, penile cancers also.
In many cases, HPV infection clears by itself from the body’s own immune response. However, some HPV infection may not clear, and will become persistent subsequently affecting the cervix. It could take up to a decade or more for those with persistent HPV infection to develop cervical cancer. If not detected and treated, HPV infection can cause precancerous lesion in the cervix that can develop into cervical cancer. Having HPV infection does not mean one already has cancer.
Prevention of HPV and cervical cancer can be achieved through HPV vaccination and cervical cancer screening. The ideal way to prevent cervical cancer is to avoid HPV infection. HPV vaccination in girls aged 9 to 13 years, combined with HPV screening in women aged 30years and older is recommended to prevent disease. It is important to know that HPV vaccination does not replace screening for cervical cancer.
Research shows that it is possible to reduce deaths from cervical cancer through screening. However, HPV testing is regarded as much more accurate and effective in identifying women with greater risks of developing precancerous cervical lesions. The HPV test determines whether there is HPV infection in the cervix and HPV test samples can be taken by a clinician/ healthcare provider or by a woman herself (self-sampling) depending on available facilities in an area. You should discuss with your health care provider on your eligibility and preferred test for the disease. It is recommended that all women aged 30 to 49 years should be screened for HPV at least once in their lifetime. Screening may be extended to younger or older women, depending on the available resources and the woman’s risk of cervical cancer. Cervical cancer screening checks for pre-cancer and cancer among women who have no symptoms. It includes pap smear test done every 3 years starting from the age of 21; Co-testing (pap smear and HPV test) every 5years in women above 30years of age; Visual inspection with acetic acid. Screening should be followed up with appropriate and adequate treatment where necessary. Diagnosis of cervical cancer is made by histologic examination of tissues.
In developing countries, limited access to preventive measures as well as poor health seeking behaviour causes late presentation which usually worsens prognosis. Adopting a multidisciplinary approach can create more awareness, encourage regular screening, early treatment and lead to improved outcomes. The treatment option for cervical cancer will depend on the stage of the disease when detected and appropriate modality will be applied the physician/specialist. Vaccines do not treat HPV infection or cervical cancer and should not replace screening for the disease. Vaccines are most effective in preventing the disease when administered before exposure to HPV (which is usually before the onset of sexual activity).
Women with positive HPV results, pre-cancer or cancer require follow-up care an as well as appropriate counselling, education and treatment by the specialist. It is important for the women to respond to the invitation for follow-up when contacted in order to prevent cervical cancer.
Eating healthy, being physically active as well as generally adopting a healthy lifestyle will improve a woman’s immune system and help protect her from developing cervical cancer. The government has an important role to play in reducing the burden of cervical cancer and this can be achieved by creating more awareness, increasing women’s access to quality healthcare especially in terms of screening, diagnostic and treatment services, implementing policies that protect and promote reproductive health among many other interventions.
Health quote of the week:
“Deaths from cervical cancer could drop even lower if more women routinely had a Pap test. Because cervical cancer produces no symptoms in the early stage, regular screening is extremely important”
– Dr Joann Schaefer