The word cancer instils shock and fear in most people and in some cultures it is associated with stigma. In this article I will talk about cervical cancer (CaCx), one of the leading causes of cancer deaths and illness among women worldwide. The good news is that with proper interventions, this is a largely preventable cancer if it is detected early.
Globally, one woman is diagnosed with cervical cancer every minute each year and the majority of these women are in developing countries. Approximately 275 000 women die from CaCx every year. Cervical cancer is rare in women below 30 years and common above 40 years, with most deaths occurring in women between 50 to 60 years. Globally cervical cancer is the second most common cancer in women after breast cancer and this is also true for Namibia.
The sad thing is that in developing countries more than 80 per cent of women are diagnosed late when they already have advanced diseases, due to lack of organised screening programmes.
The cervix is the opening or “mouth” that leads into the woman’s womb and the cancer starts in this small anatomical area which is 3 cm in length and 2,5 cm in diameter, before it spreads to other parts of the womb and body if left unattended.
Cervical cancer is caused by a sexually transmitted virus called Human Papilloma Virus (HPV). There are several types of this virus but the ones that cause CaCx are mainly type 16 and type 18 (these two types account for 70 per cent of CaCx). HPV is a very common virus and more than 80 per cent of sexually active women have had or have HPV infection, therefore every sexually active woman is at risk of acquiring the cancer causing HPV infection (type 16 and 18) during their lifetime. The good news is that not all HPV infections lead to cancer. In most instances, the body’s own immune system clears this virus and the infection resolves on its own in women with strong immune systems. Thus most women with HPV infection do not necessarily develop CaCx.
Given that most sexually active women have HPV infection during their lifetime the frequently asked question is, why do other women progress to cervical cancer and others do not develop cancer? There are some risk factors that may cause HPV infection to progress from pre-cancerous stage to cancerous stage. The link between lung cancer and tobacco smoking has long been established, but smoking is also a risk factor for developing CaCx.
Women who smoke tobacco are at a greater risk of getting cervical cancer than those who do not smoke. HIV infection is also a risk factor for developing CaCx as it weakens the women’s natural immune system and thus women with HIV have greater chances of getting CaCx than those who are not HIV infected. Girls who engage in sexual activity very early have a high risk of developing CaCx late in life. Having more than 5 children is also a risk factor for CaCx. Women who have unprotected sex and have multiple sexual partners also have a higher risk of developing CaCx.
It is important to note that medical male circumcision reduces the female partner’s risk of getting cervical cancer. So women, that’s a bonus for you, get your partners circumcised! Voluntary medical male circumcision is being offered free of charge in state facilities in Namibia and also by private doctors where it’s covered by medical aid.
Early CaCx has no signs and symptoms and therefore screening is very important as a preventive measure. Another good piece of news is that it takes 10 to 20 years for pre-cancer cells to develop into cancerous cells in women with strong immunity. It is therefore possible to stop progression of the cancer by screening women at regular intervals given the time it takes for pre-cancer cells to develop into cancer. The commonly used screening method in Namibia is the PAP smear and these tests can prevent most cases of cervical cancer. This involves taking cells from the woman’s cervix and sending it to the laboratory to check for pre-cancerous cells.
This procedure is simple and non-invasive and can be performed by your doctor at their practising rooms. According to WHO, resources permitting, woman who are HIV negative should have a PAP smear every 2 years and women with HIV should have annual PAP smears since they have a higher risk of getting cervical cancer. However, even with limited resources if all women above 30 years could get a single PAP smear in a life time this would lead to a decrease in the burden of disease from cervical cancer.
Another prevention strategy is through vaccination against the common types of HPV (type 16 &18). As mentioned before all sexually active women are at risk of acquiring HPV infection – it therefore follows that the best time to vaccinate is before sexual debut. So the primary target for vaccination is young girls between the ages of 9 to 13 years or before sexual debut. Sexually active women should know that whilst they can be vaccinated, the vaccine may be less effective since they may already have been exposed to HPV. In Namibia the current vaccine against the two common types of HPV that causes cervical cancer (Cervarix) is given as three shots on day one, after two months and after six months. This HPV vaccine is available in pharmacies in Namibia and is covered by medical aid.
The old adage, prevention is better than cure, rings true for cervical cancer. So the next time you visit your health facility or doctor always remember to ask about PAP smear – NOT pap as in food! And remember to tell your partner to get circumcised to lower your risk of getting cervical cancer.
• Dr Shepherd U Shonhiwa operates from the Baobab Medical Centre, Stop and Shop, Okuryangava. He can be contacted at firstname.lastname@example.org. 061 – 305381