Health Arena With Dr. Adesina: Cancer Series (1) – Why Preventing Cervical Cancer Is Better Than Cure

 

Cancer of the cervix kills more women worldwide than HIV/AIDS, TB and Malaria put together. The cervix is the lower part of the uterus (womb). The womb is where a fetus (unborn child) grows. The cervix connects the womb to the vagina. Cancer of the cervix (also known as cervical cancer) is a major public health problem in Nigeria and it is the second most common cancer (next only to breast cancer), among women worldwide. More than half a million new cases of cancer of the cervix are recorded each year, while about 86% of the cases occur in developing countries including Nigeria. Each year, about 10,000 women develop cervical cancer in Nigeria and 26 women die from cervical cancer daily in Nigeria. Cervical cancer ranks as the 2nd most frequent cancer among women in Nigeria, and the 2nd most frequent cancer among women between 15 and 44 years of age. Cervical cancer occurs rarely in women under 30 years of age, and occurs most commonly in women over 40. Since it’s also associated with the early age at which sexual intercourse begins, it remains a problem in African countries. Despite the burden of cervical cancer in Nigeria, only about 52% of Nigerian women are aware of this deadly disease, while less than 7.1% of Nigerian women have reportedly had cervical cancer screening done. Cancer of the cervix is 99% preventable and prevention is the key for reduction and control of cervical cancer in Nigeria.

 

What are the causes of cancer of the cervix?

Like most other cancers, definitive cause of cancer of the cervix is not known. However, some risk factors that are strongly associated with cancer of the cervix have been identified. A risk factor is anything that increases someone’s chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

 

Several risk factors increase someone’s chance of getting cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these factors increase the odds of getting cervical cancer, many women with these risk factors do not develop this disease. It is important to know these risk factors because the knowledge will help you to focus on what you can change or avoid such as smoking, rather than those that you cannot (such as your age and family history). Furthermore, knowing about risk factors will increase your awareness on getting regular Pap tests to detect cervical cancer early. Cervical cancer risk factors include:

 

1. The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV) infection. HPV is spread through sex (anal, vagina and even, oral sex) and from one person to another during skin-to-skin contact. Although HPV can be spread during, sex doesn't have to occur for the infection to spread. Although scientists believe that it’s necessary to have had HPV for cancer of the cervix to develop, most women with this virus do not develop cancer. Doctors believe that other factors must come into play for cancer to develop. Some of these known factors are listed below.

 

2. Male factor. Having a promiscuous male partner and having sex with a male partner who is not circumcised are recognised risk factors.

 

3. Smoking. Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals. Smoking also makes the immune system less effective in fighting HPV infections.

 

4. Immunosuppression. HIV damages the immune system and puts women at higher risk for HPV infection. This might, in part, explain the increased risk of cervical cancer in women with AIDS. Diabetes is also a condition that predisposes a woman to cervical cancer.

 

5. A diet low in fruits and vegetables. Women whose diets don’t include enough fruits and vegetables may be at increased risk for cervical cancer.

 

6. Being overweight: overweight women are more likely to develop cancer of the cervix.

 

7. Family planning/birth control pills choices. Long-term use of oral contraceptives increases the risk of cancer of the cervix, while use of Intrauterine Contraceptive Device (IUCD) is protective and might prevent development of cervical cancer.

 

8. Being younger than 17 at your first full-term pregnancy. Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.

 

9. Having a family history of cancer of the cervix. Cancer of the cervix may run in some families. If a woman’s mother or sister had cervical cancer, her chances of developing the disease are 2 to 3 times higher than if no one in the family had it.

 

What are the features of cancer of the cervix?

Women with early cancer of the cervix usually have no symptoms. Symptoms often do not begin until when the disease is advance. When this happens, the most common symptoms are:

 

• Abnormal vaginal bleeding, such as bleeding after sex, bleeding after menopause, bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual.

 

• An unusual discharge from the vagina − the discharge may contain some blood and may occur between your periods or after menopause.

 

• Pain during sex 

 

It is important to stress that these signs and symptoms can also be caused by conditions other than cancer of the cervix. For example, an infection can cause pain or bleeding. Still, if you have any of these problems, you should see your doctor right away. If it is an infection, it will need to be treated. If it’s cancer, ignoring symptoms might allow it to progress to a more advanced stage and the chance for effective treatment. Better still, don't wait for symptoms to appear. Be screened regularly.

 

How can cancer of the cervix be prevented?

1. Cervical cancer screening via Pap smear test. Cervical screening is a method of preventing cancer by detecting and treating early abnormalities which, if left untreated, could lead to cancer in a woman's cervix. This simple test picks up pre-cancer cells before they can turn into invasive cancer. If a pre-cancer is found, it can be treated, stopping cervical cancer before it really starts. In most countries, there are national policies on population-based screening for cancer of the cervix through pap smear test. These policies recommend pap smear test of between 3 – 5 years interval for women starting from their mid-twenties. Whilst cervical cancer screening cannot be 100 per cent effective, cervical cancer screening programmes have been shown to reduce the incidence of cancer in a population of women. This test is available in a few places in Nigeria and there is no definitive national policy on cervical cancer screening in Nigeria.

 

2. Avoid getting HPV infection. Si nce HPV is the main cause of cervical cancer, avoiding exposure to HPV could help you prevent this disease. HPV infections occur mainly in younger women and are less common in women older than 30. The reason for this is not clear. Certain types of sexual behaviour increase a woman's risk of getting HPV infection, such as having sex at an early age and having many sex partners. Women who have had many sex partners are more likely to get infected with HPV, but a woman who has had only one sex partner can still get infected. This is more likely if she has a partner who has had many sex partners. Waiting to have sex until you are older can help you avoid HPV infections. It also helps to limit your number of sex partners and to avoid having sex with someone who has had many other sex partners. Although the virus most often spreads between a man and a woman, HPV infection and cervical cancer also are seen in women who have only had sex with other women.

 

3. Use of condoms. Condoms provide some protection against HPV but they don’t completely prevent infection. Men who use condoms are less likely to be infected with HPV and to pass it on to their female partners. One reason that condoms cannot protect completely is because they don’t cover every possible HPV-infected area of the body, such as skin of the genital or anal area. Still, condoms provide some protection against HPV, and they also protect against HIV and some other sexually transmitted infections.

 

4. Don’t smoke. Not smoking is another important way to reduce the risk of cervical pre-cancer and cancer.

 

5. Get vaccinated by HPV vaccines. Vaccines are available that can protect against certain HPV infections. These vaccines only work to prevent HPV infection − they will not treat an infection that is already there. That is why, to be most effective, the HPV vaccines should be given before a person becomes exposed to HPV (such as through sexual activity). These vaccines help prevent cancers of the cervix. Ideally, young women, aged between 11 and 14, should be vaccinated before they have sexual intercourse since they often acquire HPV infection within months after the first sexual intercourse. The vaccines require a series of 3 injections over a 6-month period. The vaccine is available and accessible at some private and public hospitals in Nigeria at an average cost of N15, 000:00. In April 2009, WHO issued a position paper on HPV vaccination. It recommended that routine HPV vaccination be included in national immunisation programmes, provided that cervical cancer or other HPV-related disease prevention measures are a public health priority for the country. Nigeria is yet to key in to this policy.

 

6. Visual Inspection with Acetic acid (VIA) followed by cryotherapy treatment for pre-cancer cells offer new opportunities to improve the impact of cervical cancer prevention efforts, especially in low resource settings. VIA consists of inspecting the cervix with the naked eye using a bright light source, after applying a 3%-5% solution of acetic acid. This test is effective, supported by an extensive body of scientific evidence, simple, feasible, and accessible and can be performed by mid-level health personnel after a relatively short training period. It requires minimal infrastructure and the consumables are within reach in any setting. The enormous advantage of VIA is that its results are available immediately and therefore the “screen and treat” approach can be applied, whereby treatment is administered to positive women during the same visit. This method is being adopted by a number of local and international NGOs in Nigeria. A number of private health facilities in Nigeria, particularly in Lagos has already keyed in into the process.

 

Can cancer of the cervix be treated?

Yes, if detected early. Cancer of any kind is a bad news everywhere, but not a death sentence as it is the case in Nigeria. Comprehensive treatment is not readily available, expensive and the outcome is usually gloomy. The available treatment modalities for cervical cancer are Surgery, Radiotherapy, Chemotherapy and or combination of Chemotherapy and surgery, chemotherapy and radiotherapy (Chemoradiation).

 

In conclusion, health awareness is the key to healthy living and prevention of diseases including prevention of cancer of the cervix. Cancer of the cervix constitutes a major public health problem in Nigeria. There is a lot of works to do at individual, community and policy-making levels to tackle the menace of cancer of the cervix. Living healthy life style such as avoidance of smoking and sex education at early life is important measures of prevention. Dedicated use of condom as a preventive method of infection prevention is a laudable individual decision for prevention of cancer of the cervix, especially when history of multiple sexual partners can be elicited. By and large, routine screening is the main stay of prevention as potential victims with non-modifiable risk factors such as women with family history of cervical cancer can be captured and treated early.  Government at all levels should, at the background of widespread awareness campaigns, summon political will to formulate policies on immunization against HPV infections in among pre-teenage girls in line with the world Health Organization recommendations and organized cervical cancer screening programmes. Generally, treatment is expensive and survival is poor because of late presentation. Therefore prevention remains the best approach control of cervical cancer as it is cheaper, wiser, more feasible and better than cure.

 

About the Author

Dr Olasunkanmi Adesina, our anchor for Health Arena, is a General Medical Practitioner and a Public Health Policy Analyst. After obtaining his first degree in Medicine and Surgery from LAUTECH, Ogbomoso, Oyo State, he proceeded to the University of East London, UK, to obtain his postgraduate Masters Degree in Public Health. He currently works with NGOs and he is a Medical Research Consultant for Government and non-governmental agencies. For further enquiries, the author can be contacted via his personal email: drsunky14@yahoo.com