Cervical cancer is not something that happens to “other women only”. 18.81 million SA women over the age of 15 are at risk.
The subject of cervical cancer has not received nearly as much attention as other life-threatening illnesses affecting women, says Dr Thandi Mtsi, a gynaecologist and obstetrician practising at Netcare Park Lane Hospital in Parktown, Johannesburg.
“And yet, according to a recent report of the HPV Information Centre, as many as 7 735 South African women are diagnosed with cervical cancer every year while 4 248 lose their lives annually because of the disease,” she adds.
The Human Papillomavirus and Related Disease Report published by the ICO HPV Information Centre on HPV and Cancer last year, indicated than 18.81 million South African women, over the age of 15 are at risk of cervical cancer.
“Given that approximately 80% of women will be exposed to the human papilloma virus (HPV) in their lifetime, this is clearly not something that happens to ‘other’ women only. These statistics are all the more disconcerting when one considers that cervical cancer is nowadays a preventable disease,” says Mtsi.
“With the aid of annual Pap smears and timeous vaccination against the cancer-causing human papillomavirus, a sexually transmitted infection, cervical cancer should have been totally eradicated by now.
“However, because of the incorrect perception that sexual promiscuity lies at the heart of this disease, it has been a difficult issue to tackle. Also of great concern, is the fact that girls are nowadays exposed to the virus at a younger age.
“Vaccinations against HPV became part of the national vaccination programme in 2014 when SA became the first African country to fund cervical cancer vaccines for schoolgirls. While awareness of the importance of the Nobel Prize-winning HPV vaccine has grown, take-up has sadly been slow,” says Mtsi.
According to Dr Kim Lohlun, an oncologist at Netcare Olivedale Hospital, despite the fact that cervical cancer is a preventable disease, it causes more deaths in South African women than of any other type of cancer.
“Vaccination against HPV is highly effective, but it is best to be vaccinated before becoming sexually active and it is recommended that girls as young as nine get vaccinated. However, it is never too late to get the injection, even though you may have come into contact with some of the HPV strains.
“The gold standard these days is the HPV test which checks for the virus that can cause these cell changes on the cervix. It may be used to screen for cervical cancer together with the Pap test and may also be used to provide more information when the results of a Pap smear are unclear. The HPV test is unfortunately not yet widely available and is also costly,” says Lohlun.
“Young women in their teens or early 20’s carry the highest rates of HPV infection. However, these are mostly cleared by the immune system. A positive HPV test in an older women is more likely to indicate persistent infection and this puts her more at risk of developing cervical cancer.”
“At the advent of the HIV/AIDS outbreak, people were very hesitant to talk about the disease, the HI virus and how it is transmitted. With the introduction of anti-retroviral treatment, which essentially rendered HIV infection a manageable ‘chronic disease’, this stigma was greatly reduced. In the same way, we now need to get discussions going on and spread awareness of HPV and cervical cancer. South Africans need to know that there is no shame in discussing this condition openly,” notes Lohlun.
WHAT IS THE HPV?
The human papilloma virus (HPV) is a double-stranded DNA virus. Up to 80% of sexually active women will acquire an HPV infection in their lifetime, with the risk of persistence increasing with age.
Approximately 100 types of HPV have been identified to date and, of these, nearly 15 virus types are considered to cause cervical cancer. Together the highest-risk virus types 16 and 18 are responsible for over 70% of cervical cancers globally.
“If you can protect yourself from getting an HPV infection, your chances of developing cervical cancer are miniscule,” says Mtsi.
The virus is transmitted through sexual contact and in rare cases from a mother to her newborn baby, explains Mtsi. Because the virus is not carried by bodily fluids but is transferred by contact, having protected sex will not give 100% protection against becoming infected. This also means penetration does not have to take place before the HPV is transmitted – rubbing against your partner can be enough to contract the virus.
WHAT IS THE LINK BETWEEN THE HPV AND CERVICAL CANCER?
The high-risk HPV virus types are responsible for virtually all cervical cancer, which is cancer of the cervix, the small canal between the womb and the vagina.
The more a woman comes into contact with the HPV, the greater her chances are of developing cervical cancer. “When your cervix is scarred from frequent infection, your cervical cells multiply to heal themselves. However, abnormal cells can multiply out of control as a result of the HPV infection and can cause pre-cancerous cervical lesions, which ultimately cause cervical cancer,” explains Mtsi.
According to Mtsi, there are no early symptoms for cervical cancer. “The first symptoms only appear as the disease progresses. Women should, however, look out for pain during sex, any change in their menstrual periods, an increased vaginal discharge, and any abnormal vaginal bleeding,” she advises.
According to Lohlun cervical cancer can be difficult to treat if it is diagnosed at a late or advanced stage. If caught early, however, the disease can be very effectively treated. “This is why screening is so important. Treatment is either surgery or chemo-radiation, depending on how advanced the cancer is.”