By Adetutu Kunuji
1. The Facts
Cervical cancer is the second most widespread cancer in females in Nigeria with a mortality rate of 22.9 deaths per 100,000 women totalling about 10,000 deaths from cervical cancer in a year ranking 10th in the world. Nigeria has been named one of the most dangerous places to be a woman with cervical cancer together with India, China, Brazil and Bangladesh.
It is important to recognise cervical cancer as a preventable disease and the second largest cancer killer of women in low and middle income countries. It has been projected that by the year 2030, about half a million women will have died from cervical cancer and 95% of such deaths will be from the low and middle income countries.
2. What is Cervical Cancer?
Cervical cancer is an abnormal growth of cells in the cervix. The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body of the uterus (the upper part) is where the foetus grows. The cervix connects the body of the uterus to the vagina (birth canal).
3. How is it diagnosed?
These changes/growth can be detected by the Pap test and treated to prevent cancer from developing. The change from pre-cancer to cancer usually takes several years but it can happen in less than a year. For most women, pre-cancerous cells will remain unchanged or even go away without any treatment.
4. Signs and symptoms of cervical cancer
Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until a pre-cancer becomes a true invasive cancer and grows into nearby tissue. When this happens, the most common symptoms are:
- Abnormal vaginal bleeding such as bleeding after sex (vaginal intercourse), 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 or may occur between your periods or after menopause.
- Pain during sex ( vaginal intercourse)
5. What are the risk factors for cervical cancer?
Several risk factors increase your chance of getting cervical cancer. Although these factors increase the odds of getting cervical cancer, many women with these risk factors do not develop the disease.
6. The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV). HPV is a group of more than 150 related viruses, some of which cause a type of growth called papillomas, which are more commonly known as warts. HPV can be spread from one person to another during skin to skin contact. One way HPV is spread is through sex, including vaginal, anal and even oral sex.
Certain types of HPV may cause warts to appear on or around the genital organs and in the anal area. These warts are known as genital warts. These are called the low risk type of HPV because they are seldom linked to cervical cancer.
Other types of HPV are called high risk types because they are strongly linked to cancers, including cancers of the cervix, vulva and vagina in women. There might be no visible signs of infection with a high risk HPV and pre- cancerous changes or cancer develops.
Other important risk factors include : Long term use of oral contraceptives (Birth control pills) having multiple full term pregnancies, use of Diethylstilboestrol(DES), being younger than 17 at your first full term pregnancy, having a family history of cervical cancer, smoking, immunosuppression, chlamydia infection, diet low in fruits and vegetables, being overweight.
7. Can cervical cancer be prevented?
A well proven way to prevent cervix cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. Since no HPV vaccine provides complete protection against all of the HPV types that can cause cancer of the cervix, it cannot prevent all cases of cervical cancer. This is why it is very important that women continue to have cervical cancer screening even after they’ve been vaccinated. Most invasive cervical cancers are found in women who have not had regular screening.
8. The Pap (Papanicolaou test)
The Pap test is the main screening test for cervical cancer and pre-cancerous changes. The new guidelines state that the first pap test should be done at age 21. Although earlier guidelines recommended that women begin pap test screening three years after they become sexually active, waiting to begin testing until age 21 is now recommended because adolescents will likely clear the Human Papilloma virus on their own without any persistent cervical cell abnormalities.
9. Prevention against HPV
Human papilloma Virus can be prevented by the use of condoms (though this is not fully protective), stop smoking and getting vaccinated.
Vaccines are available that can protect against certain HPV infections. All of these vaccines protect against infection with HPV subtypes 16 an 18. Some can also protect against infections with other HPV subtypes, including some types that cause anal and genital warts.
If your pap test result is normal, but you test positive for HPV, the main options are:
- Repeat co- testing (with a Pap test and an HPV test) in one year
- Testing to see if you test positive for HPV types 16 or 18 (this can often be done on the sample in the lab). If you are, colposcopy would be recommended. If you test negative, you should get repeat co- testing in one year.
It is important to get tested. Visit cancer screening centres for a pap smear. Prevention is the key. Together we can fight against cancer. #WecanIcan.
This article was written by Adetutu Kunuji. Adetutu is a medical doctor and an advocate for maternal and child health with a special interest in the care and rehabilitation of pregnant teenage girls. She is also the founder of Femme Aid Foundation- a non profit organisation offering sexual health information and counselling to women. Send your emails to firstname.lastname@example.org