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Partnership for Eradication of Cancer in Africa (PECA) has said Nigeria records 14,000 cervical cancer cases annually, and according to an Oncologist, Kehinde Okunade, no fewer than 9,000 Nigerian women die yearly as a result of cervical cancer.
These figures are scary, and people want to know what they can do to contain the phenomenon.
There have been speculations that there is a relation between human papillomavirus (HPV) and cervical cancer. We want to allay the speculations by unravelling the mystery behind HPV and cervical cancer.
The masses need to be educated; so we need you to tell us everything the masses need to know about HPV and cervical cancer.
From what they can do to help themselves and what government is doing to contain these phenomena.
Can we meet you, sir?
My name is Dr. Okangba Blessing. I am the Medical Director of God’s Centre of Excellence Medical, GCEM Hospital, located in Alagomeji, Yaba, Lagos. I am a gynaecology consultant and a public health analyst.
I am pleased to welcome you to discuss cervical cancer and vaccination against cervical cancer, and to discuss the contribution of Human Papillomavirus (HPV) as it relates to cervical cancer.
What is cervical cancer?
Cervical cancer is simply known as cancer of the cervix. Simply put, it is the abnormal proliferation (growth) of the cells that line the cervix. It is the growth of cells that do not respect the normal system guiding the regulation of cell growth in the human body.
I am using this definition so that readers can best understand this health concern.
Epidemiologically, cervical cancer is the third most common cancer in the world, and in terms of prevalence of cases, it accounts for 2.3 million. In incidence, 510,000 cases are diagnosed each year. Out of these incidences, 288,000 women die of cervical cancer. That is to say before this interview is concluded, one woman must have died of cervical cancer.
Out of these 288,000 women that die of cervical cancer, 80% are from low resource settings, which we call the sub-saharan Africa, in which Nigeria is a big player. In Nigeria, cervical cancer is second to carcinoma of the breast, and in a year, we have 9,000 women die of cervical cancer in the country.
Cervical cancer is the most common gynaecological cancer, and a leading cause of cancer death among women in Nigeria, but most disheartening is that cervical cancer is a curable disease.
Cervical cancer is of public health importance. In fact, it should be at the same pedestal with maternal mortality. Unfortunately, government agencies, donor agencies, professional bodies and even civil societies pay more attention to maternal mortality i.e. Safe Food Initiative, and less attention to this non-communicable disease called cervical cancer. They equally kill our women.
So, how does cervical cancer develop?
Cervical cancer development is a gradual process and can take up to 10-15 years. At the initial stage, subtle changes (dysplasia) occur in the superficial cells of the cervix, as these changes progress, the degree of abnormality of these cells (dysplasia/CIN) moves from CIN I to CIN II to CIN III. CIN III is also thought to be a pre-malignant condition of the cervix which eventually may lead to invasive cancer.
From invasive cancer, cancer then begins to spread to organs close by or to distant organs (distant metastasis).
Permit me to explain Cervical Intra-epithelial Neoplasia (CIN). CIN is also known as cervical dysplasia, which means that there are changes in the cells on the surface of the cervix which over time is possible for these abnormal cells to change or progress into cancer.
Any woman can have CIN. Although CIN itself is not cancer, it can turn or progress to cancer of the cervix as the degree of dysplasia worsens.
And there are different types of CIN:
- CIN I means mild dysplasia
- CIN II Moderate dysplasia
- CIN III Severe dysplasia
The risk of CIN 1 is low and the changes may regress with the cervix going back to being normal. With CIN II and CIN III, the risk of progression to carcinoma is high.
CIN is discovered through PAP’s smear test and can be treated and it’s equally curable.
What part of the human body is the cervix?
The cervix is a cone shaped neck structure of the uterus that protrudes into the vagina. It is about 2cm-4cm long, and penetrated by the cervical canal (the os), which serves as a passage for menstrual flow, the fetus, gynaecological instrument used to asses the womb and for reproductive purposes.
What are the predisposing factors to cancer of the cervix or CIN?
Cancer of the cervix or changes in the cervix that may lead to the development of cancer of the cervix( CIN) is closely associated with sexual habits and sexual activity.
These risk factors include multiple sex partners, or if your partner has many sexual partners; early onset of sexual activity, usually at age<18 years; STI like gonorrhea, syphilis infection, cytomegalovirus infection, genital herpes infection, a pap’s smear test that is not normal, and cigarette smoking and alcohol consumption.
Another heavy risk factor is human papillomavirus (HPV) infection. This virus has been scientifically proven to be a cancer-causing virus especially the oncogenic stereotypes like 16, 18, 31, 33, 43 and 45.
What are the signs and symptoms of cervical cancer/CIN?
Cervical cancer does not just start suddenly. Before cervical cancer start, there are signs and symptoms. In fact, it takes 10-15 years for cervical cancer to develop, and that is why it is not good news that people should die of cervical cancer in Nigeria, because a lot of time have been provided for it to be detected and taken care of early enough.
The cervix has cells that it exfoliate, it releases. So, sampling those cells can give an idea that all is not well with the cervix.
Some signs and symptoms of cervical cancer/CIN are abnormal vaginal bleeding which can be noticed during douching (a wrong habit of washing the vagina); after sexual intercourse; bleeding in between menstrual periods (intermenstrual bleeding), bleeding after menopause (post menopausal bleeding).
Other signs and symptoms include persistent vaginal discharge which is usually watery and copious, occasional blood stained and foul smelling.
Late symptoms include loss of appetite, back pain or leg pain, weight loss, failure of kidneys to perform their function, involuntary loss of urine or faeces from fistulas.
How is cervical cancer/CIN diagnosed?
Your best bet to know if you have CIN is to go for a pap’s smear test.
This is a simple test in which cells on the surface of the cervix is scrapped, put on the glass slide or liquid-based and examined by a pathologist who issues a report.
Pap’s smear test is not painful and usually take less than 8 to 10 minutes to conduct. It is important that a qualified personnel take this test for you as an important area of the cervix from where CIN/cancer of cervix develops (transformation zone) is the focus.
A positive pap’s smear means that the result is abnormal. You may be requested to repeat the test in 3-6 months time or you may be further investigated with colposcopy and treatment follows or a biopsy (tissue sample from the areas of concern on the cervix) is taken for histological (confirmation) diagnosis and treatment.
A negative pap’s smear test means that you probably do not have cancer.
The average age of which cervical cancer affect our women is usually between 40 to 45 years, but because of civilization (with associated sexual sophistication prevalent these days) and change in our lifestyle and diet (more of westernized diet), the average age at which cervical cancer afflict our women is decreasing to between 35-45 years. These are the active, working age of women.
What are ways to prevent cervical cancer?
Cervical cancer/CIN has primary and secondary ways of prevention.
What is the primary way to prevent prevent cervical cancer?
Our sexual orientation should change. Young girls should delay the commencement of sexual activity. They should be empowered to go to school. By the time they go to school, they would have reached a certain age before they get married. In terms of prevalence of cervical cancer, it is commoner where there are early marriages, and where there is poor women empowerment. That is why we have it more in the North than in the South.
Also, fidelity, even in relationship is a preventive measure as well. People should avoid multiple sexual partners, and avoid a partner with multiple sexual partners. Our singles should practice abstinence while married couple should practice fidelity.
All STI should be treated promptly and by qualified personnel. Let us stop this practice of going to a chemist and asking them to mix drugs for us to take in perceived pelvic infections. Improperly treated STI are important risk factors for carcinoma of the cervix.
Our diets should include fruits, vegetables, and minerals rich in antioxidants and folic acid and less of carbohydrates and saturated fats.
Use of alcohol and cigarette smoking should be avoided as this lifestyle causes persistence of HPV ( a virus that has been shown to cause cancer).
Cervical Cancer Vaccine: This is targeted against the acquisition of oncogenic (high-risk HPV) HPV 16 & 18. These viruses have been implicated in over 80% of cervical cancers. It is better, and advisable that young girls from age 11 and 23 be vaccinated, and commence screening once they become sexually active.
The government should capitalize on this and make it routine immunization, as it is in Rwanda. Rwanda is having cervical cancer vaccination as part of routine immunization.
Our children in secondary schools, government agencies, civil societies should advocate that our young ladies at the age of, in fact, in abroad, they talk about 9 years, but we are saying 11-13 here, should have cervical cancer vaccination before they are exposed to sex.
For those who have been exposed to sex, they should have pap’s smear screening done. While older women should be vaccinated after screening result is reviewed.
What is the secondary way to prevent prevent cervical cancer?
This is achieved through Pap’s smear screening which aims to detect pre-malignant and malignant changes on the cervix before they transform into cervical cancer.
All women and ladies that are sexually active should have a pap’s smear test done yearly or at least once in two-three years.This test is available and accessible and a call away to schedule appointment. A pap’s smear is a simple procedure; it takes 5-8 minutes to get it done. It costs between N10,000.00 and N15,000.00.
Testing for oncogenic (high risk/cancer causing) HPV virus HPV 16,18 are also available though costly but affordable.
Research has shown that women who developed cervical cancer have not had a cervical screening done before or have not done one in the last three year before cancer diagnosis.
If we follow these, we won’t be talking about cervical deaths anymore.
Conclusively, what is your advice to Nigerians as regards cervical cancer?
Cervical cancer is entirely a preventable disease and potentially curable if precursors are detected early enough through pap’s smear screening. This is the only reason where women in advanced societies do not die from this disease. In those climes, the populace are responsive and regularly go for their annual pap’s smear screening while their government are responsible in providing centers where screening and treatment can take place and provision of cervical vaccines for their people. Since our situation here is different, why not go for your pap’s smear today and also receive the vaccines. These measure can save your life and lives of your loved ones.
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