Cervical Cancer: Every sexually active woman is at risk

In recent times, statistics available have shown that in Nigeria, cervical cancer accounts for 15 per cent of female cancers as compared to just about 3.6 percent in the developed countries. Shockingly, less than 0.1 per cent of Nigerian women have ever had cervical cancer screening in their lifetime and less than 1 per cent is aware of the existence of this silent killer. Consequently, cervical cancer kills a woman every hour in the country. Although 100 percent preventable, the cancer kills more women aged 24 to 35 years old women in developing countries than any other cancer in other parts of the world.
The World Health Organisation (WHO) projects a 25 per cent increase over the next decade in the absence of widespread interventions. This is a sharp contrast to what obtains in countries like Britain which have national screening programmes. There, deaths from cervical cancer have reduced by 75 per cent and reducing by further 7 percent annually.

Unfortunately, according to WHO estimates, Nigeria has a population of 40.43 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 14,550 women are diagnosed with cervical cancer and 9659 die from the disease.
Worse still, 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. About 23.7 per cent of women in the general population are estimated to harbour cervical HPV infection at a given time and percentage of invasive cervical cancers are attributed to HPV s 16 or 18.
Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs and various strains of the human papillomavirus (HPV), a sexually transmitted infection, playa role in causing most cases of cervical cancer.
When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. Today, most cases of cervical cancer can be prevented with a vaccine for young women
In a study, Senior Lecturer/ Consultant at the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Dr. Marliyya Zayyan noted that all Nigerian sexually active women are at risk of cervical cancer but the risk of cancer of the cervix is reduced with male circumcision.
She says cancer of the cervix is the commonest malignancy among women in northern Nigeria. Three to four new cases are diagnosed every week in ABUTH, Zaria
“We had 203 cases of cervical cancer in 2007. This number represents 75 percent of the total cases of confirmed gynecologic cancers presenting to the unit. The age distribution was very wide and youngest age of presentation was 28 years and the oldest was a 90year old with very advanced disease.
The median age of presentation is 35 years. Maj ority of the women were married however 3 per cent were single women who have never married and 20 per cent were divorced or widowed. It affected family women with an average of 5 children.”
Stating in Nigeria cervical cancer patients present late, she said only four cases (1.9 per cent) out of 203 presented early enough for cure to be achieved. “For 98.5 per cent of cases the disease could best be palliated.
“The early symptom of bleeding after intercourse is often ignored by the patients. Two hundred cases were not possible to treat surgically. These cases were treated by heat treatment (radiotherapy).
A quarter of the patients presented with complications of very late disease like leaking urine or faeces, or blockage of their intestines or urinary flow”
Challenges of management, includes deaths from cervical cancer on poverty. “The cost per cycle of heat treatment is N25,000 and six to seven cycles are normally required. Special drugs required to melt out the cancer are very expensive and toxic. Could be unavailable. Follow up of discharged patients is difficult. Many specialists are required to effect treatment in the advanced stages patients present.”
On the way forward, “Cancer of the cervix is about the only human cancer that is almost entirely preventable. “It is also 100 per cent curable if picked at very early stage. Treatment is cheap and simple in early stages requiring minimal manpower to achieve the high cure rate. Cancer of the cervix has an established screening method that works. Today vaccines are available for primary prevention of cervical cancer. Theses vaccines are already in use in other places and technology for their production is known.
Control of Cervical cancer depends on increase in public awareness of the disease. Government should subsidise the treatment and incorporate screening programme into the primary health care as well as improve infrastructure and development of health facilities.
To reduce the burden, she posited that there should be constant training and re-training of personnel. She recommended that “We need a strategy to reduce the burden of disease in the community through education. We need to roll out a reliable screening plan to cover at least 80 per cent of our population.
The vaccine for cervical cancer should be part of our immunization plan. We should get rid of cervical cancer like other countries have done so we can direct attention on other cancers that have more complex biology.
Overview of Cervical Cancer
Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, playa role in causing most cases of cervical cancer.
When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years before it eventually converts some cells on the surface of the cervix into cancer cells. Cervical cancer occurs most often in women over age 30. Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. And today, most cases of cervical cancer can be prevented with a vaccine for young women.
At a glance
In Nigeria, cervical cancer is the second most common cancer in women after breast cancer
It accounts for 13 percent of all female cancers. Overall, the mortality: incidence ratio is 52 percent. There has been a steady rise in frequency of cancer over the years. Cancers of the cervix (30.1 percent) topped the list of the most frequent female cancers. Recent predictions of an increase in incidence of cervical cancer is manifesting. Findings at the Kano Cancer Registry, Ahmadu Bayero University, Kano, supports evidence for establishment of comprehensive cancer control programmes.
At a rough estimate, Nigeria records 10,000 cases of cervical cancer yearly,” notes Prof. Isaac Adewole, Consultant Obstetrician and gynaecologist at the College of Medicine, University of Ibadan. “The women with this ailment die in a painful, miserable and undignified manner.
At least 80 per cent of cases in Nigeria are at advanced stage where very little can be done. Measures including prevention, early detection and effective management of cervical are necessary to prevent an increase in incidence and deaths of women from the disease. He said there is need for stronger advocacy to ensure that cervical cancer vaccine becomes available in the public health sector. Adewole, also principal investigator Operation Stop Cervical Cancer Nigeria laments that cervical cancer fuels a cycle of poverty. Most of these women are low income earners and often located far from health institutions.
The disease which affects the poorest and most vulnerable women sends a ripple effect through families and communities that rely heavily on women’s role as both providers and care givers.”
Every 10 minutes, two women die from cervical cancer worldwide, affecting more of younger productive women between 20 years and mid 30s. Once a woman is affected, it can take between five and 30 years for the virus to develop into full cancer, but since it has no early symptoms, the woman feels very healthy while the virus continues to ravage her. By the time the symptoms begin to show, the situation becomes uncontrollable. Virtually nothing can be done to remedy the situation and the woman waits for death. Cervical cancer has been reduced drastically in the western world thanks to universal screening. “The rate of the cancer in Nigeria is 70 per cent and rising. If we can introduce universal screening, it would reduce drastically.”
Symptoms
Early cervical cancer generally produces no signs or symptoms. This is why regular screening is so important. As the cancer progresses, the following signs and symptoms of more advanced cervical cancer may appear:
* Vaginal bleeding after intercourse, between periods or after menopause
* Watery, bloody vaginal discharge that may be heavy and have a foul odor
* Pelvic pain or pain during intercourse
When to see a doctor: If you experience any unusual bleeding between periods or pain during intercourse, make an appointment with your doctor.
Risk factors
* The greater your number of sexual partners – and the greater your partner’s number of sexual partners – the greater your chance of acquiring HPV.
* Early sexual activity. Having sex before age 18 increases your risk of HPV.
* If you have other STDs – such as chlamydia, gonorrhea, syphilis or HIV / AIDS – the greater your chance is of also having HPV.
* A weak immune system. Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer.
* Cigarette smoking. The exact mechanism that links cigarette smoking to cervical cancer isn’t known, but tobacco use increases the risk of precancerous changes as well as cancer of the cervix. Smoking and HPV infection may work together to cause cervical cancer.
Complications
Treatments for invasive cervical cancer often make it impossible to become pregnant in the future. For many women especially younger women and those who have yet to begin a family infertility is a distressing side effect of treatment. For a specific subgroup of women with early cervical cancer, fertility-sparing surgery may be a treatment option.
Causes
In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. There are two main types of cervical cancer:
* Squamous cell carcinomas begin in the thin, flat cells that line the bottom of the cervix (squamous cells).
Screening
Most guidelines suggest beginning screening at age 21, and some recommend starting within three years of becoming sexually active, or no later than age 21.
*Pap test. During a Pap test, your doctor brushes cells from your cervix – the narrow neck of the uterus – and sends the sample to a lab to be examined for abnormalities.
* HPV DNA test. Your doctor also may use a lab test called the HPV DNA test to determine whether you are infected with any of the 13 types of HPV that are most likely to lead to cervical cancer.
Diagnosis
Your doctor may examine your cervix:: During an exam called colposcopy, your doctor uses a special microscope (colposcope) to examine your cervix for abnormal cells.
Staging exams:
* Imaging tests. Tests such as X-rays, computerised tomography (CT) scans and magnetic resonance imaging (MRI) help your doctor determine whether your cancer has spread beyond your cervix.
* Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder (cystoscopy) and rectum (proctoscopy). Your doctor then assigns your cancer a stage.
Treatments and drugs
Treatment of cervical cancer that’s confined to the outside layer of the cervix typically requires treatment to remove the abnormal area of cells. For most women in this situation, no additional treatments are needed.
For Invasive cancers
Cervical cancer that invades deeper than the outside layer of cells on the cervix is referred to as invasive cancer and requires more extensive treatment.
Treatment options may include: Surgery to remove the uterus (hysterectomy) is typically used to treat the early stages of cervical cancer. Hysterectomy can cure early-stage cervical cancers and prevent cancer from coming back, but removing the uterus makes it impossible to become pregnant.
* Radiation therapy uses high-powered energy to kill cancer cells.
* Chemotherapy uses strong anti-cancer medications to kill cancer cells. Chemotherapy drugs, which can be used alone or in combination with each other are usually injected into a vein and they travel throughout your body killing quickly growing cells, including cancer cells.
Prevention
You can reduce your risk of cervical cancer by taking measures to prevent HPV infection. HPV spreads through skin-to-skin contact with any infected part of the body – not just during intercourse. Use a condom every time you have sex in order to reduce your risk of contracting HPV.