By Dr Brighton Chireka.
This week I am calling on all women aged 25 and above who are reading this article to go and get screened for cervical cancer if not already done so.
What is Cervical cancer Doc?
Cervical cancer is a type of cancer that develops in a woman’s cervix. The cervix is the entrance to the womb from the vagina. Worldwide cervical cancer is, after breast cancer, the second leading cause of cancer in women causing over 270,000 deaths per year.
In most communities, diagnosis of cancer induces fear both in the individual and the immediate family and is viewed as a death sentence, which is wrong. We can change that by getting screened early.
What are the statistics for Zimbabwe?
Research has shown that the five commonest cancers in Black Zimbabwean women are cervical cancer (33.9%), breast cancer (9.7%), Kaposi sarcoma (9.6%), eye (8.7%) and non-Hodgkin lymphoma (4.1%). It is also estimated that 3,700 women die per year of cervical cancer in South Africa. In Zimbabwe, HIV and AIDS contributed 60% of cancers in 2005 (Chokunonga et al, 2010).
Symptoms of cervical cancer
Cervical cancer often has no symptoms in its early stages and the effective way of preventing it is to go for screening regularly.
If one has symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in-between periods or after the menopause. Abnormal bleeding does not mean that one definitely has cervical cancer, but it should be investigated by your own General Practitioner (GP) as soon as possible. In the UK, if a GP suspects cervical cancer, he/she should refer the individual to see a specialist within two weeks.
What are the causes of cervical cancer?
Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that’s often spread during sex. There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can disrupt the normal functioning of the cells of the cervix and can eventually trigger the onset of cancer.
Two strains of the HPV virus called HPV 16 and HPV 18 are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection have no symptoms, so many women will not realise they have the infection. However, it is important to be aware that these infections are relatively common and most women who have them do not develop cervical cancer. Using condoms during sex offers some protection against HPV, but it cannot always prevent infection.
How can the spread of HPV be prevented?
A lot of work is being done to stop the spread of HPV and I urge all the parents to make sure that their daughters are vaccinated before they become sexually active. Find out from your doctor about the local arrangements with regard to HPV vaccine. In the UK since 2008, an HPV vaccine has been routinely offered for free to girls between the ages of 12 and 13. I know that HPV vaccination is not fully functioning in some parts of Zimbabwe and in the absence of an HPV vaccine, cervical screening to detect and remove early, precancerous lesions is the most effective way to prevent the disease and the suffering it causes.
What should you do?
The blame culture does not help. We have to take ownership of our health and play an active role in preventing unnecessary death from cervical cancer. Early detection of cancer remains the best strategy in reducing cancer deaths, hence my call to every woman reading this article, to make sure that they present early to their doctor. Do not leave it until it’s too late as the chances of surviving depend on the stage of cervical cancer.
What is staging and why is it important?
The stage at which cervical cancer is diagnosed is an important factor in determining a woman’s outlook. The staging, given as a number from 1 to 4 indicates how far the cancer has spread. The chances of living for at least five years after being diagnosed with cervical cancer are: stage 1 is 80% to 99%, stage 2 is 60% to 90%, stage 3 is 30% to 50% and stage 4 is 20%. We can see from these figures that early presentation does help and should be encouraged.
What is the situation in Africa and Zimbabwe in particular?
Cancer mortality in Zimbabwe is still high mainly due to late presentation of disease, inter-current diseases including HIV and limited access to early detection and treatment services. Also most of the developing governments focus mainly on diseases like Cholera, HIV and AIDS and Malaria while non-communicable diseases like cancer are left with limited funding. However Cervical Cancer screening is supported by the United Nations Population Fund (UNFPA). Let’s then play our part by making sure that we present early to our doctors and go for screening regularly.
In Zimbabwe there are only nine health centres offering cervical cancer screening using VIAC countrywide. VIAC is Visual Inspection with Acetic Acid and Cerviography. It is sometimes called screen and treat. This screen and treat program uses a simple, inexpensive and proven method to detect precancerous lesions on the cervix, and a relatively simple and proven technology to remove those lesions and thereby prevent the development of invasive cervical cancer, for which few treatment options exist in rural Zimbabwe.
These health centres are United Bulawayo Hospitals, Newlands Clinic, Edith Opperman Clinic in Mbare, Warren Park Polyclinic, Highfield Polyclinic, Masvingo Provincial Hospital, Zimbabwe National Family Planning Council, Spilhaus and Cancer Association of Zimbabwe (CAZ). I am also reliably informed that more clinics are opening in Harare. However, all of these services are centralised in urban areas leaving women in rural areas uncovered.
Those in UK here are the arrangements;
The NHS, in the UK, offers a national screening programme open to all women from the age of 25. During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities. This test is commonly referred to as a cervical smear test. An abnormal smear test does not mean you definitely have cancer, as most abnormal results are caused by an infection or the presence of treatable precancerous cells rather than cancer itself.
It is recommended that women who are between the ages of 25 and 49 are screened every three years, and women between the ages of 50 and 64 are screened every five years. You should be sent a letter telling you when your screening appointment is due. Contact your GP if you think that you may be overdue for a screening appointment. Sadly some of the Zimbabwean women in the UK are not taking advantage of this free service but I hope this will change after reading this article.
Treatment of cervical cancer
If cervical cancer is diagnosed at an early stage, it’s usually possible to treat it using surgery. In some cases it’s possible to leave the womb in place, but it may need to be removed. The surgical procedure used to remove the womb is called a hysterectomy. Radiotherapy (using X-rays to treat) is an alternative to surgery for some women with early stage cervical cancer. In some cases it is used alongside surgery. More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy.
In conclusion
We know that cervical cancer prevention, diagnosis and treatment pose great challenges particularly in resource constrained environments such as ours in Zimbabwe but there is evidence that raising awareness and encouraging people to change their lifestyles can prevent about a third of cancer. It is one of the reasons why this article has been compiled. Remember cervical cancer can be prevented and can also be cured if diagnosed and treated early.
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