Imagine treating cervical cancer by releasing leeches into the cervix to rid the body of the disease. The very thought of it gives you the shakes, doesn ’t it? But that was the fate of many women in the 1800s who contracted this cancer. Thankfully, we ’ve come a long way from those dark ages, when so little was know about this disease and treatment was downright barbaric.
Medical science has since advanced by such leaps and bounds that scientists have recently fashioned a vaccine that can actually prevent the manifestation of some of the most common viruses that contribute to the development of this dreaded cancer.
But let ’s begin from the basics, by clarifying what cervical cancer means. It ’s a cancer that starts in the cervix, part of a woman ’s reproductive organs. The cervix is the lower, narrow end of the uterus, also know as the womb.
Cervical cancer usually grows very slowly. Over a period of several years, cells on the surface of the cervix mutate. Initially, the change is simply abnormal, not cancerous. But research indicates, these abnormal changes are the precursor to a series of slow changes that can lead to cancer. If the pre-cancerous cells change into full-blown cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer.
In Malaysia, cervical cancer is the second most common female cancer, constituting 12.9% of all female cancers. The Malaysian National Cancer Registry reports an average of 2,000-3,000 hospital admissions of cervical cancer annually.
THE VIRAL CONNECTION What causes cervical cancer? The answer should make all women sit up and take note, as it involves a sobering fact: all sexually active women are at risk of contracting it.
That ’s because cervical cancer is specifically linked to a virus, the human papillomavirus (HPV). And this virus, HPV, is contracted from person to person by genital contact or sexual intercourse. There are umpteen HPV strains, bLit only forty typically affect the genital areas.
In studying cervical cancer, scientists have managed to identify two types, HPV 16 and 18, as the high-risk HPV strains that account for over 70% of all cases worldwide.
More than 99.7% of cervical tumour specimens contain detectable HPV, making the association between HPV infection and cervical cancer one of the strongest in cancer epidemiology. In layman ’s terms, one could put it this way: HPV ’s link with cervical cancer is stronger than the association of smoking with lung cancer However, what has perplexed scientists in the study of cervical cancer is the fact that not all women who contract the specific HPV associated with cervical cancer go on to develop the cancer. In some cases, there is a self-remission, that is to say, the virus clears up on its own. Whereas in some women, these strands of HPV do go on to develop into cervical cancer. For this reason, scientists believe that other co-factors act together with HPV5 to trigger the dreaded cancer
RISK FACTORS The insidious nature of HPV is such, transmission frequently occurs unknowingly.
Infected persons are often unaware that they are carriers. This is simply because most HPV infections have no initial adverse effects, including the common strains associated with cervical cancer.
What this means is that a woman can have HPV for years and not know it. It stays in her body and can lead to cervical cancer years after she was infected. This is why it is important that women regularly screen themselves via Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If these pro-cancer cells are attended to, it could prevent cervical cancer Because of cervical cancers association with HPV, it stands to reason that there are some obvious categories of people who have a higher risk of contracting the disease.
For starters, these would include people who have many sexual partners. The greater your number of sexual partners and the greater your partners number of sexual partners the higher your chances of acquiring a HPV that could develop into cancer.
Studies also indicate that early sexual activity increases the risk of HPV. Immature cells in the cervix seem to be more susceptible to precancerous changes that HPV can cause.
Other high-risk candidates are those who have other sexually transmitted diseases (STDs) such as chlamydia, gonorrhea or syphilis.
Women who have a weakened immune system are also high-risk targets. This includes those carrying the HIV virus and organ transplant patients who receive drugs that suppress the immune system to prevent rejection of the new organ.
There are also studies that indicate smoking increases the risk of cancer of the cervix, although it is not clear exactly how or why.
The risk appears to increase with the number of cigarettes a woman smokes each day and with the number of years she has smoked.
BELATED SYMPTOMS As mentioned previously, at the early stages, cervical pre-cancerous abnormalities usually have no signs or symptoms Recognizable symptoms usually do not arise until the cancer becomes invasive and grows into nearby tissue. At this point the most common symptoms are likely to be: Unusual watery, bloody vaginal discharge that may be heavy and have a foul odour. Blood spots or light bleeding when youre not having your period Bleeding after menopause Bleeding or pelvic pain during intercourse SCREENING PROCESS By now, the importance of monitoring the cells in the cervix for any abnormal changes should have bit home to most readers. Remember, you will not get any initial symptoms of the cancer that will spur you to the doctor ’s clinic.
This screening process is strictly preventive.
In other words, you get yourself screened to avoid developing any cancer symptoms, The beauty of the screening process is that it is simple, quick, relatively painless and inexpensive. All that ’s needed on your part is the discipline to make the time on a regular basis to do it.
And what does the screening process involve? In a nutshell, it ’s a medical procedure in which a sample of cells from a woman ’s cerv x is collected and spread (smeared) on a microscope s ide. The ce Is are examined under a microscope to look for pre-mal gnant (before-cancer) or malignant (cancer) changes.
This piocess is called a Pap smear or a Pap test Like any other medical procedure it is not 10000 accurate. Thus, a few women develop cerv ca cancer desp te having regular Pap screening. But in the vast majority of cases, a Pap test does identify minor cellular abnormalities before they have had a chance to become malignant and at a point when the cond tion is most easily treatable.
Between 60o and 80c of American women who are newly diagnosed with invasive cervical cancer have not had a Pap smear in the past five years and may never have had one If we logica ly extrapolated that ev dence to women worldwide, t simply accentuates the ircportance of regular Pap tests.
Untortunately, in Malaysia, cervical cancer scieening coverage is poor, at less than 2% in 1992, 3.5% in 1995 and 6.2% in 1996. Dr Nor Hayati Othman of University Sains Malaya listed some obvious reasons for these dismal statistics in a research paper in 2003 She wrote, "The nation-wide campaign for women to come forward for screening is not aggressively put forth.. The general public is largely unaware of the benefits of screening.
The screening, when done is not targeting the population at risk. Many pap smears are done on women who come for post natal check up.
PAP TESTS GUIDELINES As a rule of thumb, (according to the American College of Obstetricians & Gynecologists guidelines) you should start getting a Pap test within 3 years of becoming sexually active or when one hits 21 years of age, whichever comes first. However, if you are under 21 years old but have been sexually active for three years, you would also qualify to begin Pap tests. These target groups should test annually until they hit the age of 30.
From the age of 30 onwards, if you have had three normal annual Pap results, you could begin to scale back the Pap tests to once every three years.
For post-menopausal women aged 65-70, those that have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years, can cease having Pap tests.
However those in the high-risk category below should have an annual Pap test, regardless of their age: Those with a weakened immune system or If your mother was exposed to diethyistilbestrol (DES) while pregnant Bear in mind that the best time to do the Pap test is 10-20 days after the first day of your period. Pre-Pap test preparation is as simple as the test itself. You simply avoid douching, having sex or using tampons/vaginal medicines for two days before the test.
REVOLUTIONARY VACCINE Apart from the Pap test, there is now an added safeguard against cervical cancer. For the first time, a vaccine, Gardasil, has been developed to combat this cancer. And how does it work? Rather simply, actually.
HPV types 6 and 11 cause about 90% of genital warts and mild Pap test abnormalities Additionally, HPV types 16 and 18 are the HPV5 found in 70% of all cervical cancers as well as in severe precancerous changes of the cervix. Gardasil protects women against all four of these HPV5.
Bobbie Gostout,(M.D) is a gynecologic surgeon at Mayo Clinic, USA. She elaborates on who best benefits from this vaccine, "The vaccine is recommended for girls aged 11 to 12, although it may be used in girls as young as nine years old. This allows a girl ’s immune system to be activated before she ’s likely to encounter HPV, Vaccinating at this age also allows for the highest antibody levels. The higher the antibody levels, the greater the protection." However, Gardasil can also be useful in women who are already sexually active up to the age of 26, but who have not yet been exposed to the four HPV types covered by the vaccine. But research is ongoing as to Gardasil ’s efficacy for women who have already been exposed to the HPV5 that it prevents.
The vaccine is given as a series of three injections over a six-month period. The second dose is given two months after the first dose, followed four months later by the third dose.
Doctor Gostout explains, "We really don ’t know that three doses are necessary because we don ’t know what antibody levels provide adequate protection from HPV. Since antibody levels inevitably fall once you stop getting a vaccine, it makes sense to start with high antibody levels to get the greatest HPV protection for the longest possible time years or even decades." "Overtime, we may find that three doses of the vaccine aren ’t necessary, or we may discover that a booster shot is needed years later. Those are details we just don ’t know right now," she clarifies.
LOCAL RELEVANCE In Malaysia, the vaccine received regulatory approval in November 2006. A research paper written by Dr Wong Li Ping and Dr Sam l-Ching of University Malaya in 2007, stresses the potential barriers Malaysia faces in promoting this vaccine due to a combination of cultural, religious and economic reasons.
They write, "There is no data available on the Malaysian public ’s knowledge on HPV or attitudes to [the] HPV vaccine. Comprehensive surveys need to be carried out to address this, if the vaccine is to be considered for widespread use. The vaccine may be contentious due to the sexually-transmitted nature of HPV, which carries the stigma of unacceptable sexual behaviour. ’ Their paper elaborates, Parental acceptance of HPV vaccination is critical since the vaccines are recommended for children and young adolescents before the onset of sexual activity. Due to religious or moral values, some [parents] may perceive that their children are at low risk [of] contracting the infection, and thus believe that vaccination is unnecessary.
Parents may fear that vaccination of their children might promote sexuality and result in increased unsafe sexual behaviour. ’ The authors also highlight the role of religious beliefs. They state, "Religion plays an important role in our society. It is not known how our society and local religious conservatives [will] react to vaccinating youngsters against a sexually transmitted virus. In the US, for instance, religious groups oppose HPV vaccination, preferring instead to advocate abstinence for prevention of STIs." They also highlight that the prohibitive economic cost involved puts the vaccine out of the reach of many Malaysians as the recommended three-dose course, costs approximately USD $360 * The information provided is for educationai and communication purposes nniy and it shouid not be construed as personal medical advice.
Information published in this article is not intended to replace, suppiant or augment a consultation with a health professional regarding the readerS own medicai care. H&B dues nut give any warranty on accuracy completeness, functionality use fuiness or other assurances as to the content appearing in thin column. H&B disclaims all responsibilities fur any loses, damage to pruperty or personal iniury suffered directly or indirectly from reliance on such information
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