By Henrylito D. Tacio
Cervical cancer can be cured if diagnosed and treated promptly, according to the Geneva-based World Health Organization (WHO).
“Cervical Cancer is highly preventable and treatable,” tweeted WHO Director-General Tedros Adhanom Ghebreyesus, adding that “it could be the first cancer ever to be eliminated.”
Cervical cancer is the fourth most common cancer among women globally, WHO said. About 90% of the new cases and deaths worldwide occur in low- and middle-income countries. “Currently, a woman dies of cervical cancer every two minutes,” Dr. Tedros said.
In the Philippines, cervical cancer is the second most common form of cancer among women, most of whom are diagnosed during the later stages. Eleven Filipino women die of cervical cancer each day, says Dr. Ronald B. Capito.
“Cervical cancer places such a heavy burden on society,” deplores Dr. Capito, a gynecologic specialist and a fellow of the Philippine Obstetrical and Gynecological Society (POGS).
Cervical cancer starts when cells lining the woman’s cervix start to grow out of control. The cervix is the lower part of the uterus that connects the body of the uterus to the vagina.
Two human papillomavirus (HPV) types (16 and 18) are responsible for nearly 50% of high-grade cervical pre-cancers, the WHO said. HPV is mainly transmitted through sexual contact.
“Most sexually active women and men will be infected at some point in their lives, and some may be repeatedly infected,” the WHO explained. “HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission.”
“It doesn’t necessarily mean that you’ve been sexually promiscuous (or a prostitute!) if you should develop cervical cancer,” points out Rina Jimenez-David, a recognized advocate in reproductive health. “Even if you’ve been monogamous, your partner may not have been, and even just a single encounter with an infected partner could end up infecting him with HPV which he in turn could pass on to you. Remember, while HPV does not generally affect the health of a man, it can lead to cervical cancer in a woman.”
The risk of developing cervical cancer is increased by the following: smoking, long-term use of oral contraceptives, and a family history of cancer, especially cervical cancer.
HPV infections usually clear up without any intervention within a few months after acquisition, and about 90% clear within two years. But a small proportion of infections with types 16 and 18 can persist and progress to cervical cancer.
It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems. For instance, women living with human immunodeficiency virus (HIV) are 6 times more likely to develop cervical cancer compared to women without HIV.
According to the United Nations health agency, symptoms of early-stage cervical cancer may include irregular blood spotting or light bleeding between periods in women of reproductive age; postmenopausal spotting or bleeding; bleeding after sexual intercourse; and increased vaginal discharge, sometimes foul smelling.
As cervical cancer advances, more severe symptoms may appear including persistent back, leg or pelvic pain, weight loss, fatigue, loss of appetite, foul-smelling discharge, vaginal discomfort, and swelling of a leg or both lower extremities.
“Other severe symptoms may arise at advanced stages depending on which organs the cancer has spread to,” the WHO said.
There is nothing more tragic than suffering and dying from a disease that is largely preventable through both vaccination and screening for precursor lesions, with appropriate follow up and treatment, according to the International Agency for Research on Cancer (IARC), an intergovernmental agency under the WHO umbrella.
The United Nations health agency is recommending vaccination, as follows: one or two-dose schedule for girls aged 9-14 years; one or two-dose schedule for girls and women aged 15-20 years; and two doses with a 6-month interval for women older than 21 years.
There are currently 4 vaccines that have been prequalified by WHO, all protecting against HPV types 16 and 18. “The vaccine provides up to 95% coverage against cervical cancer,” Dr. Chia Yin Nin, a gynaecologic oncologist practicing at Gleneagles Hospital in Singapore, told Business World.
The Department of Health (DOH) has included HPV vaccination in its national vaccination program since 2016. Data from WHO Philippines showed the national HPV vaccination program coverage among girls aged 9 to 14 years old remains low. In 2020, only one in 10 girls – around 30% of the primary target cohort – have received their HPV vaccinations. Of this number, only about 5% were able to receive their final doses of the HPV vaccine.
“Vaccination at a young age is ideal; this is when the immune system is at its strongest and induces a robust response from the vaccine, with only mild side effects,” said Dr. Van Phillip Baton, head of the DOH’s Non-Communicable Diseases Section of the Central Visayas Center for Health Development.
Cervical cancer screening involves testing for HPV infection to detect pre-cancer and cancer, followed by treatment as appropriate. “Testing is done among women who have no symptoms and may feel perfectly healthy,” the WHO said.
When screening detects an HPV infection or precancerous lesions, these can easily be treated, and cancer can be avoided. Screening can also detect cancer at an early stage where treatment has a high potential for cure.
Screening should start from 30 years of age in the general population of women, with regular screening with a validated HPV test every 5 to 10 years, and from 25 years of age for women living with HIV.
“Eliminating any cancer would have once seemed an impossible dream, but we now have the cost-effective, evidence-based tools to make that dream a reality,” said Dr. Tedros. “But we can only eliminate cervical cancer as a public health problem if we match the power of the tools we have with unrelenting determination to scale up their use globally.” – ###
