Sexually active women prone to cervical cancer—Expert

In this interview with MOTUNRAYO JOEL, Dr. Elijah Onwudiwe of the Gynaecology Unit, University of Nigeria Teaching Hospital, Enugu, raises more awareness about cervical cancer

 What is cervical cancer?

Cervical cancer is a disease in which cancer cells form in the cervix. Cervix is the lower, narrow end of the womb that opens into the vagina. The cervix is popularly known as the neck or the mouth of the womb.

 Who is affected by cervical cancer?

Cervical cancer can affect any woman who has cervix and has had vaginal sexual intercourse even if it is only once. However some people are more at risk of developing the disease more than others. They include: persons with multiple sexual partners or whose spouses have other sex partners, early age at first sexual intercourse/early marriage, persons with other sexually transmitted diseases including the Human Immunodeficiency Virus, cigarette smokers and women who gave birth to five or more children.

 How is Human Papilloma Virus connected to cervical cancer?

Human Papilloma Virus has been found to cause cervical cancer in 99.9 per cent of the cases. However premalignant stage (pre-cancer stage) caused by the HPV can stay as long as eight to 10 years in the cervix before it transforms into a cancer.

 How is HPV infection transmitted?

Human Papilloma Virus infection is sexually transmitted. About 70 per cent of female adult population gets infected with HPV at some point in their life. However, most HPV are cleared from the body by the immune (defence) mechanism. If the HPV is not cleared, it replicates in the cervical cells, transforms into pre cancer lesions which may turn cancerous after staying in the cervix for 10 to 18 years.

 Do condoms help protect against HPV infection?

Condoms do not totally protect against HPV because contact with scrotal skin and the vulva can transmit the infection unlike HIV that is transmitted through body fluids.

 What are some of the policy issues surrounding the cervical cancer vaccine?

The policy issues include: lack of awareness- much awareness has not been created on the use of Human Papilloma Virus (HPV) vaccine unlike that of other vaccines like the pentavalent vaccines given during the childhood period. Secondly, HPV vaccination has not been incorporated into the National Programme on Immunization. Thirdly, financial constraints – complete course of HPV vaccination will cost a little less than N30,000, which is above the minimum wage. Little or no support comes from the government or NGOs. Moreover, the vaccination is not covered under the National Health Insurance Scheme. Another issue is socio-economic /religious – most parents may not want their children vaccinated because of the presumed early exposure to sexual matters. Also most religious bodies may not allow sexual education to be discussed among their members.

 What is the prevalence rate of cervical cancer?

Worldwide about 751 women die from cervical cancer everyday and more than 80 per cent of these deaths come from the Sub-Saharan Africa. In Nigeria, 14,000 to 20,000 new cases are diagnosed every year while 9,659 deaths occur every year translating to the loss of 26 women every day due to a preventable disease.

 What do pregnant and lactating women need to know about cervical cancer vaccine?

HPV vaccine is not recommended in a pregnant woman however it can be given during the lactation period.

 What is cervical cancer screening and how is it performed?

Cervical cancer screening is a medical examination carried out on the cervix to determine the women at risk of developing cervical cancer. The screening detects the pre-cancer stage and treatment is offered at this stage to prevent the screened individual from developing cervical cancer later in life. The most popular and widely accepted method is the Pap smear; here the cervix is exposed and scrapped with spatula. The scrapings are smeared on a glass slide and viewed with the aid of a microscope. It is not a painful procedure and can be done within three to five minutes.

 What are the challenges facing the current cervical cancer screening process?

Death from cervical cancer in the more advanced countries is almost going into extinction because of the excellent implementable cervical cancer screening method they have. In Nigeria there is no accepted and implementable screening programme on ground, there is still very poor awareness of cervical cancer screening in Nigeria, lack of enough manpower especially histopathologists who will examine the smeared slides under a microscope, financial constraints and lack of follow up after the initial screening.

 What should individuals do to protect themselves from cervical cancer?

They should get health education and avoid habits that place one at higher risk of contracting HPV infection, HPV vaccines for young girls aged nine to 26 years, screening for premalignant lesions of the cervix and appropriate treatment. The screening could be in form of Pap smear, liquid based cytology, HPV Deoxyribonucleic acid assay, visual or aided inspection using acetic acid or Lugols Iodine etc. The screening should be done once one starts sexual intercourse and should be repeated at intervals of six months and three years, depending on the initial result.

 What is the latest on HPV vaccine?

There are more than 150 types of HPV divided into cancer forming(oncogenic) and non-cancer forming. Types 16 and 18 are notorious for cervical cancer while types six and 11 cause the irritating, ugly genital warts both in males and females. HPV vaccines are available, two types exist- the bivalent which covers for HPV types 16 and 18 while the quadrivalent vaccine covers for types six, 11, 16 and 18. The full course of the vaccine is three doses given at some months. Interval apart after the initial dose. It is recommended for young girls between the ages of 9 and 26 years. Those who already have HPV infection may still benefit because of cross protection to other strains of the virus.

 What type of support and information do cervical cancer survivors need most?

They need psychosocial and emotional support from relatives, friends and religious bodies to improve the quality of their lives. More so, they need medical follow up and care. The survivors should share their experience and join other support groups in advocating for a well packaged and implementable programme for cervical cancer screening. If we can allow a few hours old baby to receive polio vaccination, six weeks old to receive PENTA vaccination, how much more our lovely daughters who are at risk of HPV monster cell hijackers that are almost synonymous with cervical cancer. The mouth that will give birth to the fruit of the womb is worth vaccinating to enjoy the fruit.

 At what level are you contributing to cervical cancer awareness?

I’m a strong advocate for proper implementable cervical cancer screening programme in Nigeria. I’ve also made public presentations within and outside Nigeria on cervical cancer screening. I’m currently carrying out a research on a cost effective way of cervical cancer screening in a resource-constrained setting.

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