It’s a Decision: Cervical Cancer Screening

Some days are not as great as others.

Vanel, a  32year old female came to the hospital with complaints of extreme pain during sex (dyspareunia) coupled with slight bleeding after sex. She was frustrated and reiterated that this has been disturbing her business. When asked what she did for a living, she outrightly told me she was a sex worker. Inclined not to judge her, I asked her if she used protection when she rendered services to her customers. She said some customers are not welcoming to the idea and others will only pay well when there is no use of condoms. She went further to tell me, and I quote

“I am not a prostitute oh. I just sleep with booked clients and I have a small circle, so I don’t think I have a Sexually Transmitted Infection (STI). I am not like those girls who sleep with just anyone”.

When she said this, I was sure there was much to be done. Going back to her history, I discovered she was not vaccinated as a girl for Human Papilloma Virus (HPV) neither has she been coming to the hospital for regular checks and screening. When I examined her, there was enormous discomfort and a foul-smelling vaginal discharge. I sent her to the lab to do the basic test for STIs. The results came back and tested positive for Chlamydia. I started her on treatment but strongly advised she go to the Gynaecologist for a screening test called ‘Vial and Villi’. After doing the test, it was positive and immediately, she was asked to do another test called Papanicolaou test (PAPs test) where cells are scraped from the cervix and the scrapings are studied to identify the disease. She was told there was an abnormality with her test and asked to do further tests so that the diagnosis could be confirmed, and the stage of the disease could be determined.
In anger and not understanding the situation, she came back to me. She was very furious and demanded to know why they keep asking her to do more tests.

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Cervical Cancer

Definition

It is a type of cancer (Abnormal mass of tissue that results when cells divide more than they should or do not die when they should) that occurs in the cells of the cervix (the lower part of the uterus [womb] that connects to the vagina). The leading cause of this cancer is the Human Papilloma Virus which is sexually transmitted.

Epidemiology

• Cervical cancer is the second most common form of cancer in women living in the developing world.
• Over 80% of new cervical cancer cases worldwide are in less developed regions.
• Over 85% of cervical cancer deaths occur in developing regions.
• HPV causes 81% of cases of cervical cancer. Out of every 10 teen girls, 8 will get HPV in their life. 6 have HPV right now. One in five of these cases go on its own but some give genital warts and some lead to cancer. 1 in 3 women who get cancer will die.
• 266,000 women die of cervical cancer each year, the clear majority in the developing countries.

Causes

The causes are not very clear, but HPV has been highly incriminated. Seeing that not everyone with HPV gets cancer, it implies other factors such as environment and lifestyle choices also have a role to play.

Risk Factors

• Multiple sexual partners: the more sexual partners, the more likely it is you will get HPV.
• Early sexual activity: having sex at early ages before 16 increases the risk of HPV.
• Other sexually transmitted infections like chlamydia, gonorrhoea, syphilis and HIV/AIDS increase the risk of HPV.
• A weak immune system; which could be caused by another health condition or HPV.
• Smoking
• Taking oral contraceptive pills: This simply is translated by the fact that, when women are on the pill they are comfortable with the fact that it prevents them from getting pregnant but forget the fact that it does not prevent STIs.

Diagnosis and Treatment

If cervical cancer is suspected, a thorough physical examination is done and the cervix  is visualised with samples collected for pathological testing.

Based on the results, further testing can be done to identify the disease stage which are:

• STAGE ONE: cancer is confined to the cervix.
• STAGE TWO: cancer is present in the cervix and upper portion of the vagina.
• STAGE THREE: cancer has moved to the lower portion of the vagina or internally to the pelvic side wall.
• STAGE FOUR: cancer has spread to the nearby organs, such as bladder and rectum, or it has spread to other areas of the body such as the lungs, liver or bones
• As well as it could be a pre-cancerous lesion. This is a benign lesion and only indicates there is an eminent Cancer. With cervical cancer, it occurs between the ages of 20-30.

Prevention

• Vaccinate boys and girls against HPV. Girls aged 13-26 and boys aged 13-21 should be vaccinated against HPV.
• Do screening with PAPs test every three years from age 21.
• Do PAPs and HPV co-testing every five years from age 30.
• Safe sex practices

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After all this talking, Vanel was more comfortable and went ahead to do the other test. She had stage one cancer and was treated accordingly.

For Vanel, she was fortunate to identify the condition early because it was affecting her ‘business’. But many cases go unnoticed and are only diagnosed when these women are in the mid to late 50s or when complications have set in. The easiest way out is for women to go for regular screening and endeavour to vaccinate your children at the appropriate time.

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Thanks to Fozao Mbi Vanessa for this very educative piece. You shall be reading more often from her and other new contributors in this space under their own gravatars.  Anticipate!

January is Cervical Cancer Awareness Month and so we saved the best for last.

Get tested, Get Vaccinated, Get Treated.