In 1990, while I was a student at a prominent rural high school, I learnt that a fellow student had cervical cancer. My initial reaction was shock and dismay, since it was a common belief that this particular disease was caused by early sexual activity. I maintained this perception for a long time.
Years later, I discovered that cervical cancer was actually caused by a virus - the Human Papilloma Virus (HPV). The relationship between cancer and virus was first discovered in 1908 by virologists, scientists who work with viruses, Wilhelm Ellerman and Olaf Bang in Denmark. They were trying to isolate the causative agent of chicken leukemia. They found that leukemia could be transferred to healthy chickens by cell-free filtrates that contained viruses. Since then various cancers have been linked to viruses. This article will be focusing on the risk factors, preventative measures and treatment of cervical cancer.
Cancer is the abnormal growth of cells in the body. This can occur in any organ of the body. It is usually named after the organ in which it occurs. The cervix is the ring of muscles at the entrance of the uterus (womb). It is commonly referred to as the neck of the womb. Cervical cancer is caused by the Human Papilloma Virus (HPV). HPV is a sexually transmitted disease. There are over 100 types, but only four types are linked to cervical cancer -- types 18, 16, 35 and 45. It causes almost all of the cases of cervical cancer. An infection with this virus can also cause cancer of the vulva and vagina. There are also documented cases of the virus being present in the oropharyngeal area where it leads to mouth and throat cancer. It is usually transferred to this area by oral sex. In some cases, the immune system may destroy the virus. However, certain persons are at a greater risk than others. This includes smokers and individuals with suppressed immune systems as in the case with HIV.
Cervical cancer is the second most prevalent cancer in Jamaica. 'The Age Specific Incidence of Cancer in Kingston and St Andrew Jamaica, 2003 to 2007', a report published by the Cancer Registry of Jamaica, showed a total of 302 cases of cancer of the cervix uteri and 363 cases in cancer of the cervix uteri in situ. Cancer of the cervix uteri is most common in the age group 25-59. The report further states that the incidence of cancer of the cervix has fallen from 25.2 per 100, 000 in 1993-1997 to 17.4 per 100, 000 for the period 2003- 2007. They attributed this decline to the 'ad hoc screening via cervical smears and the introduction of the HPV vaccine'.
According to Dr Orville Blair, consultant obstetrician and gynecologist at Mandeville Regional Hospital, the number of reported cervical cancer cases is still too high. He attributes this to lack of education. He feels that too many women do not know about pap smears or they do not take it seriously. He feels that an educational campaign on the issue would be helpful.
Dr Blair further states that initial diagnosis can be made, based on the symptoms present. Signs include abnormal vaginal bleeding. However, a pap test can make an early diagnosis. A pap test can be done by a gynecologist or a general practitioner. The doctor takes a sample of cells from the cervix and smears it unto a microscopic slide. It will be sent to the lab where a medical technologist will look at it under a microscope. They can detect pre-malignant cells (abnormal cells before the cancer stage) or malignant cells (cancer). It is imperative that women, who are sexually active, regardless of the age, get a yearly pap test done. This test can detect any changes before it becomes cancer. If the pap smear shows abnormal cells, a cone biopsy is done. A cone biopsy is both diagnostic and therapeutic. The abnormal cervical tissue is removed by the gynecologist and sent to the lab. The aim is to remove all the abnormal tissue. A sample is sent to the lab to confirm the pap smear results.
According to Dr Blair, if cervical cancer is detected in the early stages, a hysterectomy (removal of the uterus) will be done. This may be simple hysterectomy, which is the removal of just the uterus. It may also be radical hysterectomy in which case the uterus and tissues on either side of the cervix will be removed. He stresses that this procedure will not affect the individual's sex life since the opening at the other end of the vaginal cavity will be surgically closed.
The greatest news about cervical cancer is that it can be prevented. It can be done by:
o Getting the HPV vaccine. The vaccine gives protects against the viral infection. It is given in a series of three shots. The recommended age is from age 11 to 12.
o Every sexually active woman and those 21 and over should get a yearly pap smear done. Early detection is important.
o Avoid cigarette smoking, since this is a risk factor for all cancers.
o Use condoms. Condoms can prevent the spread of sexually transmitted diseases, including HPV. However, it is imperative that condoms be stored properly. Condoms should not be stored in wallets as the friction could cause them to deteriorate and lessen the effectiveness. They should be stored in a cool, dry place. Please note that plastic cannot substitute for condoms. Plastics do not have the durability of latex and will not confer the same protection.
o Limit the number of sexual partners. Engaging in sexual intercourse with more than one partner or with a partner that has many partners can increase your risk of sexually transmitted diseases, including HPV.
Cervical cancer can be prevented but each woman will need to take the initiative and take advantage of the preventative measures available.