CANCER of the cervix is the second most common cause of cancer among women, and also the second leading cause of deaths compared to other cancers in women of all ages.

According to obstetrician-gynaecologist Dr Sean Parkinson, developing countries like Jamaica bear the major burden of new cases of cervical cancer and its accompanying problems.

He said there are numerous risk factors for developing cervical cancer. These include:

1. Having a high-risk sexual partner

2. Having multiple sexual partners

3. Early onset of sexual activity (below 21 years old)

4. Having a sexually transmitted infection

5. Suppression of the immune system by the human immunodeficiency virus (HIV)

6. Cigarette smoking

7. Low socio-economic status

8. Early age at time of giving birth

9. Use of the oral contraceptive pill

10. Increased number of children.

Dr Parkinson explained that the risk conferred by the oral contraceptive pill declines after stopping the pill and often returns to baseline after stopping for more than 10 years.

Moreover, he said the Human Papilloma Virus (HPV) is central to the development of cervical cancer.

“HPV has many different types with some being associated with the development of cervical cancer while others predominantly cause anogenital warts (warts on the penis, anus or vulva),” Dr Parkinson said.

Dr Parkinson said HPV is primarily sexually transmitted but unlike most other sexual transmitted infections, it often stays latent with no overt symptoms or signs of infection developing.

“Most HPV infections are short-lived and do not progress to cancer. Only a few HPV infections persist and progress to cause cancer or pre-cancerous lesions. It is still not fully understood what factors cause some HPV infections to persist while others regress,” he said.

But he noted that certain high-risk types of HPV account for virtually all cases of cervical cancer, with HPV 16 and 18 being the most lethal types.

Fortunately, however, he said cervical cancer can be prevented if women consult their doctors for regular Pap smears beginning at 21 years of age.

“Pap smears are recommended every three years until age 29 years, while HPV testing is recommended along with Pap smear (co- testing) every five years starting at age 30 until age 65. Thereafter, screening is discontinued once previous tests were normal,” he said.

According to Dr Parkinson, the majority of women diagnosed with cervical cancer either never had a Pap smear or did not have Pap smears done in a timely manner. He said the recent introduction of vaccines targeting certain types of HPV has decreased precancerous lesions and will likely prevent cervical cancer.

“The vaccines are recommended for administration between the ages of nine to 26 years old with the aim of administration prior to the onset of sexual intercourse when it is most effective,” he said.

With regards to treatment Dr Parkinson said there are three vaccines, approved by the Food and Drug Administration, which help to provide protection against some types of HPV.

“One provides protection against HPV 16 and 18 (bivalent vaccine), which accounts for most cases of cervical cancer. The second provides protection against HPV 16 and 18 along with HPV types 6 and 11 (quadrivalent vaccine) that causes genital warts. Both the bivalent and quadrivalent vaccines are available in Jamaica. The most recently released vaccine provides protection against nine HPV types (nanovalent vaccine). This vaccine is not yet available in Jamaica,” he said.

Dr Parkinson said it is important to emphasise that HPV vaccination supplements but does not remove the need for cervical cancer screening with a Pap smear.

“It is therefore imperative for all women to consult their doctors to get advice about proper screening with Pap smears and to be given information about the benefits and recommendations for the use of HPV vaccines in cervical cancer prevention,” he said.