Cervical Cancer, one of the few “infectious” cancers, the number 2 cancer killer of women in Nigeria and in most part of the developing world, is almost 100% preventable and in most cases, curable if detected early. Despite the screening test to detect changes in the cervix that may suggest impending cancer, have been with humanity for close to a century. Notwithstanding the fact that the test is reasonably affordable and does require much skill or high technology to perform, Nigeria as a country still lags behind in making the test available to her women folks. Thus, most cases of cervical cancers are seen at late stages when the outlook for survival is grim.
But what is the Cervix?
The cervix often called the neck of the uterus is like a veranda, a kind of setback for the womb which plays the all-important role of harbouring the growing fetus. It, therefore, functions as the border post that keeps the growing baby inside the uterus until it is ready to be delivered. It also provides the exit for menstrual flow to leave the woman body. The cervix is present in every woman except in few cases of congenital absence of cervix and in those that lost it to surgery consequent on some diseases.
Every woman with a cervix who is sexually active stands the risk of developing cancer of the cervix. Every year 14,500 Nigerian women (40 per day) are diagnosed with cervical cancer representing 2.8% of the global burden while 9,659 women (26 per day) dies from the disease representing 3.5% of worldwide cancer death. It affects more of younger women in the reproductive group between 20 and 35years. Unfortunately, less than 1% of Nigerian women are aware of the disease and just about 0.1% has ever had the much-needed servicing of the cervix to prevent its cancer.
Human Papilloma Virus (HPV), one of the commonest sexually transmitted viruses with more than 200 types has been conclusively incriminated as a constant factor in the development of cervical cancer with HPV types 16 and 18 causing more than 70% of all cancers of the cervix. About 70% of HPV infection are gone within a year or two without any treatment. However, in some 5-10% of infected women, the infection persists with a high risk of cancer-causing changes within the cervix. This process of transition from HPV infection, precancerous changes and frank cancer takes between 15-30 years, giving ample opportunity for prevention through regular screening to detect and treat any precancerous changes.
It is not known conclusively while some women develop persistent HPV infection with risk of changes in the cervix that can result in cancer, it is however known that cigarette smoking, high childbirth, multiple sexual partners, long-standing use of oral contraceptive pills and co-infection with HIV and or herpes are co factors for persistent HPV infection and precancerous changes in the cervix.
While decision on cervical cancer screening is becoming increasingly individualized based on a number of factors such as personal risk profile, medical history, availability of screening tests and follow-up options, to prevent cervical cancer and catch any changes at the early treatable stage requires that all women from age 21 years or from 3 years after becoming sexually active (whichever is earlier) should subject their cervix to regular servicing in the form of a pap smear, a simple, quick relatively painless screening test costing less than ₦5,000 in most centers. This test is generally recommended to be done routinely every 2-3 years until around age 65 years. Testing for HPV infection requires more technology and it’s costlier but can also be done every 5 years as a routine servicing of the cervix. In addition, two preventive vaccines (Gardasil and Cervarix) have been developed which reduces significantly the risk of acquiring HPV infections. These vaccines are most effective when given to girls before they become sexually active and is usually given from age 9years in 2-3 doses.
Most of us take our cars to the mechanic for routine servicing to optimize its performance. In the same way, women need to routinely service their cervix for optimal cervical health.
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This article was first published on 28th September 2017 and updated on September 29th, 2017 at 8:04 pm
iziaq
Dr. Iziaq Kunle Salako is a public health physician, political epidemiologist and former commissioner of health in Ogun State. A strong believer in a proactive healthcare system that prioritizes prevention and early detection and proponent of DIY Healthmization, he anchors a popular health promotion radio programme; Wellness Connect and is the President of a Non-Governmental Organization, Health and Wellness Optimization Foundation working on proactive actions to promote and protect the health of the public.
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