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Cervical cancer, caused by a virus called human papillomavirus (HPV) that is mainly transmitted through sexual contact, is the leading cause of cancer death in women in South Africa.
Number one killer
More than 4 000 women die from cervical cancer in South Africa every year, although it is one of the most preventable diseases.
"Breast cancer is number one in terms of incidence of female cancers in South Africa. However, more women die of cervical cancer than of breast or any other cancer," Dr Kim Lohlun, an oncologist at Netcare Olivedale Hospital, explained to Health24.
Read: Diagnosed with breast cancer at 15
At the beginning of the HIV/Aids outbreak, people were very hesitant talk about the it, but with the introduction of anti-retroviral treatment the stigma was greatly reduced.
"In the same way, we now need to get discussions going on and spread awareness of HPV and cervical cancer. South Africans need to know that there is no shame in discussing this condition openly,” said Dr Lohlun.
The Human Papillomavirus and Related Disease Report, published in February this year by the ICO HPV Information Centre on HPV and Cancer indicates than 18.81 million South African women, over the age of 15 are at risk of cervical cancer.
Read: Causes of cervical cancer
Alarmingly, it noted that as many as 7 735 South African women are diagnosed with cervical cancer every year, while 4 248 lose their lives annually because of the disease.
Disconcerting statistics
“Given that approximately 80% of women will be exposed to the human papilloma virus in their lifetime, this is clearly not something that happens to ‘other’ women only," said Dr Mtsi, a gynaecologist and obstetrician at Netcare Park Lane Hospital in Parktown
These statistics, said Dr Mtsi, are all the more disconcerting when one considers that cervical cancer is nowadays a preventable disease.
“If you can protect yourself from getting an HPV infection, your chances of developing cervical cancer are miniscule.”
What is HPV?
HPV is a double-stranded DNA virus. Up to 80 percent of sexually active women will acquire an HPV infection in their lifetime, with the risk of persistence increasing with age.
Read: 7 facts about HPV
Approximately 100 types of HPV have been identified to date and, of these, nearly 15 virus types are considered to cause cervical cancer. Together, virus types 16 and 18 are responsible for over 70 percent of cervical cancers globally.
How is HPV transmitted?
The virus is transmitted through sexual contact and in rare cases from a mother to her newborn baby, explained Dr Mtsi.
Because the virus is not carried by bodily fluids but is transferred by contact, having protected sex will not give a hundred percent protection against becoming infected. This also means that actual penetration does not have to take place for HPV to be transmitted.
The link between the HPV and cervical cancer
Cervical cancer affects the small canal between the womb and the vagina. It can take about ten years to develop from the high-risk HPV virus.
“When your cervix is scarred from frequent infection, your cervical cells multiply to heal themselves. However, abnormal cells can multiply out of control as a result of the HPV infection and can cause pre-cancerous cervical lesions, which ultimately cause cervical cancer,” explained Dr Thandi Mtsi.
Read: HPV test replaces Pap smear
The more a woman comes into contact with the HPV, the greater her chances are of developing cervical cancer.
Symptoms of cervical cancer may include:
- Bleeding from the vagina that is not normal, such as bleeding between menstrual periods; after sex; or after menopause
- Pain in the lower belly
- Abnormal vaginal discharge
- Pain during sex
Dr Mtsi said with the aid of annual Pap smears and timeous vaccination against the cancer-causing HPV, cervical cancer should have been totally eradicated by now.
Exposure at a younger age
“However, because of the incorrect perception that sexual promiscuity lies at the heart of this disease, it has been a difficult issue to tackle. Also of great concern, is the fact that girls are nowadays exposed to the virus at a younger age.”
Steps to lower the risk of cervical cancer include:
- Using condoms during sex
- Limiting your number of sexual partners
- Going for regular Pap smears, starting at age 21
- Having a HPV test done after 30 years of age
- Not smoking
“Vaccination against HPV is highly effective," says Dr Lohlun.
Never too late for injection
She said vaccinations against HPV became part of the national vaccination programme in 2014 when SA became the first African country to fund cervical cancer vaccines for schoolgirls, whereby all grade four girls in public schools would be vaccinated with two doses of the bivalent HPV vaccine, Cervarix. Currently, boys are not vaccinated.
Read: HPV vaccine for boys?
The private sector is not included in this programme, said Dr Lohlun, adding that families with children in private schools would need to request the vaccine from their GP.
"It is best to be vaccinated before becoming sexually active and it is recommended that girls as young as nine get vaccinated. However, it is never too late to get the injection, even though you may have come into contact with some of the HPV strains.”
“The gold standard these days is the HPV test which checks for the virus that can cause these cell changes in the cervix. It may be used to screen for cervical cancer together with the Pap test and may also be used to provide more information when the results of a Pap smear are unclear."
Dr Lohlun said the HPV test is unfortunately not yet widely available and is also costly.
Read more:
HPV vaccine= fewer cervical problems
HPV vaccine stops genital warts
Resources:
- Netcare material: Cervical cancer is not something that happens to “other women only”
- The Conversation:Failure to set up affordable cervical cancer tests costs SA https://theconversation.com/failure-to-set-up-affordable-cervical-cancer-tests-costs-south-africa-43378
- Southern African Medical Journal:Paradigm shift needed for cervical cancer: HPV infection is the real epidemic http://www.samj.org.za/index.php/samj/article/view/6936/5069
