Cervical cancer is the most common cancer diagnosed in women in southern Africa with an estimated lifetime risk of one in 26. The absence of a sound healthcare system available to all means that many women are diagnosed late, resulting in a poor prognosis for survival.
The newly available vaccine against cervical cancer can be given to girls as young as nine, but many have argued that this sends out a mixed message: don’t be sexually active but, just in case you are, here’s a vaccine. The reason behind giving the vaccine at a younger age is that it is believed to be more effective if immunisation takes place before the girl becomes sexually active; that is, before she is exposed to human papillomavirus.
The vaccination should come with some wise counsel and sound sexual education. Smoking, early sexual activity and multiple partners (in the case of both partners) are also factors that increase chances of contracting the virus.
In the United Kingdom, there is a national immunisation drive to the tune of about ₤9-million a year. Sweden, Australia, Canada, New Zealand and Greece are all currently offering the vaccine free of charge and in most of these countries immunisation is taking place at schools. In Kenya, the vaccine costs more than most people’s annual earnings – a tragedy considering the fact that in developing countries, cervical cancer is the leading cause of death among women – with an estimated 190 000 deaths each year.
What is Cervical Cancer?
Cancer of the cervix is mostly caused by various strains of a virus known as the human papillomavirus (HPV). HPV is a sexually transmitted infection and most of the time the immune system will eradicate the virus itself and you’ll be none the wiser. However, in some cases, the virus remains and over time has the potential to convert normal cervical cells into cancerous ones.
What is HPV?
HPV is a group of common viruses responsible for almost all forms of cervical cancer. In addition to this, HPV causes a variety of other problems such as common warts and genital warts, as well as cancers of the vulva, vagina, anus and cancers of the head and neck.
How is HPV Transmitted?
Affecting both men and women, HPV can be passed through skin contact, the most common being through intercourse. Condoms can help to prevent the transmission of HPV but they are not 100 per cent effective. CANSA reports that it is thought that there may be other ways of spreading the virus that have not yet been identified.
What are the Symptoms of Cervical Cancer?
During the early stages of the cancer there are likely to be no symptoms, but as the conversion to cancerous cells progresses, some but not all of these symptoms may be experienced:
- Blood spots or light bleeding when you’re not having your period
- Unusual discharge from the vagina
- Bleeding after menopause
- Bleeding or pain during sex.
Additional symptoms may include:
- Anaemia because of abnormal vaginal bleeding
- Ongoing pelvic, leg or back pain
- Urinary problems because of blockage of a kidney or urethra
- Bleeding from the rectum or bladder
- Weight loss.
(Courtesy of the Cervical Cancer Campaign, USA)
Which Vaccine and at What Cost?
There are two vaccines available in South Africa, Cervarix and Gardasil.
Cervarix protects against the two strains of HPV responsible for 70 per cent of cervical cancers (HPV types 16 and 18), but does not prevent genital warts, which can be caused by HPV.
Gardasil protects against HPV types 16 and 18, as well as HPV 6 and 11 that together cause 90 per cent of genital warts.
For effective immunisation you need three injections over a six-month period. Cervarix costs around R700 a dose, while Gardasil costs around R1 200 a dose. The vaccines are currently only available in the private sector. These are the most expensive vaccines ever developed and for this reason, even with subsidised sales to developing countries, the cost is unlikely to fall until companies have recouped costs and met targeted profits.
What about Boys?
Boys can’t contract cervical cancer, but are at risk of genital, anal and throat cancers as a result of HPV. In October 2009, the Food and Drug Administration in the US approved the use of Gardasil to prevent genital warts in boys. It’s an expensive vaccine and, therefore, not a popular one, but with ongoing research the vaccine may soon be implemented in developed countries on a national scale.
… and their Moms?
Dr Hennie Botha, Head of the Unit for Gynaecological Oncology at Tygerberg Hospital and Stellenbosch University says there is enough conclusive scientific evidence to indicate that the vaccine will improve protection against cervical cancer when given to women over the age of 26. However, he recommends adult women also follow a secondary prevention route and go for regular Pap smears.
“When an older woman has her cervical cancer screening she should have a Pap smear every year for three years in a row. If there are no abnormalities in these first three tests then the woman’s chances of contracting cervical cancer become markedly lower and she then only needs to have a Pap smear every three to five years,” says Dr Botha.