Cervical cancer (Womanhood Nightmare)

Cervical cancer is one of the most common gynecological cancers affecting women. It is world’s one of the deadliest, but easily preventable cancers of women. It is a huge public health problem and a big challenge to society. Cervical cancer kills one woman every 1.5 minutes around the globe despite being detectable early, fully preventable, and being a treatable cancer.

An estimated 604,127 new cancer cases and 341,831 deaths were recorded around the globe in 2020 (GLOBOCAN; 2020), of which 90 percent (9 out of 10) cancer-related deaths were recorded in resource-poor countries mainly due to inadequate prevention, control, and treatment facilities.

In Nigeria, current estimates indicate that every year 12,075 women are diagnosed with cervical cancer. And every year, 7,968 women die from the disease (Cancer Fact Sheet 2023).

Cervical cancer is a complex disease caused by the interaction of viral, host, and environmental factors.

Human papillomavirus (HPV)

Human papillomavirus (HPV) has been detected in more than 90% of cases and therefore, implicated as the main cause of cervical cancer. The oncogenic HPV types 16 &18 are the most prevalent sexually transmitted virus which can be transmitted through even micro-abrasions from one individual to another.

Persistent infection with these oncogenic HPVs is the most critical factor for the development of various defined stages of cervical cancer, which takes at least 10-20 years.

At the same time, about 90 percent of HPV infection is cleared spontaneously by the body’s immune system within 1-2 years, while only in a few cases (10 percent). This viral infection persists due to a weakened host immune system which can lead to the development of cervical cancers as mentioned above.

Other identified risk factors of Cervical cancer are but not limited to:

• Multiple sexual partners
• Early age of sexual debut (< 16 years old)
• Smoking
• Oral contraceptive pills (OCP)
• Genetic alteration and
• Immunosuppression.

Common signs and symptoms of cervical cancer include

• Intermenstrual bleeding (Bleeding between periods)
• Postcoital bleeding (Bleeding after sexual intercourse)
• Postmenopausal bleeding
• Abnormal foul-smelling vaginal discharge
• Dyspareunia (discomfort during sexual intercourse) and pelvic pain.

Prevention and elimination of Cervical cancer

Prevention and elimination of this deadly disease require focused efforts. The World Health Organization’s (WHO) 90-70-90 elimination strategy, which requires accelerated action in prevention, screening, and cancer management has been quite helpful.

It is a 3-pillar approach which means: 90 percent of girls ought to be fully vaccinated with the HPV vaccine by 15 years, 70 percent of women ought to be screened with a high-performance test by 35 and 45 years of age, precancerous lesions are treated early, and 90 percent identified with the cervical disease receive treatment. This will avert 74 million new cases of cervical cancer and 62 million deaths in 78 low-and middle-income countries in the coming decades. Most importantly, accurate information and increased awareness and knowledge can empower us all to recognize early warning signs, make informed choices about our health, and counter our own fears and misconceptions about the disease.

Vaccination

Prevention of infection with a cost-effective HPV vaccine licensed globally is for effective prevention and control of cervical cancer. The bivalent vaccine (Cervarix) for HPV serotypes 16 & 18 and the Quadrivalent vaccine (Gardasil) for serotypes 6,11,16 & 18 are available, and a single dose of this vaccine has shown a robust antibody response against targeted HPV types between 9-14 years. This is meant for the target age group before they are potentially exposed to the virus. Currently, more than 10 developed countries have successfully implemented national catch-up HPV immunization programs. Notably, this has led to a substantial reduction in the incidence and mortalities due to cervical cancer, but this is far from the case in our region.

Other preventive measures, therefore are:

• Lifestyle and behavioral modification to prevent the acquisition and spread of HPV infection
• Regular and periodic screening exercises as the case may be
• There’s a need to be physically active
• Avoid smoking
• Eat healthy diets, and
• Increase the consumption of fruits and vegetables to boost susceptible host immunity.

Let us note, that the vaccine may be administered to anyone until age 45. However, the effectiveness of this vaccine cannot be ascertained after sexual activity has begun, as someone may have already been exposed. In addition, women vaccinated against HPV still need to follow the cervical cancer screening recommendations.

Prevention is key: Get informed! Get screened!! Get vaccinated!!!