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Cervical cancer: over 8,000 Nigerian women ‘ll be saved annually

By Sola Ogundipe
EVERY year, no less than  8,000 Nigerian women die as a result cancer of the cervix – a preventable disorder that has huge physical, emotional and psychological burden on the individual, family and society at large.

Human papillomavirus, or HPV, which causes cervical cancer, is so common that one out of every two sexually active adults has been infected with one or more of the approximately 100 types of HPV, only 30 of which are transmitted sexually.

Most of these are benign (non cancerous), but some can cause cervical cancer—a disease that can be prevented with the HPV vaccination or halted in its very early stages by a gentle, painless scraping of the cervix known as a Pap smear, generally recommended annually.

Worried by  the increasing burden of cervical cancer cases in the country, observers within medical circles have for long proposed adoption of  routine immunisation of  women at risk with the HPV vaccine.

Mr. Dipo Akinlade, Manager, Quality Assurance Caretotalis Nigeria Ltd., with Dr. Winfred Osaruwense, Managing Director Caretotalis Ltd., during the media advocacy for adoption of routine Human Papilloma Virus Vaccine  (HPV) Immunisation against cervical cancer, last week in Lagos. Photo by Bunmi Azeez.
Mr. Dipo Akinlade, Manager, Quality Assurance Caretotalis Nigeria Ltd., with Dr. Winfred Osaruwense, Managing Director Caretotalis Ltd., during the media advocacy for adoption of routine Human Papilloma Virus Vaccine (HPV) Immunisation against cervical cancer, last week in Lagos. Photo by Bunmi Azeez.

In the view of Dr. Winifred Osarumwense, a consultant gynaecologist and obstetrician based in the United Kingdom: “The need for action now may be considerd a medical emergency as failure to act now could result in a missed opportunity to immunise a generation of currently eligible young Nigerians who in future could potentially become infected.”

Osarumwense who is Coordinator, Caretotalis Nigeria Ltd., a health concern advocating for routine HPV immunisation of all woman at risk of cervical cancer in Nigeria, avows said the actual national figure of cervical cancer fatalities was likely to be much higher because the quoted figure of 8,000 was only  from findings at the nation’s tertiary health institutions.

“HPV can cause pre-cancerous abnormalities of cells in the cervix or vulva) and cervical cancer the vaccine specifically targets young girls and adolescents (10-25 years old) for immunisation before they are sexually active.

She said while the  vast majority of women are potentially at risk of re-infection with HPV, however notes that previous natural infection with these cancer-causing human papilloma virus types do not confer lifelong protection.

“Thus, women of all ages are at risk for future infections with the same virus types, some infection persists and can develop into cancer.”

She warned that progression from infection to cervical cancer may take as little as two years in some of these cases and that the older a woman is when infected with HPV, the more likely that the infection will become persistent, which may lead to the development of precancerous lesions.

“As women age, their immune responses typically declineand evidence shows that older womwn have robust immune responses to the HPV vaccine and so should derive benefit from vaccination if they are exposed to HPV type 16 or 18 in the future.”

Making a case for cervarix, the vaccine produced by GSK, she said it had an excellent safety profile. high efficacy and protection from up to 80 per cent of all cervical cancers if fully implemented. The  action for HPV immunisation in Nigeria, Osarumwense noted, was necessay as  cervical cancer remains one of the few cancers that is 100 per cent preventable.

“Education, awareness and now availability of HPV vaccine are the corner stone strategies to the successful prevention of this disease in Nigeria.

In her view, cervical cancer is no longer a disease of the older generation, the age of presentation and diagnosis can be as low as in the latter half of the first decade while the decreasing age of sexual activity in modern day teenagers and the increasing incidence of teenage pregnancy is a significant risk factor globally more so in developing countries.

She said an indeterminate estimate of Nigerian teenagers are sexually active but the figure was likely to be comparable to the 66 per cent of sexually active teenagers in the UK.

“Focus on prevention alleviates the huge financial burden of treatment and care on state and family. The nature of the cancer, age distribution and the associated high mortality provides a fertile market for the uptake of this initiative and the preventative nature of this intervention better compliments the current Nigerian Health system that lacks the comprehensive tertiary infrastructure that can correctly treat this disease in its advanced stages.”

In addition to immunisation, the essence of routine screening is also important. A Pap test, or Pap smear, is part of a woman’s routine physical examination and the best way to prevent cervical cancer, because it can find cells on the cervix that could turn into cancer.

Good Health Weekly established that “When a Pap test is “abnormal,” it means that the test found some cells on the cervix that do not look normal. It does not mean that the woman has cancer.”

Most of the time, abnormal cell changes on the cervix are caused by certain types of  HPV which is a sexually transmitted disease. Usually these cell changes go away on their own. But certain types of HPV have been linked to cervical cancer. That’s why it’s important for women to have regular Pap tests because it takes many years for cell changes in the cervix to turn into cancer.

High-risk such as  having sex without condoms and having more than one sex partner (or having a sex partner who has other partners) all  raise  chances of getting HPV and having an abnormal Pap test.

HPV can stay in the body for many years without detection, so even if a woman has one partner and practices safe sex, she could still have an abnormal Pap test if she was exposed to HPV in the past.

The cell changes themselves don’t cause symptoms. HPV, which causes most abnormal Pap tests, usually doesn’t cause symptoms either. This is why regular Pap tests are so important.

Typical symptoms include a discharge from the vagina that isn’t normal such as a change in the amount, colour, odour, or texture. Others are pain, burning, or itching in your pelvic or genital area when urinating or having sex, sores, lumps, blisters, rashes, or warts on or around the genitals.

On the whole, an abnormal Pap smear requires  more tests to find out if there is an infection or to find out how severe the cell changes are.  These incluse an HPV test done on a sample of cells taken from the cervix and another Pap test in four to six months.

Treatment, if any, will depend on whether the abnormal cell changes are mild, moderate, or severe.   During a Pap test, a small sample of cells from the surface of the cervix is collected. The sample is then spread or smeared on a slide (Pap smear) or mixed in a liquid fixative and sent to a lab to be looked at under a microscope. The cells are examined for cell changes that may be or can lead to cervical cancer.


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