Latest update April 23rd, 2024 12:59 AM
Feb 02, 2020 News
By Dr. Martin Campbell
Cervical cancer is akin to the Sloth, one of several of the slow-moving arboreal mammals inhabiting South and Central America. It would be fatal, to link the sloth of the cancer of the cervix with apathy or laziness.
It is true that it takes about a decade for cervical cancer to mature from pre-cancerous lesions, thus patients have ample opportunities for prevention, and if contracted, to benefit from early detection and life-saving treatment.
Cervical cancer is common among women globally. According to 2018 figures, there were some 580,000 new diagnoses that year. This disease, affects women between the ages of 30 and 65 years. However, younger women are also usually victims of this deadly ailment.
As a South American state, Guyana has not escaped the sluggish, imperceptible but relentless march of cancer of the cervix.
The multi-racial Cooperative Republic ranks among the most affected countries in the Region of the Americas with an age-standardised incidence rate of 32.7 per 100,000 in 2018. Cervical cancer is also the second most frequently-diagnosed cancer with 124 new cases or 16.5 percent of all reported cancer cases and results in the most cancer-related deaths with 64 cases or 13.6 percent of mortalities for 2018, regardless of age or sex.
Although the highest rates are documented among Guyanese women of African and East Indian heritages, women of indigenous heritage (Amerindian women) have a very high incidence of the Human Papilloma Virus (HPV) related cervical changes.
Cancer of the cervix was the second most common cancer overall in Guyana also among women. There were 1,014 cases of cervical cancer for a cumulative incidence rate of 270 per 100,000 population. Afro-Guyanese women had marginally the highest incidence (384) followed by Indo-Guyanese women with 383.
Guyanese women of Chinese decent had the cumulative rate of cervical cancer (561 per 100,000), followed by Afro-Guyanese women with 339 per 100,000 and then Amerindian women with 276 per 100,000 population.
The largest number of cases was diagnosed in 2000 with minimal decreases seen in the following three years. There were reductions in 2009 with less than a hundred cases, following by increases above 100 cases in the next two years. In 2012, there was a marked reduction of cases to fewer than a hundred.
Cervical cancer begins in the cervix, the lowest portion of a woman’s uterus (womb) that opens into the vagina. The normal cervix has two main types of cells: Squamos (flat) cells, that protect the outer part and Glandular cells, which are mostly inside and make the fluids and mucus commonly seen during ovulation. Cervical cancer occurs when either of these cell types grows abnormally and progressively invades other parts of the body.
The HPV is behind almost all cases of cervical cancers. Most adult women have been exposed to HPV infection. HOW? – through sexual contact.
HPV infection usually clears up on its own. Although the body’s normal immune system is able to destroy the HPV infection, some infections persist. This persistent HPV infection in the cervix causes cell changes (pre-cancerous lesions) that can become cancerous, unless treated.
HPV 16 and 18 are two of several common cancer-causing types responsible for an estimated 70 percent of all cervical cancers. However, HPV infection by itself is not sufficient factor for developing cervical cancer since that usually requires the presence of other risk elements such as one’s family history; sexual and reproductive history; smoking; Immuno-suppression, overweight and eating unhealthy diets low in fruit and vegetables.
It is a known fact that early sexual intercourse and multiple sexual partners expose an immature cervix to the various strains of HPV and other sexually transmitted infections (STIs). Additionally, women who had their first full term pregnancy by age 17 are twice as likely to develop cervical cancer as women who waited to get pregnant at age 25 or older.
Any history of STIs also multiplies the risk. Women with three or more full-term pregnancies and those with prolonged use of oral contraceptives (especially if taken longer than five years) also increase that risk.
Also, women who have had a first-degree relative (mother or sister) with cervical cancer have double or triple the risk of contracting the deadly disease.
Plus, a woman who is a HIV-positive or suffers from any other condition that weakens the immune system (prolonged steroid use such as women with lupus and asthma or having uncontrolled diabetes) is at a higher risk of contracting HPV which may develop pre-cancer and cervical cancer at a faster rate.
Smoking is another risk factor since the nicotine and other carcinogenic substances found in tobacco (cigarettes) tend to accumulate in the cervical mucus and cause precancerous changes heightening the chances of developing the cancer.
While pre-cancers usually have no symptoms, positive signs of the disease include abnormal vaginal bleeding; bleeding after sexual intercourse; bleeding between menstrual cycles and after onset of menopause; menstruation lasting longer and heavier than normal; excessive vaginal discharge; pain during sexual intercourse and pelvic pain.
Many of these symptoms can also be caused by other health problems, it is therefore important for a woman to visit her doctor for an accurate diagnosis of her medical problem(s) via a pelvic examination, Pap smear or VIA (vaginal inspection by acetic acid).
If problems are detected, the physician may recommend undergoing a colposcopy (observing the cervix through a magnifying scope). If the colposcopy reveals any abnormality, a biopsy may be done to confirm diagnosis. The patient may be advised to undergo a surgery, radiation therapy and/or chemotherapy if cervical cancer is diagnosed.
The treatment regimen will depend on several factors including: the stage, size and location of the cancer and the age and general health of the patient.
In theory, no woman should die from cervical cancer since this is almost 100 percent avoidable through vaccination, screening and effective treatment.
HPV vaccination for Guyanese girls 9-16 years old is a big first blow to defeating cervical cancer as it offers lifelong protection from certain high-risk types of HPV known to cause 70 percent of cervical cancer cases.
However, for older, sexually active women, regular screening for cervical cancer is extremely important in preventing unnecessary deaths.
VIA screening is FREE at public health facilities in Guyana. It is a quick, pain-free process of assessing the Cervix after applying vinegar (acetic acid solution). This test is suitable for all sexually active women 50 years and younger. With a VIA your results are given to you immediately and pre-cancer treatment by means of Cryotherapy is offered in the same instance.
This treatment option is proven to destroy precancerous cells thus preventing them from developing into cancer.
The VIA service can be accessed at the following government health facilities: Mabaruma Regional Hospital, Moruca District Hospital, Anna Regina Health Centre, Charity Hospital, Leonora Cottage Hospital, West Demerara Regional Hospital, GPHC VIA clinic, National Care And Treatment Centre, Dorothy Bailey Health Centre (South Road clinic), Campbellville Health Centre , Kitty Health Centre, Industry Health Centre, Mahaicony Hospital, Fort Wellington Hospital, New Amsterdam Hospital, Skeldon Health centre , Bartica Hospital, Mahdia District Hospital, Lethem Regional, Linden Hospital Complex and the Upper Demerara Hospital.
It is recommended that women should be screened every three years. It is also recommended that women with Immuno-suppressive conditions such as being HIV positive should be screened every year. Furthermore, women who have had a supra-cervical hysterectomy (without removal of the cervix) should continue routine cervical cancer screening.
Specialists also urge women from 50-yrs old (and those with menopausal changes to cervix) to have routine Pap smears every three years until they reach the age of 69. They may stop taking the procedure if all previous results are found to be normal.
Delaying their first sexual contact until after age 20, avoiding multiple sexual partners, using a condom correctly, quitting smoking and having a healthy weight and diet are other ways to mitigate the risk of contracting the disease.
Remember screen routinely, early detection saves lives.
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