January is celebrated as cervical health awareness month in some parts of the world. As far as I know, Ghana does not celebrate any such month, or day; if we do, then it seems to be too low-key.
Considering that cervical cancer is fast overtaking breast cancer as the leading cause of cancer-related deaths among women in Ghana, we need to talk more about it.
Cervical cancer is a type of cancer that affects the cervix, the opening into the uterus (womb). Because it is not in plain sight, the cervix may not be realized to be diseased until quite late. Cancer is an indolent disease and cervical cancer is usually only diagnosed when complications like bleeding set in, by which time the cancer has probably spread to other parts of the body, a situation that makes cure quite difficult.
Many women die every year from cervical cancer. The International Agency for Research on Cancer (IARC) has estimated that in 2008, 3,038 Ghanaian women developed cervical cancer and 2,006 Ghanaian woman died from cervical cancer. And the numbers seem to be increasing.
But cervical cancer need not kill or affect so many women. We know that persistent infection with some specific strains (so called high risk strains) of the Human Papilloma Virus (HPV), a sexually transmitted infection, is the cause of virtually all cases of cervical cancer. Cervical cancer is one of the very few cancers caused by an infection and this peculiarity serves as a good first point in our fight against the disease.
In his address at the Annual General Meeting of the Medical Women Association of Ghana in November, 2015, Gynaecologist at the Battor Catholic Hospital, Dr. Kofi Effah, stated that there are certain factors that increase the chance of contracting HPV infection and therefore increase the likelihood of developing cancer. These include:
- Early age of first intercourse.
- Multiple sexual partners.
- A male partner with multiple previous sexual partners.
Following from this knowledge, it goes without saying that any strategy that prevents transmission of sexually transmitted infections can also help prevent cervical cancer. These include abstinence, condom use and limiting the number of sexual partners.
Beyond this, a vaccines is available to prevent contraction of the infection. CervarixR and GardasilR are two of the commonly used internationally, and are available in Ghana. The vaccines are typically reserved for adolescents, between the ages or 12 and 15, before the commencement of sexual activity, but older women who are HPV negative can also take the vaccine.
Once HPV infection is avoided, the risk of cervical cancer is reduced to almost zero.
Should this opportunity for prevention of HPV infection be missed, there are screening tools available to prevent cervical cancer. Unlike with most other cancers, where screening involves the detection of early stage disease, cervical cancer screening tries to identify lesions that are not yet cancerous, but can develop into cancer. This allows for intervention to be put in place even before cancer occurs.
This auspicious peculiarity of cervical cancer screening has reduced deaths from cervical cancer to remarkably low levels in most developed nations.
The Pap smear test is a widely available screening tool that identifies cells in the cervix that have the potential to become cancerous. Once these cells are identified, appropriate treatment is given. Every Ghanaian woman should endeavour to have a Pap smear once every 3 years, or as frequently as prescribed by their physician.
Another strategy, which is usually used in combination with the Pap smear test, is HPV testing. This test tries to identify infection with high risk strains of HPV. Once these are identified, appropriate treatment and follow-up is done. Unfortunately, very few centres in Ghana offer this test, and at cut-throat prices. Dr. Effah and his colleagues are thus working to secure equipment that can run this test at low cost. Theirs is a noble cause to bring HPV testing to every Ghanaian woman, affluent or underprivileged, urban or rural.
But all these screening tests must necessarily be followed by appropriate treatment. In an interview for this article, Dr. Effah commented that screening without follow-up is an exercise in futility: “the Pap smear is not treatment, it only allows for early detection so that appropriate treatment is given”. As such, if pre-cancerous lesions are identified on Pap smear, the affected woman must follow through with the recommended treatment.
Cervical cancer can be devastating when it is not caught early. The suffering it brings to patients and their families is unfathomable and it is best avoided.
Cervical cancer can be easily prevented: should every adolescent girl be vaccinated against HPV and every woman be regularly screened and followed-up with appropriate treatment, our women will have one less cancer to worry about.
Vaccinate, screen, follow-up! Prevent cervical cancer!
By: K.T. Nimako (MB ChB)
Dr. Kojo Nimako is a private medical practitioner with an interest in public health, and Citi FM’s Chief Medical Correspondent. He is also the editor of healthbloggh.com and the Executive Director of Helping Hand Medical Outreach, an NGO focused on health education.
Follow on Twitter: @KTNimako
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