Promoting Awareness On Cervical Cancer

As a global public health problem, cancer has become one of the leading causes of women’s death. Globally, nearly 18.1 million new cancer cases and 9.6 million cancer-related deaths occurred in 2018, with 70 per cent of such deaths occurring in developing countries.  In Nepal, 2,244 new cases of cervical cancer are diagnosed annually, and 1,493 women die of this disease.

Three-year data from the National Cancer Registry Programme (NCRP) from 2013 to 2015 showed that the top leading cancer sites among females are the cervix followed by the breast, lung, ovary and stomach. 

Increase in life expectancy, changes in lifestyle-related factors like food habits, sedentary lifestyle, sexual behaviour, and environmental pollution due to industrialisation are mainly related to increasing the burden of cancer incidence and deaths in developing countries. This challenges the existing healthcare system with the added economic burden on the health economy of countries like Nepal.

Cervical cancer is a disease in which cancer cells arise in the cervix that connects the uterus to the vagina. These cancer cells can spread to other parts of the body. Initially, this cancer may be asymptomatic. Later, patients may start showing symptoms like abnormal vaginal bleeding, pelvic pain, blood-stained foul vaginal discharge or pain during sexual intercourse.

Bleeding after sexual intercourse may not be serious but this symptom should not be underestimated in the late reproductive years. When the disease is in an advanced stage, metastases may be present in the abdomen, lungs, or elsewhere.

Symptoms of advanced cervical cancer may include loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen legs, heavy vaginal bleeding, bone fractures, and rare leakage of urine or faeces from the vagina.

Though most women with Human Papillomavirus  (HPV) infections may not develop cervical cancer, it causes more than 90 per cent of cases. HPV 16 and 18 strains are responsible for nearly half of all high-grade cervical pre-cancers.

Other risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners. Genetic factors also contribute to cervical cancer risk. According to Wikipedia, cervical cancer typically develops from precancerous changes over 10 to 20 years.

The disease is diagnosed typically by cervical screening followed by a cervical cone biopsy. Further diagnostic and treatment procedures include loop electrical excision procedure and cervical conisation, in which the inner lining of the cervix is removed to be examined pathologically.

This is carried out if the biopsy confirms severe cervical intraepithelial neoplasia. Certain radiological imaging like ultrasound, CT and/or MRI is done to determine whether cancer has spread to other parts of the body or not.

While the risk of cancer still exists, guidelines recommend continuing regular screening tests like Pap tests or liquid-based cytology. Other screening methods include visual inspection with acetic acid, Lugol’s iodine (VIA and VILI), HPV DNA testing and colposcopy. These screening methods help in identifying precancerous changes, which, when treated, can prevent the development of cancer. Other methods of prevention include having few or no sexual partners and the use 

of condoms.

HPV vaccines protect against two to seven high-risk strains of this family of viruses, and may prevent up to 90 per cent of cervical cancers. 

With preventative interventions like vaccination and screening methods, these new cervical cancer cases will impact the next 10-20 years. Hence, priority must be given to the early detection of precancerous and treatment of invasive cancer.

Several recommended options exist for screening those aged 30 to 65. This includes cervical cytology every three years, HPV testing every five years, or HPV testing together with cytology every five years. 

Screening is not beneficial before the age of 25, as the rate of disease is low. Screening is not beneficial in women older than 60 years if they have a history of negative results.

Primary prevention includes HPV vaccination programme coverage and programme details, related risk factors such as tobacco use prevention and condom use, at least for high-risk sex and HIV incidence. Secondary prevention includes a national screening programme for cervical cancer details and cervical cancer screening rates. In addition, national guidelines should be formulated for cervical cancer management, cancer diagnosis and treatment service availability, availability of 

specialised medical staff and palliative care. About 90 per cent of cervical cancer cases are squamous cell carcinomas, 10 per cent are adenocarcinoma, and a small number of such cases are other types. The treatment may consist of some combination of surgery, chemotherapy, and radiation therapy. Treatment methods, outcomes and five-year survival rates depend very much on how early the cancer is detected and its type.

By 2040, it is estimated that the number of new cases of cancer will rise to 29.5 million worldwide. GLOBOCAN 2018 estimates that the age-standardized cancer incidence and mortality rates in Nepal are 103.7 and 77.8 per 100,000 population in Nepal. Previous studies have shown that the cancer burden in the country may still rise in future and pose a serious threat.

And the low level of awareness of people with cervical cancer and the low screening rate has additionally raised the burden of cancer, which is diagnosed at a late stage. Hence, it highly demands awareness programmes on cervical cancer.

Though cervical cancer is invasive, the disease is preventable with vaccination and appropriate screening. January is cervical cancer awareness month. It is the perfect opportunity for WHO and its partners to raise awareness about cervical cancer and HPV vaccination. The theme for Cervical Cancer Awareness Month this year is focused on ending cervical cancer within a few generations. 

 As part of educating and advocating for increased knowledge of cervical cancer and HPV disease, you can contact your local and national media to encourage coverage of Cervical Health Awareness Month.

Cervical cancer is one of the most successfully treatable forms of cancer if it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care. With a comprehensive approach to prevention, screening and treatment, we can end cervical cancer as a public health problem within a few generations.

The messages of Cervical Cancer Awareness Month are clear – get informed, get screened and get vaccinated. Get informed: find out the facts about cervical cancer and the human papillomavirus (HPV) that causes it. Help educate other women in your life too.

Getting screened: cervical cancer screening typically starts at age 30 and is repeated periodically. Get vaccinated: the HPV vaccine is given in two doses that should begin when a girl is between 9 and 14 years old.

The Cervical Cancer Awareness Month also takes place at a time when the world continues to recover from the COVID-19 pandemic, where substantial disruptions to essential health services persist. So, during this month and beyond, let us work together to build back healthier communities by improving access to HPV vaccination, screening, treatment for cervical pre-cancer and management of cervical cancer by 2030 and end cervical cancer within a few generations.

Despite being a preventable and curable disease, cervical cancer is responsible for a large burden of suffering in women around the world, especially in low- and middle-income countries. To uphold the right to health for adolescent girls and women, disparities in access to high-quality health services must be addressed.

In 2020, the World Health Organisation (WHO) set a goal to eliminate cervical cancer as a public health problem globally by 2120. To reach this goal, member states of WHO should strive to meet the following interim scale-up targets (90-70-90) by 2030:  first, 90 per cent of girls are fully vaccinated with the HPV vaccine by 15 years of age; second, 70 per cent of women are screened using a high-performance test by 35 years of age and again by 45 years of age; and third, 90 per cent of women with pre-cancer are treated, and 90 per cent of women with invasive cancer are managed.

To build on the momentum of the global strategy to accelerate the elimination of cervical cancer as a public health problem, a regional cervical cancer elimination strategy has been developed for the particular region that is adapted to the religious, cultural, social, economic and geographical contexts in the region.

And the educational materials should be in their understandable languages.  So let us not focus on this awareness programme only in January, considering its grave consequences such kind of awareness programmes should be continued throughout the year.