Cervix is the narrow lower end of the uterus (womb) which directly connects the womb to the upper part of the vagina. Cervical cancer develops when the cells in the cervix begin to grow and replicate abnormally, eventually growing to form a tumour mass. Basically, cervical cancer grows slowly over the years usually beginning as precancerous lesions (also known as cervical intra-epithelial neoplasia). Just like other malignant tumours, cervical cancers can spread to other parts of the body, further causing growth of malignant cells in the affected body parts.
Cervical cancer is the second most common cancer in women globally and over 90% of cervical cancers occur in developing countries where regular screening and effective treatment programmes are lacking. According to the World Health Organization (WHO), over 530,000 new cases of cervical cancer and 275,000 deaths were reported globally in 2008. In the WHO African region, cervical cancer is rated the leading cancer among women accounting for over 75,000 new cases and 50,000 deaths in 2008. In fact, according to GLOBOCAN reports, the highest incidence of cervical cancer occurred in Africa, with Malawi and Mozambique having the highest incidence rates globally. Cervical cancers affect more people in the younger age group (with age of onset in the late 30s) due to early age at first sex, history of multiple sexual partners and infection with Human Papilloma Virus (HPV), which is mostly responsible for cervical intra-epithelial neoplasia (CIN). Indeed, cervical cancer remains a major public health problem in Africa. The good news is that there are now proven, efficient, and cost-effective screening and preventive options, including HPV vaccines, available in many low- and middle-income countries (LMIC). However, current research evidences show that awareness of cervical cancer (which is necessary for success of national programmes on cervical cancers) in many African settings is low, and this has been a major challenge over the years.
Causes of Cervical Cancer and Risk Factors
Oncologists reported that almost all cervical cancers result from an infection with HPV (which is mainly sexually transmitted), but this does not imply that all women infected with HPV develop cervical cancers. It is important to note that there are specific types of HPV that increase the risk of cervical cancer and a vaccine that protects against about 70% of these HPV strains has been developed. Environmental factors and many host genetic or immune factors also contribute to the development of cervical cancer. Other risk factors include early age at first sex, multiple sexual partners, weak immune system, smoking and poor diet.
Early Symptoms of Cervical Cancer and How to Stay Healthy
The main symptom of cervical cancer is abnormal vaginal bleeding, which may occur between menstrual periods or during sexual intercourse. Due to the association with HPV infection, there could also be vaginal discharge, lower abdominal pains and pains during sex. All these may not necessarily be symptoms of cervical cancers; however, we should always seek immediate medical attention to ascertain the cause.
Raising awareness on cervical cancers especially in rural areas, and establishing early screening, vaccination and treatment programmes remain effective measures in the control of cervical cancers. According to the American College of Obstetrics and Gynecology guidelines, vaccination against HPV is encouraged at age 11 or 12, and it is recommended that ladies go for first “pap smear test” (a screening tool for cervical cancer) at age 21, while teens that have not been vaccinated against HPV or have some diseases that have weakened the immune system may have pap smear done before age 21. The guideline recommends that women in their 20s be screened every two years, while women in their 30s may be screened every three years only after having three consecutive negative smears. In Uganda, Rwanda and Uzbeskitan, there are on-going plans to administer vaccines to about 1.5 million young girls under an international support programme of the GAVI Alliance. Due to the huge resources needed in a country like Nigeria, we hope our government will be more pro-active and encourage such international partnership.
From all indications, especially due to the prevalence of infectious diseases in Africa, cervical cancers already present a huge public health burden. Please, stay away from these risks, and present to standard health facilities if you think you have any of these symptoms. Thank you.
Dr. Davies Adeloye is a medical doctor and epidemiologist. He currently lectures at Covenant University, Ota, Nigeria