Cancer that robs women of their life after intimacy

Not many people understand the causative or risk factors and how to catch the disease before it goes far and turns fatal.

According to the World Health Organization, cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020.

In Kenya, cervical cancer is the leading cause of cancer-related deaths, with the fatality rate among affected women being at 67 per cent.

Studies show cervical cancer is by far the most common HPV-related disease, with nearly all cases attributed to HPV infection.

January is Cervical Cancer Awareness Month, and it provides an opportunity to highlight and raise awareness about cervical cancer.

Cervical cancer remains a major public health concern in Kenya. It is the second-most common cancer in women but the leading cause of cancer deaths.

Experts estimate that the disease can take 10 to 15 years to progress into invasive cancer, thus a great opportunity for prevention through screening using various screening tests and subsequent treatment through available options.

National Cancer Institute CEO Dr Alfred Karagu says cervical and breast cancers contribute to almost a quarter (23 per cent) of all cancer-related deaths in the country.

HPV can be transmitted through vaginal, anal or oral sex. As long as there is skin-on-skin contact. Therefore, any genital-on-genital stimulation can result in the exchange of HPV

SEXUAL LINK

Cervical cancer is mostly caused by cell abnormalities in the lining of the cervix, a result of the human papillomavirus (HPV).

The HPV virus is often spread through sexual intercourse.

Moses Liruma, an oncologist in Kakamega, explains that while there are several strains of the HPV, the types 16 and 18 are the most notorious cause of high-grade cervical pre-cancers.

He says HPV is mostly transmitted through sexual contact, and most people get infected with the deadly virus shortly after they become sexually active.

Although more than 90 per cent of the cases will eventually clear, people with compromised immunity are likely to develop cancer.

“We are talking about women living with HIV and other illnesses that weaken your immunity and make it hard for your body to fight off the infection easily. This is, however, not to say that only this group will develop cervical cancer,” he says.

Liruma clarifies that sexual transmission of the HPV doesn’t just imply the penis-in-vagina intercourse alone but rather any other way used under the sex umbrella.

“We all define sex differently but of essence is to understand that HPV can be transmitted through vaginal, anal or oral sex. As long as there is skin-on-skin contact. Therefore, any genital-on-genital stimulation can result in the exchange of HPV,” Liruma says.

The oncologist explains that when a person develops cervical cancer, it is normally because of a disruption of healthy cells in the cervix.

“Most sexually active women and men will be infected at some point in their lives, and some will even be repeatedly infected. But most of these cases clear off, about 90 per cent.

He, however, says that while certain strains of HPV are a risk factor for cervical cancer, not everyone who tests positive for those strains of HPV will go on to develop the disease.

“This suggests that there are additional factors that determine your likelihood of developing cervical cancer,” he says.

SCREENING VIA PAP SMEAR

Dr Ismael Kizito of the Tropical Wellness Centre in Kakamega explains that cervical cancer screening involves testing for HPV infection to detect pre-cancer and cancer.

He says anyone with a cervix must ensure they start screening for cancer by age 21, irrespective of whether or not they are sexually active.

The medic explains that there are two ways to screen for cervical cancer: Pap smears and HPV tests.

While many women are uncomfortable with the entire screening process, Kizito encourages women to get screened regularly as it is the only way to catch the disease early and treat it before it reaches the ‘point of no return’.

He explains that the examination takes place with the woman lying on the examination table, usually with their bottoms slid down to the end of the table, with the feet resting on stirrups on either side of the table.

This, he says, helps keep the patient’s legs open so the doctor or clinician can better access the vaginal canal.

“A lubed-up speculum is then inserted into the vagina to gently open it and help the doctor visualise the cervix, which is located at the back of the vaginal canal,” Kizito says.

Once the speculum is in position, the clinician inserts a small, brush-like tool inside the cervical canal and rotates it a few times to collect cervical cells.

‘The brush is then removed and placed in a preservation jar, after which it will then be investigated under a microscope for any signs of cervical cancer,” he says.

The doctor says Pap smear results take three to four weeks to process.

He encourages women to undertake an HPV test alongside the Pap smear.

“For the HPV test, the doctor inserts a Q-tip-like device into your cervical canal and swaps just the same way as the Pap smear to collect cervical cells. The results take between a week and three to be ready,” he says.

To dispel the belief that cancer screening is painful, Kizito urges women to take comfort in the fact that the tests are painless.

“But there are a few circumstances in which it might be a bit uncomfortable. If you’ve never had a Pap smear, for example, your body may need time to adjust to the sensation. Just let the doctor know so they can take it easy,” he adds.

While women with weakened immunity can develop cervical cancer within 10 years once exposed to HPV, it normally takes 15 to 20 years for cervical cancer to develop in women with normal immune systems.

“This means every sexually active woman has the right amount of time to walk into a health facility and take a cancer screening test, which can eventually save their lives,” he says.

He says screening can also detect cancer at an early stage, where treatment has a high potential for cure.

Unlike tests that rely on visual inspection, HPV-testing is an objective test, which has been proved to be simpler, prevents more pre-cancers and cancer, and saves more lives.

He encourages women to start regular screening from ages 30 for the general population of healthy women and 25 for women living with HIV.

“Women living with HIV need to do it more frequently, which is about every three to five years,” he says.

VACCINES A LIFESAVER

Consultant gynaecologist Zippy Oyando encourages women to get vaccinated for HPV probably before age 26 once they get sexually active.

She says HPV vaccines are safe and effective in preventing infections with HPV infections, high grade precancerous lesions and invasive cancer, adding that the recommended age by the WHO is girls between ages of 9 and 14.

“The vaccines work better when administered before one is exposed to HPV, which makes that age bracket most appropriate as most have not started sexual activity,” she says.

She, however, warns that HPV vaccination should not rule out or replace cervical cancer screening.

Oyando also urged women to carry through with their entire vaccination series and ensure not a single session is missed for the same to be effective.

She encourages women who want to stay free from cervical cancer to avoid immunosuppressant medications and desist from taking oral contraceptives for a long period of time.

“They must also stay away from or limit smoking cigarretes, vape nicotine and using any other tobacco products.

She also encourages women to use condoms during intercourse to prevent the transmission of HPV, which could eventually turn to cancer.

Oyando advises that women between the ages of 21 and 29 need to get a Pap smear every three years.

“Those aged 30 to 65 may choose to continue getting the Pap smear every three years but can combine with an HPV test every five years,” Oyando says.

"After 65, consider continuing to get screenings every five years if you have sex without a condom."

Oyando urges women to be on the lookout for the early-stage symtoms of cervical cancer, which may include irregular blood spotting or light bleeding between periods in women of reproductive age, postmenopausal spotting or bleeding.

Bleeding after sexual intercourse and increased vaginal discharge that is sometimes foul-smelling can also be an early sign of cervical cancer.

She says as the cervical cancer progresses, it presents more severe symptoms, including persistent back, leg or pelvic pain, weight loss, fatigue, loss of appetite, foul-smell discharge and vaginal discomfort and swelling of a leg.

Oyando says other severe symptoms of the disease may arise at advanced stages, depending on which organs the cancer has spread to.

She explains that the treatment plan depends on the stage of the disease, and that options include surgery, radiotherapy and chemotherapy.

“Palliative care is also an essential element of cancer management to relieve unnecessary pain and suffering due to the disease,” she said.

Cervical cancer prevention should encompass a multidisciplinary approach, including components from community education, social mobilisation, vaccination, screening, treatment and palliative care, she said.

The bottom line is for the public, and especially women, to understand the close correlation between sex and cervical cancer and, thererby, make informed decisions to enable them stay free from the disease or get into an effective treatment plan.

“It would be virtually impossible for someone to get cervical cancer unless they have had some sexual activity that could present the HPV to the vagina, which leads to the cervix,” she says.

"It’s highly unlikely for someone to develop cervical cancer if they have not engaged in any kind of sexual contact with another person."