Many African women stand the risk of developing cervical cancer and dying of same, while many others may have it without knowing due to poor knowledge on its diagnosis and management, researchers have found.
One of such studies by Gabriel Olabiyi Ogun of the Department of Pathology, University College Hospital, Ibadan, Nigeria and Ronald Bejide of the Department of Morbid Anatomy and Forensic Pathology, Obafemi Awolowo University, Ile-ife, Nigeria notes that the incidence is high among African women, yet there is an abysmally low level of knowledge on its diagnosis and treatment.
The study, which was featured at the World Cancer Congress 2006, says 85 percent of the studied population demonstrated very poor knowledge and a negative attitude to the utilisation of cervical cytology service.
This, according to the researchers, is associated with strong cultural and religious reasons and the non-availability or poor information about cervical cytology screening.
The non existence of a national cervical cytology screening, the lack of political-will and funding, poor advocacy and poor manpower were identified by the researchers as the cause of the continuous high prevalence of this preventable cancer in Nigeria.
The study carried out in two parts. The first part used questionnaires to assess the demographic data, awareness of cancer of the cervix, knowledge, awareness and utilisation of cervical cytology screening. The women did not have symptoms of the cancer and within the age bracket of 25-65 years. They were randomly selected from major established hospitals and clinics within the local government councils in South Africa, Nigeria and Ghana
The second part of used questionnaire circulated among informed health workers to determine the factors for high prevalence of cervical cancer in Nigeria to arrive at the result.
Similar studies have shown that in Africa very few women are screened for cervical cancer. It is estimated that only 10 percent of female physicians in Nigeria have ever had a Pap smear themselves. In another study conducted in a tertiary institution in Nigeria, seventy-one percent were aware of cervical cancer, while only 33 percent were aware of Papanicolaou’s smear. It is estimated that without a significant improvement in prevention, there will be one million new cases of HPV by the year 2049.
Cervical cancer has been proven to be caused by a virus called the Human Papilloma Virus (HPV). Global prevalence of HPV in cervical carcinoma is 99.7 percent. Over 100 types of HPV have been discovered with at least 13 genotypes associated with cancer.
Worldwide, cervical cancer is the second commonest female cancer worldwide after breast carcinoma. The prevalence of genital HPV infection in the world is around 440 million. It is estimated that there were almost 260 000 deaths from cervical cancer in 2005, and 2.7 million years of life lost. About 500, 000 cases of cervical cancer are estimated to occur each year, over 80 percent of which occur in developing countries.
Predisposing factors to HPV infection include sexual activity, prior Sexually Transmitted Infections, early sexual debut, prolonged use of birth control pills, women who smoke, and having same sex or multiple sexual partners. Genital HPV infection is extremely common and most often causes no symptoms. HPV is transmitted through sexual intercourse, however transmission can occur without penetrative sex, as HPV is transmitted through skin-to-skin contact in the genital area. Therefore, every sexually active woman is at risk.
Statistics show that 50-80 percent of women will acquire an HPV infection in their lifetime and up to 50 percent of those infections will be oncogenic HPV type. Progressions from HPV infection to Cervical Cancer is slow and usually take years. Hence, the infection is usually more prevalent among women from ages 35-50.
Meanwhile, experts maintain that cervical cancer is preventable, and treatable if detected early. Gardasil, a prophylactic quadrivalent vaccine manufactured by Merck and Company and licensed in many countries is one of the vaccines designed to protect against HPV.
It was found that the administration of three (3) doses at intervals of two months between doses one and two; six months between doses one and three in females and males between ages 9-15 years with Merck’s HPV vaccine will reduce the incidence of low-grade and high-grade lesions, infection with vaccine HPV types, long-term duration of protection and robust anti-HPV responses when administered with other common vaccines. This tends to reduce the physical, emotional, and financial burden of management of HPV disease.
Secondary prevention is done through screening and treatment of identified pre-cancerous lesions. Screening methods includes Pap Smear, Visual Inspection with Acetic Acid, Visual Inspection with Lugol’s Iodine, HPV DNA Testing, Hybrid Capture Test (HC-2) and The Fast HPV test. Pap smear screening in developed countries have contributed to an 80 percent reduction of the incidence of cervical cancer. Hysterectomy, Chemotherapy and Radiotherapy are mostly used as tertiary intervention.
World Health Organisation (WHO)’s preliminary data show that HPV vaccination may be cost-effective in developing countries. Currently, in Uganda, Programme for Appropriate Technology in Health (PATH) in close collaboration with the local Ministry of Health and other partners are piloting HPV vaccine introduction. The piloting has also been carried out in India, Vietnam and Peru. The governments of developing countries including Nigeria need cancer policies and step up media enlightenment in the fight against cervical cancer which is not only health concerns but social, economic, and psychological burdens. Operation Stop Cervical Cancer Nigeria (SCCAN) and other relevant organisations should join hands in preventing cervical cancer in Nigerian women.