Cancer is no respecter of persons. In fact, its victims most often are people of high social status. Every now and then, someone is despatched to the great beyond, courtesy of this disease which attacks in different forms. Amazingly, cervical cancer which is the only cancer caused by the Human Papilloma Virus (HPV) that has preventive vaccination has continued to wreak havoc in this country. But an expert says this should not be the case. ARONKE OLAYIWOLA writes.
In Nigeria, cancer incidences are common. No week passes without a Nigerian dying of the dreaded disease. Quite a high percentage of people are dying silently, many of them out of ignorance. Cancer is a class of disease characterised by out-of-control cell growth. There are over 100 different types, and each can be classified by the type of cell it initially affects.
It is the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death, instead they continue to grow and divide. This leads to a mass of abnormal cells that grow out of control.
Worldwide, cervical cancer is second most common and the fifth deadliest in women. In 2008, it was estimated that there were 473,000 cases of cervical cancer and in 2010, 225,000 deaths. Approximately 80 percent of cervical cancers occur in developing countries.
According to a radiologist at the University Of Nigeria, Nsukka, Prof. Ifeoma Okoye, about 26 women die daily as a result of cervical cancer in Nigeria. Okoye, who is also the founder, Breast Without Spot (BWS) Initiative, a non-governmental organisation (NGO) made the disclosure at the inauguration in Lagos of a School-Based Cervical Cancer Vaccination Awareness Initiative last week.
She said cervical cancer was killing more people worldwide than HIV/AIDS, tuberculosis, and malaria put together. “We conducted a survey and discovered that cervical cancer is the second killer cancer among women and Nigeria is also the tenth in cervical cancer deaths worldwide. Forty-eight million women are at risk, 17,550 women are diagnosed yearly, 9,659 women die annually and 26 women on daily basis in Nigeria. This is alarming and most of the cases are rampant in the developing countries like Nigeria. It, therefore, requires a proactive political commitment to fight the scourge,” she said.
Okoye said cervical cancer was 99 per cent preventable and prevention was necessary for the reduction and control of cancer burden in the country. The radiologist then urged government at all levels to improve and strengthen the healthcare system in terms of funding, infrastructure upgrade and training of medical personnel. She also urged Nigerians to imbibe regular health check to prevent late detection of cancer cases and cancer mortality.
Cervical cancer is the cancer of the mouth of the cervix, which is the mouth of the womb. Unlike some other cancers, it is a condition that is caused by a viral infection that is related to Human Papilloma Virus (HPV). One of the most common symptoms of cervical cancer is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer has progressed to an advanced stage. HPV is one of the most common sexually transmitted diseases (STDs).
Its infection appears to be involved in the development of more than 90 percent of cases of cervical cancer. HPV vaccines are effective against two to four of the high risk strains of this family of viruses. Since the vaccines only cover some types of HPV, guidelines still recommend that women have regular pap smear screening, even after vaccination.
Cancer screening using the pap smear can identify precancerous changes in cervical cells. Treatment of high-grade changes can prevent the development of cancer in many cases
According to a senior registrar, obstetrics and gynaecology department, Lagos State University Teaching Hospital (LASUTH), Dr. Joy Agbara, “it is unacceptable that many women still die when cervical cancer is preventable, treatable and curable. It is also one of the cancers which has a pre-invasive stage where if detected early, can be treated effectively”.
Agbara identified lack of awareness, resources and low budgetary allocation to the health sector as contributory to the country’s high rate of the disease burden. She, however, singled out multi-parity, a term used for a woman who has had two or more children as one of the high risk factors to the cervical cancer. This means that a woman who has had more children has been exposed to the virus causing the cancer many times as the HPV is mainly transmitted through sexual intercourse.
She further stated that “a woman can be okay, but if her husband has a high risk behaviour with several sexual partners, that can predispose her to having the virus and eventually the cancer.
Agbara advised women to go for vaccination as that would prevent the HPV from getting to the genital areas which is the primary prevention. She said “with vaccination, the burden of the virus spread can be reduced to about 72 percent. The secondary prevention is for women who have passed the age of vaccination, they must present themselves for screening. Young women who have not been sexually exposed or who have been sexually exposed but are between the ages of 9 and 27 should be vaccinated and those women, who have gone beyond that age, should present themselves for screening because, with vaccination and screening, we will be able to reduce the disease burden”.
The vaccination consists of three injections given over a six-month period. “At first contact, those who have been sexually active will have to do a pap smear test to know the state of the cells on the neck of their womb before the vaccination. The vaccine is given at first contact, at the fourth week and at sixth month in the upper arm
The vaccination like all vaccinations, according to her,“has side effects, but the side effects are tolerable ranging from fatigue, pain in the joints, and general body weakness to gastro-intestinal symptoms. It is however a passing phase. It is relatively a safe vaccine”.
She urged women to go for regular screening for early detection and prompt treatment, pointing out that the cost of screening and vaccination was by far cheaper than the cost of treating a cancer.