Sara West still remembers the night she was wheeled into a hospital’s emergency room with severe menstrual bleeding. The 45-year-old Dubai resident had been experiencing the health issue for over two days along with associated gynaecological conditions. A series of tests and a biopsy later revealed that she had cervical cancer which was at an advanced stage. A heavy smoker, the doctor suggested that it could have been a major contributing factor. Sara* is currently undergoing radiotherapy to treat her cancer.
Neha Singh, a 34-year old Sharjah resident, has a similar story to share. She began experiencing irregular bleeding for a few months, which was alarming since she had never suffered from any menstruation-related problems prior to that. While the first set of tests at a hospital revealed no major condition, she was advised to take a Pap test which revealed precancerous cells in the cervix. Since the problem was discovered early enough, complete cure was possible.
What was surprising to both Sara and Neha* is that there are tests like Pap and HPV that could help detect and even cure the cancer.
Sara and Neha are not alone. Many women, including young-adult fiction author Judy Blume, former first lady of Argentina Eva Peron, British reality TV star Jane Goody have grappled with cervical cancer, until recently the most common cause of cancer deaths among women in the US. While the good news is that with increase in awareness about the various screening tests and their role in preventing the cancer, the incidence rates for the disease – as well as the death rates – have almost halved over the past four decades, the bad news is that the stats are still alarming.
A UN report says the cancer kills more than 300, 000 women every year. Across the world, over 500,000 cases of cervical cancer had been reported just in 2018. The fourth most common cancer in women in the UAE, cervical cancer is blamed for causing at least 56 deaths annually among women aged 15 years and older in the country, according to a 2018 report by the HPV Information Center.
‘At least 108 women are diagnosed with cervical cancer every year in the country,’ states Dr Chandrakala Ganapathy, obstetrics and gynaecology consultant at Medcare Hospital, Sharjah.
A former substantive consultant at Bart’s Health London with a special interest in gynaecology oncology, she has seen many young women battling advanced cervical cancer.
A reason for the alarming statistics of cervical cancer is because women are not undergoing regular screening for cervical cancer, she says. The doctor also underscores the importance of vaccines in helping prevent the disease.
Excerpts from an interview:
What is cervical cancer and how does it progress?
Cervical cancer arises from the lower part of the uterus, which is called the neck of the womb or mouth of the uterus. There are two types – one that arises from the outer part of the cervix, and one from the inner. The more common type is the squamous cell cancer arising from the outer part of the cervix. It takes years to progress.
What could be the underlying cause?
The most common cause is Human Papilloma Virus (HPV) that is acquired through intimate relationships. About 80 per cent of sexually active adults acquire this virus in their lifetime. There are various strains of this virus. The aggressive ones, if they persist in the host, can cause changes in the cells of cervix that can then lead to cancer.
Are some people more likely to develop cervical cancer then others?
Yes. Most women who acquire the HPV virus have the ability to clear it out on their own if they have a strong immune system. This mostly happens within one or two years of acquiring the virus. The virus persists if the person’s immune system is weakened, which could be due to conditions like smoking, certain immune-suppressing medications, among other reasons. This leads to weakening of the existing cells of the body, causing it to multiply quickly and turn cancerous.
What are the symptoms one should be looking for?
Cervical cancer does not show any symptoms in the early stages. At a moderate to a fairly advanced stage, women may experience, among others, bleeding/spotting between periods, foul smelling discharge and bleeding post menopause.
Is there a cure for this?
Yes. Complete cure is possible in precancerous and early stages of cervical cancer with long survival and good quality of life.
What are the treatment options available?
One option is surgery which involves removal of the loop cone area (Cervical conisation) of the cervix along with the cancer cells and simple hysterectomy. More advanced cancers will require more advanced surgery and/or chemo-radiotherapy. These are expensive treatments.
What are the risks associated with these procedures?
Cervical conisation poses a risk of preterm labour with subsequent pregnancy if excessive tissue is removed. Following hysterectomy, the woman cannot get pregnant and may be subject to emotional trauma. Also, surgery and radiotherapy come with their own set of risks.
Is cervical cancer preventable?
Yes, in more than 90 per cent of cases it is preventable. The HPV vaccination helps prevent infection by most strains of the virus that cause cervical cancer. The Pap test screens for abnormal cells that may develop into cancer, and the HPV test screens for HPV virus
How important is it for women to get themselves screened regularly?
As cervical cancer takes a long time to progress, regular screening helps detect the cancer at a very early and treatable stage. Since the cancer does not display many symptoms in the early stages, it is very important to get screened at regular intervals to detect it as early as possible.
How safe are these tests?
The screening tests are safe and simple that require minimal preparation and can be easily performed during clinic consultations.
How often do they have to take these tests?
According to the US Centre for Disease Prevention and Control, cervical Pap test needs to be repeated every three years and is recommended for women aged 21 to 29 years. From 30 to 65 years of age, women can choose to take the Pap test every three years, or take the HPV and Pap tests together (cotesting) every five years if both are negative. Hence, cotesting offers fewer tests and fewer follow ups. Some women may need to get tested at more frequent intervals, depending on the results of previous tests or other health conditions.
Can you tell us a little about the HPV vaccine?
For girls below 15 years of age, the vaccine is given in either a two-dose or three-dose regime. After this, a definite three-dose regime is recommended. The HPV vaccine is highly effective in preventing the targeted HPV types, as well as the most common health problems caused by them. In countries such as Australia, where the vaccine coverage is good, a steep decline has been observed in HPV-related diseases.
At what age would you recommend women to get themselves vaccinated?
HPV vaccination is ideally recommended for preteens (9 to 13-year-olds). It is also recommended for girls and women from 13 to 26 years of age who have not yet been vaccinated or completed the vaccine series. The DoH (Department of Health) has included the vaccine in the immunization schedule for schoolgirls aged one to 13. The FDA (Food and Drug Administration) has recently extended the vaccine coverage up to 45 years of age as women will still be protected from strains of virus they have not acquired prior.
Are there any side effects to this vaccine?
The HPV vaccine has been licensed by the FDA. The CDC has deemed this vaccine to be safe and effective. Although most people receiving the vaccine report no side effects at all, occasionally swelling and redness around vaccinated area, fainting spells, fever, muscle and joint pains, nausea and headache are reported. On very rare occasions, allergic reactions may occur after vaccination. Some vaccines come in prefilled latex-containing syringes, hence allergy to latex should be checked before administration.
How do the benefits outweigh the risks associated with regular screening and vaccination?
Regular screening (Pap and HPV tests) and follow-up can prevent most cases of cervical cancer as these are simple and easy to perform. The Pap test can detect cell changes in the cervix before they turn into cancer. The HPV test looks for the virus that can cause these cell changes. Hence, the benefits of regular screening outweigh the risks of not being screened and facing cervical cancer at an advanced stage.
How affordable are they?
Almost all insurance plans cover HPV vaccination. If you don’t have insurance, HPV vaccine is available at very affordable price.
The UAE has had immunisation programmes in place since 2008. How do you think these have helped with raising awareness about the cancer in the country?
The HPV vaccination is compulsory for schoolgirls in Abu Dhabi since 2008. In Dubai, the vaccination program commenced in October 2018, and the second wave was given in March this year. The vaccine is part of the National Immunization Programme under the Ministry of Health and Prevention (Mohap). With the government conducting many campaigns and surveys regarding the screening and vaccine of late, awareness has started to increase.
What more, in your opinion, can be done to combat this problem?
Although the HPV vaccine is included in the National Immunisation Programme, some parents do not opt for it as they fear it is not safe. Hence, there is a need for more awareness regarding the safety of the vaccine, and how it can easily prevent a disease which can otherwise cause physical, emotional and financial distress for the patients as well as their families.
Also, education about screening is important. Since routine cervical cancer screening is not common in the UAE, women should be advised to get themselves screened when they visit a doctor for other complaints. Physicians and gynaecologists should educate women about the screening tests, and insurance companies should be urged to cover these tests as a part of health screening programmes.