Cervical cancer – the facts

Dr Cameron Meyer (MBChB, BSc)

Business Manager, Intercare Centre for Lifestyle Management.

Cervical cancer is one of the most common cancers in women aged 15-44 living in Southern Africa, and is one of the most common cancers causing death in South Africa women. Tragically, the majority of these cases could be avoided through effective immunisation and screening programmes.

What is cervical cancer?

The cervix is the part of the women’s reproductive system separating the uterus (or womb) from the vagina. Cancer results when the body loses control of the growth and proliferation of some of its cells, allowing these rogue cells to copy themselves indefinitely, and spread to other parts of the body.

How common is cervical cancer?

Cervical cancer is one of the most common cancers in women, and is also one of the leading causes of cancer deaths amongst women. About 5743 women are diagnosed with cervical cancer in South Africa every year.

What causes cervical cancer?

Almost 100% of cases are the result of long-standing infection of the cervix with the Human Papilloma Virus (HPV). This virus causes changes in the cells which allow them to escape the normal control systems of the body, and allows them to become cancerous. In addition to HPV infection, other factors which may increase your risk of developing the disease include:

  • Smoking
  • HIV infection
  • Poor nutrition

How does one contract HPV?

HPV is essentially a sexually transmitted infection (STI). It is in fact the most common STI, with 80% of sexually active women becoming infected with HPV at some point in their lives. All forms of sexual contact including vaginal, oral and anal intercourse have the ability to transmit the virus.

Does this mean 80% of women will develop cervical cancer?

No. There are two important things to understand regarding HPV infection and cervical cancer risk:

  • It is prolonged infection with HPV that is the problem. In the majority of cases (about 90%), the women’s immune system clears the infection and the risk of cancer drops. It is in individuals where the infection is not cleared and persists, that the risk of cancer rises. In addition, smoking and a weak immune system (for whatever reason) reduces the chance that the infection is cleared, and hence increases ones risk of developing cervical cancer.

  • HPV has many sub-types, only some of which are linked with cervical cancer. These are called high-risk subtypes (16 and 18 are the most commonly implicated). Infection with some other sub-types of HPV (for example those causing genital warts) does not increase the risk of cancer.

How do I know if I have HPV?

There are tests which can be done to detect the genetic material of HPV in samples collected from a women’s cervix and vagina. These samples may be collected by the doctor at the time of doing a Pap smear (read about this later in the article) or by the women herself. The methods used may depend on your provider and local laboratory services. It is important to understand however, that these tests may not be useful in certain groups of women and are more expensive than conventional methods; again, speak to your provider about what value this test would be for you.

How can I stop myself developing cervical cancer?

      • Vaccinate against HPV

Safe HPV vaccines have been developed which help protect against infection with the high risk subtypes of HPV and help significantly lower the risk of cervical cancer. Some of these vaccines also help guard against HPV subtypes causing genital warts. The vaccines are given as a series of 3 shots over several months and are ideally given to both boys and girls from the age of 9 yrs, but are still of benefit if given up to 26yrs of age. Ask your provider for more details regarding HPV vaccination for yourself or loved ones.

      • Have regular Pap smears

A pap smear is a procedure in which cells are collected from a woman’s cervix using a speculum and brush. These cells are then placed on a slide and inspected under a microscope to look for abnormalities which may indicate normal, pre-cancerous or cancerous cells. A woman’s cervix does not switch from normal to cancerous overnight, and there are stages through which a woman progresses over several years (even decades) before she develops cervical cancer. These stages are referred to as dysplasia and are completely asymptomatic (the woman will not be aware that these changes are occurring). This is why regular Pap smears are so important; they help us identify when a woman is on the path to developing cancer, and we can take measures to prevent further progression.

Should I have a Pap smear?

The frequency of Pap smears depends on your previous Pap smear results and age as well as the age at which you became sexually active, but in general, you should have a Pap smear every 3 years from the age of 21 (or 3 years after you first became sexually active) to 65. Ask your provider about the Pap smear schedule that would suit you.

What is done about abnormal results?

This depends to some degree on exactly what the results are, but may include additional tests such as HPV testing as already described, or colposcopy. Colposcopy is a procedure in which a speculum is inserted into the vagina, and the cervix visualised under a microscope. It may also include a biopsy of the cervix. Abnormal results may also require that you undergo procedures in which the abnormal part of the cervix is completely removed. Your provider will explain additional details should any of these procedures become necessary based on your results.

Men and HPV

Males can also become infected with HPV via all forms of sexual contact. The high risk subtypes have also been linked to other cancers which can affect men, including penile, anal and throat cancer. This is why HPV vaccination is also recommended for boys.

I want to vaccinate and/or have a Pap smear, what do I do?

Speak to your local Intercare GP and nurse who will be able to answer your questions and offer you these services.

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