Dr. Amina Isah is a Clinical Fellow in Reproductive Health at Nisa Premier Hospital, Abuja. In this interview, she explains the risk factors for cervical cancer, why women should go for early screening, and ways to prevent the disease among others.
What is cervical cancer, and how prevalent is it in the country?
Cervical cancer, as the name implies, is the cancer at the neck of the womb in females. It is the second leading cancer in the world, and the commonest cancer in Nigeria.
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Every year, the world diagnoses 500,000 cases of cervical cancer and 70 – 80 % of these cases are in developing countries like Nigeria.
There are 273,000 cases of cervical cancer deaths worldwide every year.
Every minute a woman dies of cervical cancer in the country. So it has become a public health emergency.
What is the cause of cervical cancer?
The main cause of cervical cancer is the Human papillomavirus (HPV) which is sexually transmitted.
It is transmitted either from oral, anal or from vaginal sexual intercourse. There are over 100 types of HPV but only some types of it cause cervical cancer. The two types that most commonly cause cancer are HPV-16 and HPV-18.
There are other types of HPV that cause genital warts.
Other risk factors for cervical cancer are: having multiple sexual partners, early marriage and early exposure to sexual intercourse, smoking, family history and obesity among others.
What are the symptoms of cervical cancer?
The typical symptom is offensive virginal discharge which many women and girls in the country usually call toilet infection. Anyone experiencing it should go to the hospital.
Other symptoms are post coital bleeding, that is bleeding after sexual intercourse, abdominal pain, and generally the symptoms are usually vague too.
What puts more women at risk of cervical cancer in the country?
The problem we have in sub-Saharan Africa or in Nigeria specifically is late presentation to the health facility.
We do not have adequate cervical cancer screening programmes in the country. There is also underutilization of such services even in some private or public institutions where they exist, because of poor knowledge and poor health seeking behaviour of the populace. We need to create awareness especially in the rural communities.
How can the disease be prevented?
Screening is the most important way of reducing the prevalence and transmission of human papilloma virus and cervical cancer.
Women of reproductive age, from age 15 to age 49 should have regular cervical cancer screening. They should go for pap smear every three years. A Pap smear is a test used to diagnose cervical cancer.
They can also do co-testing, that means doing pap smear and HPV screening together. They are very important. If the two are done at the same time, we recommend you do it every five years.
We also have target groups for HPV vaccination to prevent cervical cancer. However, HPV vaccination is not yet incorporated into the national immunization programme of the country and we are advocating to the government to include it as part of it.
This will enable women and girls in rural areas to access it thereby reducing the prevalence of cervical cancer.
The target group for HPV vaccination are children (male and female) that are not yet sexually active. The age range of this group is children from age 9 to 15.
We also give catch up dose for those that are from age 19 to 20. But from age 30, you may not need the HPV vaccine because you might have developed natural immunity against the human papillomavirus.
Vaccination for human papillomavirus does not stop you from having your normal three-year pap smear check. How is cervical cancer treated?
The treatment is in stages. When the pap smear test shows positive or abnormal findings, we then advance to more sophisticated investigation, called colposcopy. It is a procedure that allows the doctor to visualize and examine the cervix.
Once we see an abnormality, we take biopsy for histology. What histology does is that it analyzes the tissue. It confirms the diagnosis and the extent of the disease.
Frequent screening for cervical cancer, enables medical experts to also see precancerous lesions. Precancerous lesions are lesions that are not yet invasive cancer, and may take some time to progress to full cancer.
We have a centre that takes care of precancerous lesions in this hospital, either through cold coagulation method, this involves using a hot probe to burn away abnormal cells, and the cryotherapy, (this removes abnormal cells).
What is the treatment when the abnormal cells in the cervix become cervical cancer fully?
We just don’t go into treatment or removing the womb, we do Examination Under general Anesthesia (EUA) to examine the entire genital area and the rectum to ensure that there is no cancer deposit in that area.
Once the pelvic area is free, we do total abdominal Hysterectomy, that is removal of the entire uterus and cervix. But if it has spread to other areas, then there will be no need for surgery, we go straight to radiotherapy (using high-energy X-ray beams for cancer treatment ) and chemotherapy (using drugs to kill the cancer in the body).
What is your advice for women on cervical cancer?
Women should take their health seriously and go for regular screening; so that cervical cancer and other cancers like breast, ovarian and endometrial cancer to mention a few can be detected early to ensure their survival.
They should also go to the hospital for appropriate examination and diagnosis instead of self-medication when they notice any abnormal conditions in their body.
