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Women don’t go for screening – Dr Onwufor

Dr Uche Onwufor, is a gynaecologist and also head of Gynecare Research and Cancer Foundation. In this interview he advises parents to discourage their children…

Dr Uche Onwufor, is a gynaecologist and also head of Gynecare Research and Cancer Foundation. In this interview he advises parents to discourage their children from having sex at an early age, and calls on them to vaccinate all their children from age nine to prevent cancer.

So what has the  Gynecare Reserch and Cancer Foundation been doing?

Over the past two years, we have been more in the cities. It is a bit more financially tasking, going to the rural areas. In urban centres the awareness on cancer is still very poor. Worse than that, just being aware does not translate to going for screening. People will still need to be pushed to go for screening. You find that many people who go for screening do so because they have one relative who has died, or they have found out they might have it, or some other reason. We don’t have a culture of going to screen. So awareness is very poor and worse still is the fact that women don’t go for screening.

What have you done to change the trend?

Part of our vision is to create awareness about the different gynaecological cancers – breast, ovarian, cervical. Recently, we started talking about prostate cancer for men. Anywhere you go to, people tell us you cannot leave the men alone, you must do something for us. We have been able to create awareness in terms of newspaper publications, radio programmes and television. We have carried outreaches to several churches, NYSC camps. We have gone there to talk to doctors about human papilloma virus, which is the cause of cervical cancer, and we have been able to train about 30 medical personnel in the last eight months. We are hoping they can be fused into the system where they go ahead to create awareness on their own too, because we find out that the job is enormous. Statistics tell us we have about 48 million women above the age of 15 – that’s a large population we need to create awareness to.

What has been the trend in the time you have worked?
We don’t actually test for HPV. Gadget used for this is so elaborate, so most centres don’t have it. What we test is the effect of the HPV on the cervix. It has long term effect. At least about two, three percent will have changes in the cervix that require attention. These are the changes that could lead to cancer in the long run if nothing is done about it. For many of them, we have done follow-up and in a number of cases there’s been resolution. In some cases, so far in the last one year, we have found 12 clients with frank cancers. For them we refer straight to the National Hospital-that’s the closest centre where radiotherapy can be offered. Those who are financially buoyant opt to go to India or UK for treatment. For those we can’t do much, but for the others, we are able to give counselling and we have the treatment available and ready for them.

Since you are into preventive measures, what can women do to prevent it?
Cervical cancer is one cancer that is a 100 percent preventable, and it starts from the age of nine. Girls from the age of nine can take the vaccine. The best time to take the vaccine is before the girl becomes sexually active. Between age of nine and 14, they take two doses-one to start and another after six months. From 15, they take three doses. The vaccine alone can give up to 50 percent protection against a cause of cancer, and secondly we encourage ladies to live a healthy lifestyle.
Early sex should be discouraged, as it is one of the risk factors. Multiple sexual partners are also discouraged, early child birth, and having more children than necessary. From 25, they should screen for cervical lesions every three to five years until they are 65, after which in most countries most people say there is really no need to continue the screening. If we can do that, it will ensure we have a reduction in the number of cervical cancer patients in the country. Presently we have about 10,000 new cases every year,  and people are dying from it. That means we lose about 26 women every day, and it is worse because we don’t have the centres to manage cases. It is still better to prevent them. Preventive care is cheaper, a woman can live healthy life and be fruitful.

Is there any habit that can encourage cancer?
The virus is sexually transmitted, so we discourage early sex. For those who have to, condoms should be used, but condoms are not 100 percent protective because the scrotal sac can harbour the virus. People talk about use of contraceptive, but hormonal contraceptives are more beneficial than harmful. We still encourage women to continue their contraceptives but to go for screening regularly. In this age and time of same-sex partners, there are issues around it too. Those stuff should be discouraged also.

How often should a woman go for screening?
The recommendation is every three to five years. However, for women who have increased risk factor-HIV, compromised immune system, steroidal drugs-they have a low immunity to fight it so they are encouraged to do it every year, because they are more at risk of developing the cancer.
And of course HPV, which leads to development of cervical cancer, also causes cancer of the vagina, vulva, anus and throat. The vaccine has cross protection against these other cancers. The main thrust is vaccination of the girl child.
Recently a publication came out in Time magazine. The summary is that women with HPV virus can also benefit from the vaccine. It is more than being prophylactic-before you get the virus. Now we are saying even those who have the virus benefit, because it can cause resolution of the virus, it can help a person fight the virus. There is a lot of focus in the Western world about the vaccine, however, here we don’t talk much about that, because there is still a lot of fear and cultural beliefs that the vaccine is there to sterilize the girl child but it is not so. Over 120 million doses of the vaccine have been given worldwide and it has been found to be safe, without those effects.

Where does vaccination of boys come in?
The vaccination of boys is a standard, from the age of nine to 26, because HPV infection is transmitted to boys and girls. However, we are looking at the cost-benefit ratio. For men, HPV causes 30,000 cases of penile cancer every year. For women it causes 500,000 cases of cervical cancer every year. From a public health point of view, the emphasis is on the women. However the industrialized nations are also vaccinating boys. But in countries like ours where we have not accepted vaccination for girls, talking about the boy will be a distraction. That’s why we are not talking so much about the boys. But if we vaccinate both sexes, you will reduce the prevalence of HPV in the society. Why we focus on ladies is this: if all the ladies get vaccinated, it will reduce the pool of HPV. If one lady sleeps with a guy who has it and she is vaccinated, he can’t pass it to her and she can’t pass it to another guy, and so she protects the next person. If all the ladies take it, there will be some herd effect. However sexual practices are changing. Homosexual partners are now becoming an issue. For males, the recommendation is vaccinate the guys, but the emphasis is on the ladies because of the huge burden of cervical cancers compared to penile cancer.

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