(Published in Enrich magaaine, 2011)
IT'S THE SECOND LEADING CAUSE of cancer deaths among
Filipinas and kills six of its 10 victims within five years after its
detection. But unlike breast cancer, this largely unnoticed killer can easily
be prevented by the simplest of deterrents: a vaccine.
Cervical cancer is a disease that afflicts women. It attacks
the cervix, the lower, narrow part of the uterus that joins with the top end of
the vagina. It can take up to 20 years before the cancer manifests itself. When
it does, it’s usually a death sentence for the victim since medical
intervention will most probably fail.
Cervical cancer results from an infection of the cervix by
the Human papillomavirus (HPV). HPV infections cause nearly 100 percent of all
cervical cancer.
Some 120 HPV types have been identified, of which around
40—including the deadliest types—are easily transmitted by skin-to-skin contact
during sexual activity. Some sexually transmitted HPV types also cause genital
warts.
Persistent infection with high-risk HPV (of which there are
only some 12), however, may progress to pre-cancerous lesions and then to
cervical cancer. But only in a small percentage of cases.
Pap smears are
important
Potentially pre-cancerous changes in the cervix can be
detected by a Pap smear, hence the reason doctors advise women to have a Pap
smear annually. Cervical cancer can be prevented if detected early on. A most
disturbing medical fact is that most women with cervical cancer have never had
a Pap smear, or have not had one in the last five years.
In the Philippines, 6,000 women develop cervical cancer and
4,300 die from the disease every year. Some 60 per cent of Filipino women with
cervical cancer will die within five years from the time of diagnosis.
HPV vaccines can reduce the chance of developing cervical
cancer, but only if administered before girls become sexually active. The ideal
time to be immunized would be when girls are between the ages of 10 to 15.
It was only in 2006 that the first HPV vaccine was first
officially administered. This honor went to the vaccine’s creator, Dr. Ian
Frazer, an Australian. Over 60 million women worldwide have received the
vaccine in the last four years.
It is estimated the vaccine will provide protection for at
least 10 years at minimum “. . . but could very likely last the lifetime of the
woman,” said Dr. Frazer. Forthcoming clinical data will likely bear this out.
Widespread HPV immunization could reduce deaths from
cervical cancer worldwide. The vaccine remains quite expensive, especially for
women in developing countries who are its main victims.
The second deadliest
cancer
Although often lethal, cervical cancer does not command
top-of-mind attention among Filipinas as does breast cancer. A pioneering
awareness campaign was launched only in 2008 and fashion model Tweetie de
Leon-Gonzales, the campaign’s image model, admitted at the time to not knowing
that much about the disease.
She and her daughter, however, had themselves vaccinated
against HPV that causes cervical cancer to underscore their support for the
campaign.
Also as part of this drive, the government declared May
cervical cancer awareness month. This May, the government gave free cervical
cancer screenings in 58 of its hospitals.
The campaign, however, received its most important shot in
the arm on May 10 when Dr. Frazer spoke about cervical cancer prevention and
control at a forum sponsored by the Australian Embassy in Makati City. He
talked to Enrich following the conference.
Dr. Frazer explained that cervical cancer is an immune
system problem. He said a damaged immune system caused by events such as
diabetes and chemotherapy could make a woman more prone to developing a chronic
viral infection.
He noted, however, that some women with normal immune
systems also get chronic viral infections so developing cervical cancer depends
on the individual. In other words, bad luck also seems to be a factor in who
gets cervical cancer.
A woman, however, can turn the odds in her favor by leading
a healthy lifestyle (no smoking; regular exercise and a healthy diet) and
having a Pap smear every year.
Dr. Frazer pointed out that cervical cancer is an entirely
preventable disease since it can take up to 20 years for it to become
completely life threatening. This long time frame means early detection through
regular screening is entirely useful in preventing the cancer.
An entirely
preventable disease
“No woman should have to die from cervical cancer in the 21st
century,” he said. “It should be an entirely preventable disease.”
In order to deliver this outcome, doctors and researchers
will have to continue research to evaluate the effectiveness of projects on the
ground to check if they’re working.
“It all comes down to research,” he noted. “Research is key
to moving forward.”
Also as a result of his work on HPV is a growing realization
among the medical community that up to 20 percent of cancers could be caused by
infections. While seemingly frightening, this statistic does have an upside: it
means these cancers can be prevented through means such as a vaccine.
What research has shown is that HPV tends to hang around in
cancer cells and if the HPV cells are removed, the cancer cells die.
What is vital is finding the pre-cancerous lesion and treating
it. There is a 95 percent chance that there will be no cervical cancer if the
lesion is destroyed.
Dr. Frazer said the HPV vaccine has an efficacy ranging from
98 percent to 100 percent. He cautions, however, that the vaccine won’t work if
a woman is already infected with HPV.
While the Philippines clearly recognizes the danger to women
from cervical cancer, limited government resources have impeded progress in
making more headway against the disease.
Dr. Fraser emphasizes this fight should involve everyone.
“You can’t deliver part of a cervical cancer program,” he said.
He noted that it could take up to 20 years for a country to
develop the sophisticated screening techniques for cervical cancer.
“If you start now, in 20 years you’ll have a good screening
program.”
§ Almost
100 percent of all cervical cancers are caused by the Human papillomavirus
(HPV), which is a sexually transmitted infection.
§ HPV
is the most common sexually transmitted infection in the world. In over 90
percent of cases, the infection is harmless and fades away without treatment in
about two years.
§ If
the infection persists, however, a woman has a high risk of developing
pre-cancerous lesions in her cervix. These lesions can progress into invasive
cervical cancer. This process, which usually takes 15 to 20 years, presents
many opportunities for detection and treatment of the pre-cancerous lesion,
hence the absolute necessity of screening (such as Pap smears) and vaccine immunization.
§ The
HPV vaccine is designed to be given to girls before they become sexually
active. Therefore, the ideal time to be immunized would be when girls are
between the ages of 10 to 15.
§ A
cervical cancer vaccine, however, isn't recommended for women older than 26. It
also won’t work on women who have been infected by HPV.
§ Dr.
Ian Frazer, an Australian, is widely credited with developing the HPV vaccine
against cervical cancer. The HPV vaccine is the first vaccine designed to
prevent a cancer. It is marketed under the brand names, Gardasil and Cervarix.
Both protect women against HPV-16 and HPV-18, the two types that cause 70
percent of all cervical cancers.
§ Gardasil
and Cervarix are both available in the Philippines. They are injected in three
doses over six months. Gardasil can also be given to boys between the ages 9
and 26 to help prevent genital warts.
§ About
80 percent of deaths from cervical cancer occur in developing countries such as
the Philippines.
§ In
the Philippines, 6,000 women develop cervical cancer and 4,300 die from the
disease every year. Some 60 per cent of Filipinas with cervical cancer will die
within five years from the time of diagnosis.
§ In
the Philippines, cervical cancer is the second leading cause of cancer deaths
in women after breast cancer.
§ Some
266,000 women are diagnosed with cervical cancer in Asia every year. More than
half of them die.
§ Worldwide,
cervical cancer is the fifth deadliest cancer among women.
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