January is Cervical Cancer Awareness Month Get Screened

January has been designated as Cervical Cancer Awareness month by many countries which includes Ghana. Cervical Cancer incidence has been decreasing in most developed/high resource countries, but it has been increasing in low resource countries. Ghana has a population of 10.6 million women ages 15 years and older who are at risk of developing cervical cancer. Many organizations in the month of January create awareness and some clinics, polyclinics and hospitals offer discounted screening. I have an organization called “Gateway of Hope Inc.” which concentrates on education and health especially Women’s Health and so we are involved in Cervical and Breast cancer screening of women. We take the screening to where the women are located; markets, churches etc. Unfortunately, in Ghana rate of screening is very low and approximately 2.7% of women obtain regular Pre cervical cancer screening. This cancer has the most potential for prevention by vaccination, detection of lesions through screening and treatment of Precancer lesions found during screening. All these lead to prevention of Cervical Cancer.

What is Cervical Cancer
Cervical cancer develops in a woman's cervix found at the entrance or mouth of the uterus or womb. Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomavirus (hrHPV). There are about 200 HPV types and 14 of them are called “high risk” and 2 of these cause about 70% of Cervical Cancer. Low risk ones which mean they do not cause cancers like Genital or anal warts. HPV is a common virus transmitted through sexual contact and skin to skin contact. Most infections with HPV resolve spontaneously especially in those less than 21 years. Persistent infection with High-Risk HPV can cause Pre cervical cancer lesions which progress to Cervical Cancer in women over a number of years- 10-15 years. They can also cause cancers of vulva, vagina, penis, anus, and the back of the throat/tonsils (Oropharyngeal). Low risk ones can cause genital warts and growths in throat (papillomata)

Risk factors for developing Cervical Cancer
Risk factors are attributes which make one more vulnerable to develop a particular medical condition. For Cervical cancer these include:

Persistent Infection with high-risk HPV
Smoking
Decreased Immunity : History of HIV, Cancer, Cancer treatment

Infection with other STIs e.g., Chlamydia
History of several sexual partners
Early age of first intercourse
Early age first Pregnancy
Long term use of oral Contraceptives; may increase susceptibility of cervical cells to persistent hrHPV infection

High Parity (birth of many children)
Precancer or cancerous lesions of vulva and vagina

World Health Organization has recommended that to decrease this Preventable Cancer the following approach be used:

Education
Screening
Vaccination
Treatment of PreCervical and Cancer lesions
Screening of Pre Cervical Cancer
This is done to pick up abnormalities in the cells of the cervix before they become cancerous.

1. Pap smear where we look for abnormal cells in samples collected

2. VIA Visual Inspection with Acetic acid- This chemical is applied to the cervix and if abnormal cells are present one sees a change in the color of the cervix within a couple of minutes.

3.VIA with Mobile Colposcope. VIA is aided with a medical device called a colposcope which enhances visualization of the cervix

4. HPV test: Sample taken from the cervix is analyzed for the presence of the HPV and can further differentiate if the HPV detected is high risk type or not. The HPV test can either be done by a health worker or there are Self sampling HPV kits which involve the client taking the sample from the vagina with a small swab and returning it to the health facility for processing.

What Happens when Pre cervical Lesions are discovered

Depending on the extent of the lesion and seen, a “See and Treat” on the spot may be done using cryotherapy (freezing) or Thermal coagulation (heat). This decreases loss to follow up in some cases. Procedures like Biopsies may be done to know extend of the abnormality of the cells of the cervix. They can be treated with different treatment modalities which either destroy the cells or the abnormal tissue, or there can be excision of the abnormal tissue by a trained physician. This will halt any progression to cancer. Follow up is required after these treatments.

Vaccination against Human Papilloma Virus (HPV)

There have been vaccines available for over 18 years, currently 3 of them have been used worldwide in mostly high resource countries. They work because in some of these countries, infections with the HPV types which cause Cervical cancer and Genital Warts have dropped over 80-88% among Teens and young adult women. It is advised for both females and males aged 9-26 years. One usually needs 2 to 3 shots, however, recent recommendations by WHO is that getting just one shot of the vaccine which may occur in low resource countries can still protect individuals. Some African countries have been vaccinating their Preteens for a number of years now. What about Ghana?. Some clinics and hospitals have the vaccines and are available to those who can afford it. There are plans to have a National Vaccination Programme soon; late 2024 or 2025. Many lives will be saved from Pre cervical lesions or Cervical Cancer once vaccination is started; however, screening is very important and does not only have to be done in January. Some health facilities offer it the whole year round and at Well Women Clinics.

So, women, talk about cervical cancer, and go further to get screened. Men encourage women in your lives to get screened, and parents get your adolescents and young adults vaccinated.

Thank You.
Dr. Barbara Entsuah (Med) MHSc., Fellow Ghana College of Physicians and Surgeons, Board Certified Family Medicine.

Physician, Author, Health Educator, Women’s Health Advocate, Vice President Gateway of Hope Inc.

(Latest book “A Woman’s Guide to her Body and Total Health”).

#Loveyourbody#