How much is a girl’s life worth?
Cervical cancer is a disease of contradictions, even irony. As an obstetrician/gynecologist once told me: “If you can choose what cancer to get, you would do well to get cervical cancer.”
This is because the scientific world already knows what causes cervical cancer: a virus known as HPV or human papilloma virus. Most women infected with high-risk HPV, according to a study by the World Health Organization, “do not develop cancer because most infections are short-lived and spontaneous clearance of the virus usually occurs within two years.”
But for a small percentage of women, HPV infection may become persistent, and the WHO declares that “only a small percentage of these chronic infections progress to pre-cancer and of these, even fewer will progress to invasive cancer.”
The good news is that, according to the WHO, “only an estimated two percent of all women in low-resource countries (of which the Philippines is one) will develop cervical cancer during their lifetime.”
But the other side of the cervical cancer “coin” is that more than half of cervical cancer cases in the developing world occur within the Asia-Pacific region. In the Philippines, the estimate is that 12 women die each day from cervical cancer, mainly because they and their loved ones were largely unaware of the disease and its symptoms (by the time a woman starts bleeding from her cervix, she may already have cancer) and when she goes for a diagnosis, it may be too late and treatment may be too expensive.
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Here’s another bit of irony about cervical cancer: It can be prevented. Because HPV is sexually transmitted (through skin-to-skin contact), it is recommended that a woman go for testing as soon as she becomes sexually active, and have a test once a year until consecutive annual checkups indicate that she may no longer need to go for annual checkups.
The two most common types of tests are the pap smear, developed in the early 20th century, which is the “gold standard” for tests but can be expensive (lab analysis of the tested tissue is required) and time-consuming. The other test is known as the VIA, for visual inspection with ascetic acid, which is much cheaper because it needs only the application of ascetic acid (diluted vinegar) which would turn infected tissue white. The person administering the test can get the results almost instantaneously, and turn over the patient for further testing (or cryosurgery) in case lesions are detected.
But this is not the only bit of good news about HPV infection and cervical cancer. Some years ago, a team of scientists from Australia developed a vaccine against HPV, and after scientific studies and clinical trials, with the approval of authorities, the two types of vaccines manufactured by two different drug multinationals were approved for public use, including in the Philippines.
Following our theme of “good news, bad news,” however, even with the vaccine available, the number of girls and women in the country availing themselves of it has hovered around just 10 percent, about the same ratio of women having themselves screened. Prominent among the reasons for the low “uptake” of the vaccine and screening are: cost (the vaccines are expensive), lack of awareness, lack of urgency (it takes about 10 years for lesions to turn into invasive cancer), and perhaps the tendency of Filipino women and girls to place a low priority to their health needs and concerns.
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Recently, there was a development that cheered most everyone in the cervical cancer community—oncologists, caregivers, survivors and people who love the women struggling with the disease.
The Department of Health, along with the Department of Education, has scheduled a program of subsidized immunization in public schools that includes the anti-HPV vaccine. The main targets for the anti-HPV vaccinations are girls in elementary and high school—the recommended age range because that is when a person’s immunity levels are highest, and also because the vaccine is intended to be administered before the onset of sexual activity (that is, before first exposure to HPV infection).
Without government support for the program (which will be implemented in the poorest provinces), it’s highly doubtful if the girls would have access to the anti-HPV vaccine. Carrying out the immunization program in the public school setting also means that it would be easy to “capture” the girls most in need. This means preventing their deaths down the line in case they experience persistent HPV infections which would lead to cervical cancer, while sparing them and their families from the devastating expenses that cancer treatment requires.
The WHO says that “assessment of cost effectiveness of HPV vaccines is heavily influenced by parameters including vaccine price, operational costs, HPV prevalence, number of vaccine doses, and uptake of cancer screening and treatment, especially in resource-constrained settings.”
By such measures, the DOH-DepEd program certainly deserves support.
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The coming week is crucial for the anti-HPV vaccine program, I am told, because a meeting has been called to determine whether critics of the vaccine have sufficient grounds to call for scuttling the proposed program.
I would hope that, aside from listening to experts and concerned activists, officials also take time to listen to the doctors who treat women with HPV and cervical cancer, as well as women who have survived the disease and the families of those who watched those who didn’t survive and sympathized with them in their struggle.
What is a woman’s life worth? How is a girl’s future to be weighed? The next few days should give us the answers.
