MANILA, Philippines?As health experts keep stressing time and again, cervical cancer has been directly linked to a largely sexually transmitted infection of the HPV, or human papilloma virus. But while HPV is among the most common STIs, cervical cancer is a relatively rare disease arising from it.
Dr. Suzanne Garland of the Royal Women?s Hospital in Australia said at a regional conference on HPV-related diseases that of every one million women coming down with an HPV infection, one-tenth, or 100,000, will develop ?cervical abnormalities,? most of which will spontaneously regress on their own. Of this number, 8,000 will develop a pre-cancerous lesion, and of this number, 1,600 will eventually evolve into an invasive form of cancer.
Most estimates state that for the vulnerable population, the time lag between infection and developing cervical cancer is between 10 and 15 years, more than enough time to detect, treat and cure the disease. The real problem, though, is that not enough women (and men) know that cervical cancer is highly preventable and treatable.
Why is this so? Perhaps because it is linked to sexual activity, cervical cancer is a little-discussed disease, surrounded by shame and stigma, even if its cause, management and treatment are already well known. Dr. Hextan Ngan from Hong Kong, reporting on the ?public awareness and psychological aspects of the HPV vaccine,? says that in a survey they conducted, most respondents said that ?only promiscuous people get an HPV infection,? and that cervical cancer ?is a dirty disease caused by promiscuity.?
* * *
To reiterate, anyone (man or woman) who becomes sexually active runs the risk of HPV infection, but only a small number will develop health problems as a result or die from cervical cancer.
(As an aside, there are other forms of cancer that are related to HPV infection, such as vulvar, penile, anal and oropharyngeal cancer, so it?s not only women who are at risk, though the majority of deaths are those of women.)
What many may not know is that the start of sexual activity is the signal for a woman to go for her first screening test, be it a pap smear, HPV DNA test or VIA (visual inspection with ascetic acid). And to repeat, it?s recommended that a woman go for screening every year, but after three negative results, she may reduce the frequency to once every three years. True, there are already two brands of HPV vaccine available, but doctors still recommend that even vaccinated women follow the screening schedule.
Why do so many women continue to die from cervical cancer? (In the Philippines, the estimate is that 10 women die every day from cervical cancer.) There are many reasons. First is that not many know about screening, or can afford it or have access to it. Even those who undergo screening may not get the results of their tests, or the lab work on the test may be faulty. Another reason is that women may be too embarrassed to go for screening, believing it opens them to accusations of promiscuity or infidelity, and thus they go to seek treatment only when it is too late, when they already show symptoms. (One doctor observed that many of her colleagues believe a woman should go for a pap smear only when there is already vaginal bleeding, which means the disease is in an advanced state.)
* * *
To address the issues of affordability, accessibility and practicality that surround cervical cancer screening, public health authorities in developing countries have come up with ?screen and treat? methods that are cheap, simple to implement, easy to train for, but at the same time accurate and safe.
In the Philippines, reported Dr. Cecilia Ladines Llave of the Cervical Cancer Prevention Network Program (CECAP), an alliance of the Department of Health, local governments, and the private sector, they have initiated a program that involves training of nurses, midwives and even community health workers in the ?Single Visit Approach,? or SIA. Developed with JPIEGO, the SIA involves the use of VIA that allows the tester to visually check for the presence of pre-cancerous lesions with the use of diluted ascetic acid, and then treat detected lesions through cryosurgery.
So far, said Dr. Llave, they have established six pilot sites, and trained 91 providers, including 76 community health workers. Since the program began, the CECAP has screened almost 7,000 women, with 208, or less than 10 percent, referred for further treatment, plus 101 undergoing cryosurgery.
The prospects look good, judging from the results of a similar ?scaled up? program in Thailand. After foreign funding support ended, reported Khunying Kobchitt Limpahayom, the SIA was adopted at the provincial and district levels, with studies showing that the district-level procedures were able to maintain the quality of training and services provided, widening coverage and protecting more women.
* * *
Aside from the SIA, other NGOs, specifically PATH with funding from the Bill and Melinda Gates Foundation, have developed with Qiagen (formerly Digene) a fast, cheap and transportable device for performing HPV DNA tests. The reasoning behind this is that ?only HPV positive women are at risk? of cervical cancer, so it would considerably ease the burden on the public health system if uninfected women would no longer need to undergo further screening.
The ?fast? HPV test is scheduled for testing next year in Uganda, Nicaragua and India, but already, based on pilot studies, there is reason to hope that significant strides will soon be made against cervical cancer.
But as speakers stressed time and again, the best guarantee is still a well-informed public, and women who will use their knowledge to demand the best vaccines, tests and services available.
