Why women are dying

By all rights, no woman should be dying of cervical cancer.

True, the human papillomavirus (HPV) is, as Dr. Ricardo Manalastas, an ob-gyne and authority on HPV, puts it: “ubiquitous”—that is, quite common and frequently seen. The website of the US Centers for Disease Control declares that “HPV is so common that nearly all sexually active men and women get it at some point in their lives,” most commonly through skin-to-skin transmission.

For more than 80 percent of those who get infected with HPV, the virus, which most commonly causes warts, will spontaneously disappear. But some of those infected with HPV will develop a “persistent infection,” which, unless detected early, will develop into lesions and most probably lead to cervical cancer.

But the “good” news is that the time frame from the appearance of the precancerous or cancerous lesions to the development of cervical cancer can take as long as 10 years. Which is why women are encouraged to get a screening test—either a pap smear or VIA (visual inspection with ascetic acid wash)—three years or less after their first sexual encounter. With early detection and diagnosis, says Dr. Cecile Llave of Cecap or the Cervical Cancer Prevention Network, “the chances for cure are very high.”

The problem is that the majority of cases of cervical cancer exhibit no signs and symptoms, said Dr. Llave. Many patients are driven to seek medical advice only when they experience bleeding from the vagina, by which time the disease would have developed to an advanced stage.

In some cases, say doctors who’ve worked with cervical cancer patients, they can tell if one woman in their waiting room is a cervical cancer case simply by the odor of rotting or “necrotic” flesh, which can happen in the late stages.

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In the Philippines, said Dr. Llave, speaking at a forum on cervical cancer sponsored by the women’s health group Likhaan, the cervix is the “second leading cancer site,” with an average of 12 Filipino women a day dying from it.

Obviously, if more women were getting screened regularly, they would have greater chances of surviving infection from HPV. But despite years of campaigning and offering screening services, only 12 percent of Filipino women are getting screened (an annual pap smear is recommended after sexual debut, but some experts say that if three consecutive tests show no infection, then the screening can be done every three years or so.)

To this end, the Cecap has begun offering what it calls the “single visit approach,” which combines counseling with the use of the VIA—which does not require expensive lab diagnosis like the pap smear—and immediate cryosurgery (to kill off suspicious-looking cells), with no need for follow-up treatment.

Dr. Llave is also involved with the “Mother-Daughter Initiative” with various local governments, which involves gathering groups of women for mass screening programs and encouraging them to bring along their daughters for mass immunization against cervical cancer, through the anti-HPV vaccine.

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This last is the main reason I say that, in an ideal world, no woman should be dying from cervical cancer.

For some years now, the HPV vaccine has been available to provide protection from the virus, which means protecting them, too, from cervical cancer—well, at least for about 70 percent of all possible cases. (There is as yet no vaccine available against the other HPV types linked to cervical cancer.)

Dr. Manalastas says that aside from the bivalent and quadrivalent vaccines available in the market, there are reports of the development of an anti-HPV vaccine that protects against nine types of HPV, which would provide, he said, 90-percent protection against the virus, of which there are about 100 types.

The present 30 percent of cases not covered by the HPV vaccine is the reason, said Dr. Manalastas, he would recommend that “even if you have already been vaccinated, you should still go for a screening after you become sexually active.” For reasons like higher immune levels, greater efficiency and no previous exposure to HPV, health experts recommend that the HPV vaccine be given to girls as young as nine years up to their early 20s. Older women may take advantage of the vaccine, too (there is an uptick of cervical cancer cases among women in their 50s and 60s), although it may be limited in effectivity.

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Unfortunately, in previous years the uptake on the HPV vaccine was only around 10-12 percent, about the same rate for screenings. We may see better numbers soon when the vaccine is made available by the Department of Health to girls from nine to 13 years old in public schools in 20 of the “poorest” areas in the country.

But we may have to wait for a decade or more before definitive statistics on survival rates are available, when the immunized girls reach their teens or early adulthood, become sexually active and thus exposed to HPV. Only then, perhaps, will health authorities know how many lives were saved and how many women were protected from cervical cancer because of the HPV vaccine.

To parents of young women not included in the free school-based vaccination program, nothing stops you, or should stop you, from bringing them to get their HPV shots.

Cervical cancer is only one of two cancers (the other is liver cancer which has been linked to the hepatitis-B virus) that can be prevented by a vaccine. True, the vaccine shots (three shots are required, about two months apart) cost more than P10,000 in total. But think about the consequences—not just the million or so pesos needed for treatment, but the possibility of losing your daughter to a disease you could have prevented.