Cervical cancer though a preventable disease still inflicts women all over the world and more so in developing African Countries. In United States (US), the incidence of cervical cancer among Hispanic women is greater than 2 times that for non-Hispanic whites and about 50% more often in African American women than non-Hispanic whites.

Cervical cancer occurs more frequently in mid life. It is mostly found in women younger than 50, rare in women younger than 20 and occurs about 20% of the time in women older than 65. Death rate due to cervical cancer has decreased considerably. According to American Cancer Society (2009), between 1955 and 1992, the cervical cancer death rate declined by 74% and continues to decline by 4% each year. This is due to the discovery of Pap test (Pap smear), a simple, inexpensive office procedure. Pap test leads to early identification of pre-cancer cells which if treated at time of identification, prevents progression to cervical cancer. The fact that death rate due to this cancer has been on the decline shows that many women are undergoing Pap smear.

Cervical cancer screening trend show that from the 1987 to 2000, the number of women aged 18 years and older who reported having had Pap test within the past 3 years was on the rise with a maximum of approximately 80% in 2000. In 2003, 79% reported Pap test in past 3 years and by 2005 the trend had dropped to 78% (National Cancer Institute, 2007). The goal of Healthy People 2010 is to attain 90% screening trend. It does not look like the country will make this goal. Most of it is because Hispanics and African Americans are yet to take full advantage of Pap test and needs to be encouraged to step up. There is need for awareness and screening programs specifically targeting these groups. We have to identify those things that serve as barriers to routine screening among them and find ways to overcome them.

ACCI will be conducting free Pap smear at 6011 Telephone Road on Saturday, January 30^th, 2010, from 9am to 4pm. Practitioners are welcomed to volunteer. We are also accepting supplies for this program.

Most invasive cervical cancers are found in women who have not had regular or never had Pap tests. This is the case in developing African countries like Nigeria where medical facilities have no provision for Pap tests. The general practitioners are not educating their female patients about cancer prevention and the need for screening tests. Supplies for this very simple procedure are lacking. Greater than 95% of women have never heard about Pap smear. Conducting cancer awareness medical missions with screening exercises to the region, we continue to find many cases of advanced cervical cancer in women in their 30s to 50s. Contributing factors include early marriage and sexual activity, multi-parity (bearing many children), multiple sexual partners, and advent of HIV/AIDs. Education about this disease is completely lacking both among the educated as well as illiterate women. Disease prevention of all forms is not inherent in the culture. Poverty, lack of access, and expert personnel also compounds the problem.

Most of the cervical cancers discovered during our screening exercises are at late stages. These women are brought to us in lots of pain and with very copious malodorous discharge. They are unable to stand, sit or walk. The only recourse open to them is palliation either in the form of pain control with medications or pain medication and radiation therapy. However, during our last mission to Plateau State of Nigeria, most cases of cervical cancer identified were in early stages. This is the point at which we hope to find cases in order to make a difference.

ACCI is working to set up our first Cancer Prevention Center in Nigeria. We need your support. Please donate $5.00 to this course by going to our website at www.africacancercareinc.org. All donations are tax deductable. Our 501 C3 # is 87-0742927.

The most common form of cervical cancer starts with pre-cancerous changes. There are 2 ways to stop this disease from developing. The first way is to find and treat pre-cancers before they become cancerous using the Pap test. The second way is to prevent the pre-cancers. This is achieved by identifying the Human Papiloma Virus (HPV). This virus has been determined to cause pre-cancer cells. There are several types of HPV. Types 16 and 18 have been identified as causing cancer cells. HPV virus can be identified and treated before they cause cancer cells. They are sexually transmitted and its transmission can be prevented by healthy sexual lifestyle such as keeping to one partner, delaying sex till one is older and use of condom. HPV is transmitted mostly among young people in the first 3 years after becoming sexually active and could also be dependent on number of sexual partners. In young people, the virus could be self limiting but not in all instances. It also does not cause cancer cells right after it is contracted. Transformation to cancer cells is a slow process. Performing Pap test coupled with testing for HPV DNA can identify and prevent pre-cancer cells. Early detection is therefore the key to cure and survival.

HPV infection is not symptomatic. In the same token, early cervical cancer or pre-cancer has no symptoms. The only way to identify pre-cancer and HPV is to undergo Pap test and HPV DNA testing.

The American Cancer Society recommends the following guidelines for early detection:

• All women should begin cervical cancer testing (screening) 3 years after they start having sex (vaginal intercourse). A woman who waits until she is over 18 to have sex should start screening no later than age 21. A conventional (regular Pap) test should be done every year. If a liquid-based Pap test is used, testing should be done every 2 years.

• Beginning at age 30, women who have had 3 normal Pap test results in a row may be tested less often, every 2 to 3 years. Either the conventional (regular) Pap test or the liquid-based Pap test can be used. Some women should continue getting tested yearly — such as women exposed to DES before birth, those with a history of treatment for a pre-cancer, and those with a weakened immune system (such as from HIV infection, organ transplant, chemotherapy, or chronic steroid use).

• Women over 30 (who have normal immune systems and no abnormal Pap results) should get tested only every 3 years with a Pap test plus the HPV DNA test (see below for more information on this test). The Pap test used can be either the regular or the liquid-based Pap test.

• Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer testing. Women with a history of cervical cancer, DES exposure before birth, HIV infection, or a weakened immune system should continue to have testing as long as they are in good health.

• Women who have had total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer testing, unless the surgery was done as treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix (a supra-cervical hysterectomy) need to continue cervical cancer screening. They should continue to follow the guidelines above.

Some women stop having Pap tests once they have stopped having children. This is incorrect. All women should continue to follow the guideline for screening above by the American Cancer Society guidelines.

How to avoid exposure to HPV

Most pre-cancers of the cervix can be prevented by avoiding exposure to HPV. Behaviors below can increase a woman’s risk of getting HPV infection:

• having sex at an early age
• having many sexual partners
• having a partner who has had many sex partners
• having sex with uncircumcised males

Delay onset of sexual activity

Limit number of sexual partners

Avoid sex with a partner who has multiple sexual partners

Use condoms: Can lower HPV infection by 70% if used with all sexual activity.

Don’t smoke

Get vaccinated

Vaccines have been developed that can protect women from HPV infections. So far, a vaccine that protects against HPV types 6, 11, 16 and 18 (Gardasil^®) and one that protects against types 16 and 18 (Cervarix^®) have been studied. Cervarix was approved in October of this year for use in the United States by the FDA, while Gardasil was approved for use 2006. In October 2009, the FDA also approved the use of Gardasil in males to prevent genital warts. Both vaccines require a series of 3 injections over a 6-month period. Side effects are usually mild. The most common one is swelling, short-term redness and soreness at injection site. Rarely, fainting shortly after the vaccine injection may occur in a young woman. Cervarix is approved for use in girls and young women ages 10 to 25 years, while Gardasil is approved for those 9 to 26 years old. It cost about $375 for a full series. Ask your doctor about getting either yourself or your children vaccinated for those with young daughters.

It is important to note that HPV can be transmitted orally, anally and through the fingers if one indulges in these types of sexual activities. One can also develop oral and anal cancer due to HPV transmission to these parts of the body. Please be careful.

Other risk factors associated with cervical cancer

• Family history
• Obesity
• Prolonged use of birth control pill
• Improper use of Hormone replacement therapy
• Poor female hygiene

By Dr. Eucharia Iwuanyanwu, PA-C