protectIng yourself agaInst cervIcal cancer

CanCer
Breast cancer and Its screenIng programmes Have receIved a great deal of medIa and puBlIc attentIon, and most women (and men) are aware of tHIs type of cancer. But, world HealtH organIzatIon statIstIcs sHow tHat of all tHe cancers tHat affect ugandan women, cervIcal cancer Is tHe most common.
By dr mIcHael muwonge lukoma

CatCh that

• Young girls and women who are virgins (who have never had sex) can be vaccinated. The HPV vaccine is only effective if the woman has never engaged in sexual activity and it only provides protection against a limited number of virus types found in Uganda. • Prevent being infected by HIV. • Delay first sexual intercourse and marriage to at least 20 years. • Be faithful and limit the number of sexual partners, and use condoms to prevent spread of HPV. • Space out your pregnancies, with intervals of at least 2-3 years between children. • Do early and regular cervical cancer screening. • Stop or never start smoking – the chance of a woman developing cervical cancer is doubled if she smokes. • Eat foods with carotenoids (carrots, squash, tomatoes and green vegetables), vitamin C (oranges, lemons, tomatoes, watermelon) and folate (spinach, papaya and green beans). • Male circumcision is thought to provide protection, though it is yet to be confirmed by research. • Oral hormonal contraceptives prevent pregnancy, but do not provide protection against HPV infection – only condoms provide protection.

IdentIfyIng cervIcal cancer

• Vaginal bleeding after sexual intercourse • Extra bleeding between your monthly periods • Foul-smelling vaginal discharge • Persistent lower abdominal pain and backache • Difficulty controlling release of urine or stool (incontinence)

Your 50-year-old auntie has been complaining of severe back pain for two months, and she has difficulty controlling her bladder. In spite of your busy schedule you took her to a clinic in your neighbourhood. After receiving treatment for lower back pain, the symptoms disappear for a few days, but then return in full force. Finally she develops vaginal bleeding and you dedicate a whole day to taking her to a gynaecologist, where she is diagnosed with an advanced cervical cancer. The doctor mentions that the chances of survival are bleak. Sadly this is a typical story; could happen to any woman. It could be your sister, your mother, your grandmother or any friend of childbearing age. If you are a woman, it can be you. Cancer is a terrifying ordeal for both the patient and family members dealing with the disease. The purpose of this article is to provide guidance and hope, and the realisation that cervical cancer is preventable. This is especially true if women make checkups for cervical cancer part of their medicalcare routine.
• In Uganda, cervical cancer is the leading cause of female cancer deaths. The second most common cancer is Kaposi’s sarcoma (an AIDS-related cancer), with breast cancer the third most common. • Almost half of the beds in Mulago hospital’s gynaecological wards are occupied by women 64 I

being treated for cervical cancer. • The average age of a woman diagnosed with cervical cancer is 47.

How does cervIcal cancer develop?

Cervical cancer is caused by a group of viruses called human papilloma virus (HPV ) that is present in some men. Once a woman becomes sexually active, she is exposed to the HPV in her partner. Once she is infected by HPV, the lining of her cervix begins to change and grow. Changes also occur on a microscopic level. The HPV virus has many varieties that scientists call strains. Certain HPV strains are aggressive in their ability to invade normal cervical cells. Once these viral strains invade a normal cell they begin a process that shuts down protective proteins, which usually work in a protective fashion to limit cell growth. Once the proteins are blocked, cell growth becomes excessive, leading to tumor development. This rapidly dividing mass of cells (tumor) can grow and spread to other cervical layers and other organs such as the bladder, nerves or blood vessels. This infiltrating, disorganized growth is essentially called cervical cancer. As we know, women who are HIV positive have weakened immune systems, so being infected by HPV means that cervical cancer develops faster in their bodies.

cervIcal cancer screenIng

• Three years after a woman’s first vaginal intercourse encounter she should have a Pap test or Pap smear done by a trained medical professional. Taking the smear involves a painless procedure. • If your Pap smear result is abnormal your doctor will recommend further testing, such as an exam under anesthesia, to fully examine the cervix and to obtain cells for viewing under a microscope. • If your test is normal the doctor will advise you when to you’re your next Pap smear, depending on your age and risk factors. • Screening is vital to catching this disease early, so every woman should be encouraged to have testing done regularly.

protect yourself

• Don’t start having sex at a young age, and use condoms to avoid infection. • Go for cervical cancer screening. In Kampala, most private health centers do Pap smear tests, and public and mission hospitals do Pap smears and use alternative methods for cervical screening. • Don’t test alone, encourage your mother, aunts, sisters and female friends to go for the test too, and ensure happier, healthier lives for all of you.

Sources Namagembe, I: Cancer of the Cervix and its Prevention: Still a Public Health Concern. http://www.cwru.edu/med/epidbio/ mphp439/Cervical_Cancer.htm http://www.ehealthmd.com/library/cervicalcancer/cc_whatis.html http://adam.about.com/reports/000046_1.htm The author acknowledges the assistance of Drs Imelda Namagembe and Martin Origa (obstetrician-gynaecologists), who provided medical input and advice in writing this article.