Text by Henrylito D. Tacio
In a recent press briefing at the World Health Organization office in Geneva, Switzerland, Director-General Tedros Ghebreyesus believes the pandemic is “nowhere near over.” And with the incredible growth of Omicron, new variants are likely to emerge.
“Omicron continues to sweep the world. I remain concerned about countries with low vaccination rates, as unvaccinated people are many times more at risk of severe illness and death,” the WHO chief stressed. “I urge everyone to do their best to reduce risk of infections and help take pressure off health systems.”
In the same briefing, Dr. Tedros said January is Cervical Cancer Awareness month. “In 2020, an estimated 604,000 women were diagnosed with cervical cancer worldwide and about 342,000 women died from the disease,” the United Nations health agency pointed out.
Cervical cancer is the second leading cancer site among women, according to the Department of Health (DOH) reports. Every year, an estimated 7,277 new cases are reported, with 3,087 deaths. In recent years, however, more cases and more deaths have been reported.
The WHO said the main cause of cervical cancer is infection with high-risk types of human papillomavirus (HPV), an extremely common family of viruses that are transmitted through sexual contact.
HPV takes several forms, which are referred to by number. “There are about 100 types of HPV that generally infect people in various parts of the body but there are only 13 types that can cause cancer in the cervix,” wrote Dr. Cecilia Ladines-Llave in a paper presented at the Global Conference on Low-Resource Setting Cervical Cancer Prevention held at Johns Hopkins University.
The most common causes of cervical cancer are HPV types 16 and 18. These two types are responsible for 70 percent of cervical cancer around the world. HPV Type 16 also causes oropharyngeal cancer. Condoms do not fully protect against infection because the virus can exist throughout the genital area and around the anus.
“We realize that, although HPV is sexually transmitted, it is not a sexually transmitted disease,” Dr. Chia Yin Nin, a gynecologic oncologist practicing at Gleneagles Hospital in Singapore, told Business World. “It can be acquired through personal contact like fondling, petting and sexual intercourse.”
The following had been established as possible causes of cervical cancer: have had multiple sexual partners, have had sexual partners (regular or casual) who themselves had several sexual partners, have had a sexual partner who is infected with HPV, and had first sexual intercourse at a very early age, possibly 15 or 16 years old.
The risk of developing cervical cancer is increased by the following: smoking, long-term use of oral contraceptives, a weakened immune system, and a family history of cancer, especially cervical cancer.
HPV is so prevalent in the community almost all women can have it. However, there are many forms of HPV, and many do not cause problems. “HPV infections usually clear up without any intervention within a few months after the acquisition, and about 90% clear within two years,” the WHO said, adding that a small proportion of infections with certain types of HPV can persist and progress to cervical cancer.
Dr. Cecilia Ladines-Llave, the director of Cervical Cancer Prevention Network, was quoted as saying by Philippine News Agency (PNA) that 99.7% of cervical cancers are caused by HPV.
It takes 10 to 30 years of incubation before HPV infection becomes symptomatic. “There are no signs and symptoms about 18% of the time,” Dr. Llave stated. “Most women don’t go to the health centers unless they’re bleeding profusely and they experience too much pain.
For about 20% of the women who are infected with HPV, cervical cancer may develop. “It is only when the cancer develops that you experience the signs like bleeding during sexual intercourse, bleeding between menstrual periods, or bleeding after menopause,” Dr. Nin said. “The patient can also experience other symptoms like back pain, cough, and swelling in the abdomen or limbs if the cancer has spread.
When detected early, cervical cancer, however, is curable. At present, the most reliable and practical way to diagnose cervical cancer early is through a Pap smear, which involves collecting cells from the cervix, which are examined under a microscope.
Aside from the Pap smear, there is also the HPV test kit. “It is a swab test similar to the Pap smear,” Dr. Nin said. “The accuracy is so much better than the Pap smear. It is so accurate that you can space out your screening to 3-5 years. For Pap smear, it is recommended that you test once every year because it is quite prone to interpretation error.”
An ounce of prevention is better than a pound of cure, so goes a saying. The WHO said there are vaccines that protect against high-risk HPV types, which means cervical cancer should be one of the most preventable and treatable forms of cancer.
Currently, there are three vaccines protecting against both HPV 16 and 18, which are known to cause at least 70% of cervical cancers. The third vaccine protects against three additional HPV types, which cause a further 20% of cervical cancers.
The WHO reported that clinical trials and post-marketing surveillance have shown that these HPV vaccines are very safe and very effective in preventing infections with HPV. The vaccines, however, cannot treat HPV infection or HPV-associated disease, such as cancer.
HPV vaccines work best if administered prior to exposure to HPV. As such, the WHO recommends vaccinating girls aged between 9 and 14 years, when most have not started sexual activity yet.