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November 13, 2009 11:34 AM
It's Possible To Wipe Out Cervical Cancer
By Sakina Mohamed
KUALA LUMPUR, 13 Nov (Bernama) - Fifty years from now, cervical cancer will probably be a distant memory to some. The rest probably have never even heard of it.
Is this scenario possible? Yes, says consultant obstetrician and gynaecologist Datuk Dr Nor Ashikin Mokhtar.
"It is entirely possible to wipe out cervical cancer, if there are concerted efforts in screening and vaccination," said Dr Nor Ashikin, who is also the founder of the Primanora Medical Centre.
She pointed out that cervical cancer is preventable and if diagnosed early, also curable, unlike breast cancer.
"The stage when it is diagnosed makes a lot of difference. If it's confined just to the cervix, and has not gone to the blood vessel or lymphatic system, then the cure is almost 100 per cent," she said during an interview.
PREVENT CANCER, GO FOR SCREENING
To totally eliminate cervical cancer, early detection of abnormal cells that may potentially turn cancerous is needed. This can be done via cervical screening, better known as PAP smear tests, which detects changes in the cells of the cervix.
Sadly, many women do not realise how important it is to undergo regular screenings.
Dr Nor Ashikin noted even among professionals, less than 30 per cent of women go for screenings.
"What more among the non-professionals? In order to lower death from cervical cancer, we must have at least 60-80 per cent of the female population in Malaysia undergo the PAP test," she said.
Every year approximately 500,000 women worldwide are diagnosed with cervical cancer, resulting in 273,505 deaths annually.
She said in comparison with other Asian countries, Malaysia has a higher incidence of cervical cancer that ranked second among all female cancers.
The third National Health Morbidity Survey in 2006 revealed that only 43 per cent of Malaysian women, mostly younger women who are at lower risk compared with their older counterparts, have undergone PAP smears.
She said an effective national-level "smear campaign" against cervical cancer could greatly improve public awareness on the importance of going for routine screenings.
"This is where we have to lobby with the government to have whole population screening," she said.
PAP TEST IMPORTANT, BUT DOES NOT PREVENT CANCER
Although PAP test is important as it detects cell abnormalities at the early stage, it does not prevent cervical cancer, Dr Nor Ashikin pointed out.
"But it's still very important to go for PAP tests because detection of abnormal cells can help us stop the cancer from developing in the first place.
"It must also be categorically stated that there is no cervical cancer vaccine available. What is available are vaccines against specific strains of the human Papilloma virus (HPV). This basic clarification is necessary to avoid any misperception, unrealistic expectations, and in the worst-case scenario, unnecessary medico-legal consequences," she said.
She said women should not see the HPV vaccine as a license to indulge in free sex.
Dr Nor Ashikin said there are 100 types of HPV, but only about 20 of them cause cancer, most commonly the strain 16 and 18.
"You also have to understand that if you are already infected with HPV, the vaccine won't cure you," she said.
Therefore screenings are still needed, as it is essential to detect cancer and pre-cancerous lesions caused by other HPV strains.
YOU CAN GET HPV WITHOUT PENETRATIVE SEX
She said one does not need to have penetrative sex to be infected with HPV, as the virus is easily transmitted skin to skin.
The use of condoms is also inefficient in preventing HPV infections as the rubber sheath only protects certain parts of the male genitalia, while the rest such as scrotal and anal tissues can still shed dead skin which contains the virus.
"Even dead cells shed during intercourse can contain the virus which can remain infective up to four to five days," she said.
Dr Nor Ashikin stated that approximately half of all sexually active women would be infected with oncogenic (cancer-causing) HPV at some point of their lives, usually soon after their sexual debut.
Although 85 per cent of HPV infections are associated with sexual activity, 10 to 15 per cent of the infection occurs even in the absence of sexual contact.
These could be through an infected mother to her child, through unclean undergarments, surgical gloves, bed sheets, biopsy forceps and even finger nail scrapings.
"However, such cases are very rare," she says.
On that note, she added, incidences of cervical cancers have been very rare among virgins or nuns.
MEN A MAJOR VECTOR OF HPV
Dr Nor Ashikin noted that men remain the major vector in passing the cervical cancer-causing HPV to women, transmitting the virus during sexual activities.
Current studies have shown that males who report multiple sexual partners and/or who are carriers of high-risk HPV types increase their female partners' risk of developing cervical cancer.
Tests on the available vaccines carried out in Australia also show that the vaccine induces the same protective response in men, though regulators in some countries including the USA and Canada are yet to approve its use on both sexes. The vaccine is also known to protect both sexes against genital warts.
Therefore, she said, it would do well for parents to ensure their sons get the vaccine as well, preferably at the earliest possible age.
"We have to protect the girls, because the vectors are the boys," she said.
Given the current cost of the vaccines, it is not cost-effective for the government to give free vaccinations for boys in schools, at least not until all the girls have been vaccinated.
She said vaccine manufacturer Glaxo Smith-Kline has been carrying out studies on the efficacy of the vaccine on men. However, Dr Nor Ashikin has taken the onus to get her sons vaccinated anyway.
VACCINE CONTROVERSY
Cervarix and Gardasil are two vaccines that have been developed for prevention of cervical cancer related to the HPV strain 16 and 18. Several countries worldwide have approved the administration of the vaccine to girls and women.
However, when Natalie Morton, a 14-year-old schoolgirl in the United Kingdom died in hospital after receiving the Cervarix jab, thousands of people across the world voiced their concern over cervical cancer vaccinations.
It was revealed in September that Morton's death was caused by a rare tumour in her lungs that was not discovered until her death, and not the vaccine.
In Malaysia, amidst the throng of public views, the government has announced that it would seek parental consent before vaccinating 13-year-old school girls.
Dr Nor Ashikin welcomed the move and hoped that parents and worried parties can weigh in the importance of the vaccination and help their daughters get the best protection against cervical cancer.
-- BERNAMA
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