Cancer, the second leading cause of death globally, is the uncontrolled growth of a group of cells in the body. It can occur at any age and if not detected at the right time and is not treated, it can increase the risk of death.
Cervical cancer is a type of cancer that develops in a woman’s cervix (the part of a woman’s body that connects the uterus or womb and vagina).
In this interview with Premium Times’ Nike Adebowale to commemorate the World Cancer Day, Amina Isah, an expert in obstetrics and gynaecology, explains why women are at higher risks of having cervical cancer.
Ms Isah is also a Fellow in Reproductive Health, working with NISA Premier Hospital in Abuja.
The World Cancer Day (WCD) is celebrated on February 4 every year to raise awareness about cancer and advocate for governments and individuals globally to take action against the disease.
The theme for this year’s WCD is “I am and I will,” marking the endpoint of a three-year campaign which sought to reduce fear, increase understanding and change behaviours and attitudes around cancer.
Below are excerpts from the interview:
PT: The number of cancer patients, especially breast and cervical cancer, has doubled over the years. What do you think can be done to end this scourge?
Ms Isah: Yes, the cancer scourge has actually increased especially in the developing world and Sub-Saharan Africa like Nigeria. Let’s start with discussing what cancer is. Naturally, God Almighty has designed our body such that cells have their programmed time and lifespans. Once the lifespan is reached, the cells die and new cells are produced and that is what happens in every day to day life. So what happens in cancer cells is as a result of this cell timing not occurring. The DNA continues telling the cells to keep producing outrageously and they do not die. So as a result of this, those cells accumulate together, forming a mass or tumour. These are called cancer cells. However, it is not all tumours that are cancerous.
Let’s come back to breast cancer and cervical cancer. These are the topmost important cancers of females worldwide. Breast cancer is the commonest, then the second is cervical cancer. The problems we are having in the country are lack of awareness, lack of standard cancer screening programme and lack of vaccines for cervical cancers. The Nigerian government is supposed to include cervical cancer vaccines in the country’s vaccine polity. That is, it should be incorporated into the National Immunisation Programme so that it can be free and be readily available for both females and males, especially in the rural communities where we have the most population and the less-educated ones.
Another problem is that Nigerians, especially those in the rural communities, and to some extent, those in the urban centres, have poor health seeking behaviour such that when they have some symptoms, they don’t go to the hospital early. This boils down to lack of awareness on the disease.
Late case presentation is thus another problem in Nigeria. By the time they present to the hospital, most of the time, there is already full-blown cancer, to the extent that it has spread to other tissues of the body. At this point, doctors just go ahead and do supportive treatment or what we call palliative treatment to ease the pain and at the end of the day, the patient dies.
PT: It is said that all women face the risk of developing cervical cancer. What are the factors that may increase the risk for some people?
Ms Isah: Being a female is a risk factor for both breast and cervical cancer. Well, you may ask what the causes of cancers are. Most of the time, the causes are actually unknown. But for that of cervical cancer, sexually-transmitted Human Papilloma Virus (HPV) has been implicated in the causation of the cancer. What this does is that it invades the cells of the cervix when infected through either anal, oral or vaginal sex.
So once that happens, it goes to the cells and cause what we call continuous DNA replications. But it is not all those that are infected with HPV that eventually end up with cervical cancer. Besides, HPV has over 100 types and the ones that have been implicated in the causation of cervical cancer are Type 16 and Type 18, and to some extent Type 33.
The increased risk for cervical cancer is having multiple sexual partners or those that have partners with multiple sexual partners. Number two is starting sexual activities at an early age. And then smoking is a risk factor for cervical cancer too.
PT: Despite the availability of preventable vaccines for cervical cancer, most women still suffer from this disease. Why is this so?
Ms Isah: This is so because it is not readily available, it is not accessible and it is not affordable. Most of the institutions that have this vaccine in Nigeria are private institutions. It is not in our National Immunisation Programme and that is why we are pleading to the government to take this into consideration.
The World Health Organisation (WHO) has a target to reduce cervical cancer by at least 80 to 90 per cent in Nigeria by 2030. So if the government includes this in the national immunisation policy, it becomes readily available and affordable, because you don’t need to pay much to get vaccinated.
Awareness campaign should never stop and there should be sensitisation of community and religious leaders about cancer. By so doing, the people get screened and get vaccinated and, to a large extent, reduce the burden of cervical cancer in Nigeria and the entire world. Awareness can also be created through the electronic media like television and radio. Cardboard papers can also be used as a form of enlightenment of the people.
PT: How often should women get screened for cervical cancer?
Ms Isah: WHO and the Royal College of Obstetrics and Gynaecology recommend that women of reproductive age group – 15 to 49 years – should have a pap smear done every three years, provided the previous result was fine. Once the patient gets up to 50 years, it is now every five years till 65 years. So this helps us to detect any pre-cancerous legion. The legion raises a red flag that you need to either follow up such patient or you treat at that time before it becomes invasive cancer.
PT: What are the symptoms of cervical cancer and is it curable once a person is diagnosed?
Ms Isah: The symptoms include abnormal vaginal discharge, which a lot of women experience at a time and they think it is a toilet infection. What I am advocating now is for every woman that has abnormal virginal discharge to visit the health facility to get a pap smear done or even evaluate the discharge. If it is other infections, it will be treated and if pre-cancerous legion is detected, it will be treated. Others symptoms are bleeding after sex (post coital bleeding), postmenopausal bleeding, lower abdominal pain etc.
PT: What are the challenges associated with treating cancer in Nigeria?
Ms Isah: It is enormous because we don’t even have a cancer institute in Nigeria. We don’t have a centre where if one has cancer, they can just walk in there for treatment. But the teaching hospitals are there. It is just that the problem they face is late case presentation, so there is little or nothing they can do about it. They only give palliative treatment or surgery.
If it is already far gone into the person’s body, they do what we call radiotherapy and chemotherapy and, of course, less of surgery. But if it hasn’t spread to other organs, of course, the womb and the cervix can be removed totally.
Unfortunately, these radiotherapy machines are not always available in the country. The few that are available are non-functional so most people go to the National Hospital where they are given long appointments. At times, they say the machines has broken down when some patients visit the hospital. So there is little or no government contribution in those areas and we are pleading to the governments to please give attention to health because health is wealth, especially to our women. The health of a woman is the health of the world, it is the health of the state and it is the health of the family.
Once a woman is healthy, her child is healthy because she is there to cater for the child. The husband is happy and everybody is happy. But once a family loses their mother, things are no long the same.
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