Cervical cancer still the leading cause of cancer death among SA women

 The Clinical HIV Research Unit (CHRU) and health NGO Right to Care have joined forces to raise awareness about cervical cancer, the leading cause of cancer death among South African women. Tomorrow is International Gynaecological Awareness Day which aims to raise awareness about gynaecological and sexual health issues.

The primary underlying cause of cervical cancer is the Human Papilloma Virus (HPV), which is the most common sexually transmitted infection, and of which there are more than 100 types. Type 16 and type 18 cause 70% of cervical cancers.

Dr Masangu Mulongo, research medical officer at CHRU, says, “The HPV vaccine provides almost 100% protection against HPV 16 and 18 and the Department of Health regards it as an investment in the future of South African women. Yet while the HPV vaccination can go a long way in reducing cervical cancer, not everyone is vaccinated.”

“An HIV positive woman is five times more at risk to develop cervical cancer because HIV suppresses her immune system and makes her vulnerable to the HPV virus. It takes 10 to 15 years for cervical cancer to develop in healthy women. It can take only 2 to 5 years in women with weakened immune systems due to untreated HIV infection,” explains Mulongo.

Right to Care, a non-profit organisation that supports and delivers prevention, care, and treatment services for HIV, HIV-associated cancers and TB, has set up mobile clinics in three provinces that offer cervical cancer screening, distribute educational material and refer patients who have abnormal results.

“The goal of this initiative, which is funded by the Bristol Meters Squibb Foundation, was to find ways to address screen and prevent cervical cancer in specific areas across the country. We set up mobile clinics to reach them,” says Sibongile Ramotshela, cervical cancer project manager at Right to Care.

The Gauteng mobile clinic can be found at the Helen Joseph Hospital in Gauteng and the second one is at the Dwarsloop Community Health Clinic in Bushbuckridge, Mpumalanga. Two mobile clinics are also circulating in the KwaZulu-Natal region to provide screening and referral services to women in hard-to-reach areas.

“We are doing everything to prevent the progression of pre-cancer to invasive cervical cancer in a high-risk population. We have diagnostic facilities at the Thembalethu clinic at Helen Joseph Hospital, the ORT clinic in Diepsloot, Johannesburg and at our mobile clinics in KwaZulu-Natal’s uThukela district. Pre-cancerous lesions can also be treated at all our sites,” says Ramotshela.

Only half of South African women are screened for cervical cancer at the recommended intervals, with Pap Smear screening coverage rates even lower amongst the poor and women living with HIV. Nicknamed the ‘silent killer’, cervical cancer’s symptoms don’t appear until it reaches an advanced stage. It develops slowly over time giving women ample opportunities to be screened and treated.

Ramotshela explains the National Department of Health’s guidelines on the intervals for cervical cancer screening. “An HIV-negative person with negative Pap Smear results must screen again after ten years. An HIV-positive person with negative results must screen again after three years. An HIV-positive person with abnormal results must be referred for further treatment and linked to ongoing care as each case is different.

“Having a Pap Smear alone does not prevent cancer,” she says. “Patients must come back for their results and ensure the healthcare workers give them their results so that abnormal Pap Smears can be dealt with.

“Right to Care’s data-driven electronic medical record system guides our educational outreach campaigns so that we can actively link women to the screening and treatment services they need.”

Dr Mulongo commends the services provided by Right to Care to prevent cervical cancer through screening, early diagnosis and the treatment of pre-cancerous lesions.

“On International Gynaecological Awareness Day and beyond, let’s continue to share knowledge and raise awareness about cervical cancer screening and crucial HPV vaccinations so we can save womens’ lives,” she says.

Symptoms of cervical cancer

Symptoms tend to appear only after the cancer has reached an advanced stage. These include:

•        Irregular, bleeding between periods or abnormal vaginal bleeding after sexual intercourse

•        Back, leg or pelvic pain

•        Fatigue, weight loss, loss of appetite

•        Vaginal discomfort or smelly discharge or

•        A single swollen leg.

Risk factors for cervical cancer

These can include:

·         Becoming sexually active at an early age

·         Having multiple partners

·         Smoking

·         An unhealthy diet that is low in fruit and vegetables

·         A family history of cancer and

·         Sexually transmitted infections (STIs) and HIV.

Preventing cervical cancer

Prevention includes:

·         The HPV vaccine

·         Screening through regular visits to your healthcare facility

·         Delaying sexual activity for as long as possible and

·         Using condoms if you are sexually active. 

The Clinical HIV Research Unit (CHRU) is a division of the Wits Health Consortium which is part of the Faculty of Health Sciences at the University of Witwatersrand.  Dr Masangu Mulongo is a clinical researcher at the CHRU. Several of the clinical trials undertaken by CHRU are part of a research network known as the AIDS Malignancies Consortium.

 

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