Tuesday, 20 September 2022: Cancer of the cervix is the second most prevalent cancer in women in South Africa and while it is preventable, approximately 3 000 women die in SA from cervical cancer every year. The main cause is infection of the cervix by the human papillomavirus (HPV) through sexual contact.
Dr Seithati Molefi, deputy chief of party at health NGO Right to Care, explains that, “HPV can be prevented with the HPV vaccination. Cervical cancer month in September is an important opportunity to raise awareness about HPV risks and the need for the HPV vaccine for girls aged 9 and older.”
Vaccine should be given to girls before sexual debut
The World Health Organisation recommends that girls aged 9 and above should receive the HPV vaccine before they become sexually active. As part of South Africa’s public health programme, all Grade 5 girls or those 9 years and older in public schools have easy access to free HPV vaccine via the health system. The vaccine ensures that when girls reach adulthood, they will be protected from HPV infection which causes most of the cases of cervical cancer.
“Parental consent is required for a girl at school to get this vaccine. It is therefore important for parents to understand what cervical cancer is, its causes as well as how HPV vaccination could protect their daughter from the disease. This helps parents make informed decisions about giving consent for vaccination as well as the possible dire consequences for their daughters if they don’t have the HPV vaccination,” says Molefi.
Risk factors
Dr Molefi adds that, “Risk factors for HPV infection include sexual intercourse at an early age, multiple sexual partners, smoking and HIV infection. Some 60% of sexually active women will acquire an HPV infection within five years after starting to have sex. Young girls no longer in school may also access the vaccine and should go to their closest health facility and ask for the HPV vaccine.”
If girls don’t receive the vaccine before they become sexually active their chances of developing cervical cancer increases.
Dr Molefi warns that even if a young girl has had the HPV vaccine, she must still practice safe sex to prevent HIV and other sexually transmitted infections as well as pregnancy. “It is advisable for her to stick to one partner and negotiate the use of condoms with her partners. She can also ask her healthcare worker about comprehensive reproductive health services including family planning and pre-exposure prophylaxis (PrEP) if she believes she is at risk of getting HIV or if she cannot negotiate safe sex. Cervical cancer is the most common cancer among women living with HIV.”
Preventing cervical cancer
Screening is a very important part of prevention. Right to Care is working with the Free State Department of Health inthe Thabo Mofutsanyana district, to take cervical screening services into communities as part of supporting comprehensive healthcare services for women, particularly those who may have poor or no access to these services.
Molefi says, “We take our mobile unit to communities and encourage young girls and women to have a pap smear. This is a simple procedure done in a confidential setting. The nurse gently removes cells from the cervix so that they can be checked under a microscope for signs of cervical cancer. It is generally, a painless procedure but could cause discomfort or pain in some women. If signs of cervical cancer are detected, it can be fully investigated and treated early. This mobile outreach campaign has been very effective in taking this crucial service to those who need it. Some health facilities are overburdened and it becomes difficult to prioritise screening, so the mobile outreach approach is definitely beneficial.”
Doctors recommend that women should have a pap smear in line with their risk profile. In the public setting, it is recommended that all women who are asymptomatic and at low risk for cervical cancer be screened three times at 10-year intervals starting at age 30. The results then determine the subsequent interval for screening. HIV positive women, given their increased risk for cervical cancer, need to be screened for cervical cancer at the time of diagnosis and then each year depending on the results of the screening.
Circumcision prevents HPV in women
Medical male circumcision helps prevent HPV in women. Dr Molefi explains, “HPV is an infection in the skin that occurs in the moist spaces between the foreskin of an uncircumcised man. A circumcised man’s foreskin is removed so HPV cannot thrive. Medical male circumcision reduces the risk of a man getting infected with HPV and it reduces his chance of spreading it to his female partner.”
Right to Care has safely circumcised over 1.4-million men across South Africa.
Symptoms
In the early stages, cervical cancer does not typically cause symptoms. However, as the symptoms advance, they may include an abnormal vaginal discharge which may be thick and smelly, pain and bleeding during sexual intercourse, abnormal vaginal bleeding between periods, lower back pain or pelvic pain, loss of appetite, fatigue and unexplained weight loss.
About Right to Care
Right to Care is a non-profit organisation that supports and delivers prevention, care, and treatment services for HIV and TB. Through technical assistance, Right to Care supports the private sector, the National Department of Health (NDOH) and the Department of Correctional Services. Right to Care is supporting the NDOH and several regional departments of health with the Covid-19 response. USAID is a primary funder of its Covid-19 response and vaccination work.
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