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Cervical Cancer: Beyond Misconceptions and Stigma

By: Melissa Montellano-Ngo, MDCervical Cancer: Beyond Misconceptions and Stigma

Twelve Filipinas die each day due to cervical cancer. After infectious and cardiovascular diseases, cervical cancer is the third leading cause of death among Filipinas based on the Philippine Cancer Society.  Although easily detected and preventable, misconceptions and stigma plague cervical cancer, resulting in the numerous deaths. Below are some facts about cervical cancer, presented in the hope of shedding light on the condition.

Where is the cervix located and what is cervical cancer?

The cervix is the narrow lower portion of the womb (uterus) connected to the birth canal (vagina). In Filipino, the cervix is called the “sipit-sipitan” or “leeg ng bahay-bata”.

Cervical cancer occurs due to the abnormal growth of cells. There is cell mutation leading to continuous division and subsequent development of a tumor.

What causes cervical cancer?

The human papillomavirus (HPV) causes the mutation. This virus is found in approximately 99.7% of cervical cancer patients. HPV has over 150 types, with 40 of those transmitted sexually.  More than 70% of cervical cancer cases are due to HPV types 16 and 18.

Aside from cervical cancer, HPV can also cause genital warts (HPV types 6 and 11) and cancers of the vagina, vulva (labia or “lips” of the female external genitalia), penis, anus, head, neck, and throat.

What factors increase the risk for cervical cancer?

  • Early sexual activity (before 18 years old)
  • Numerous sexual partners
  • Sexual partner or partners (regular or casual) who themselves had numerous sexual partners
  • Other sexually transmitted diseases (such as gonorrhea, syphilis, chlamydia, HIV/AIDS)
  • Multiple pregnancies (7 or more full-term pregnancies)
  • Long-term use of oral contraceptives (more than 5 years)
  • Cigarette smoking and early age of smoking
  • Weak immune system (other diseases, poor nutrition, lack of sleep, stress)

Cervical cancer is primarily transmitted sexually. If there is no vaginal penetration, could you still get an HPV infection?

HPV can be transmitted by sexual intercourse or even foreplay without vaginal penetration through direct skin-to-skin contact. Both male or female partners with genital or anal warts may transmit the virus to their sexual partners. Through genital-digital manipulation or oral sex, the virus may be transferred to other sites or upwards into the cervical canal.

Is HPV infection due to promiscuity or unfaithful sexual partners?

These generalizations should be avoided since cervical cancer may not necessarily be due to these illicit activities. Even individuals with a single lifetime sexual partner could get infected. The patient may also have contracted the infection from earlier sexual partners. HPV may remain dormant in an individual for several years or even decades. With a weakened immune system, the virus can become active and cause cervical cancer.

How will you know if you have cervical cancer?

If you have one or more of the risk factors plus any of the signs and symptoms below, it is best to consult your doctor:

  • Abnormal vaginal bleeding (between periods or after intercourse, menopause, douching or internal examination)
  • Heavy or unusual vaginal discharge (watery or thick bloody discharge that may have a foul odor)
  • Lower abdominal (pelvic) pain not related to the menstrual cycle
  • Pain during intercourse
  • Other symptoms (bone pain, abnormal bowel movements, increased frequency of urination, pain during urination, swelling of the legs)

How is cervical cancer detected?

The physician will perform a pelvic examination and obtain samples for a Pap smear. The samples will be viewed under a microscope to screen for abnormal cells. A biopsy is then conducted to confirm the diagnosis.

A Pap smear can be done on an outpatient basis.  Aside from private institutions, numerous government hospitals and clinics offer the service for free or for an affordable fee based on the Department of Health. In settings with limited financial resources, visual inspection with acetic acid may be done in place of a pap smear.

How often should you undergo a pap smear?

The first pap smear should be performed 3 years after a woman’s first vaginal intercourse and every year for the following 3 years. If the results are negative for the consecutive 3 years, she can undergo the pap smear examination every 2 to 3 years.

Why is getting a pap smear important even in women without any symptom?

Based on the Infectious Diseases Society of America, up to 80% of women by the age of 50 years old have been infected by HPV. Most of the women affected with HPV do not develop cervical cancer and approximately 90% will be cleared of the viral infection within 2 years. However, there is still a number of women at risk of developing cervical cell mutation due to persistent infections.

Cervical cancer is often detected late, often at stage 3 or 4, because a majority of those infected do not experience any symptom and do not undergo regular pap smear examinations. Sadly, due to late detection, 75% of these women will not survive 5 years after diagnosis according to the World Health Organization.

If you are already 65 years old and above, should you still be worried about cervical cancer?

Although 50% of patients with cervical cancer are between the ages of 35 and 55 years, 20% of women 65 years old and above can still get affected. Even though screening for cervical cancer is generally not recommended past the age of 70, it is still prudent to consult a physician for any concerns. Based on guidelines, screening for cervical cancer can be discontinued in women with 2 consecutive negative HPV tests or 3 consecutive negative pap smears within the last 10 years, with the last test performed within the past 5 years.

Should men also be concerned?

Based on a study published in the journal Oncology, 45% of men aged 18 to 59 years old have HPV infection with 25% afflicted with the HPV-16 and HPV-18 types. Because of this, they may develop penile or anal cancers and transmit the virus to their female partners and subsequently put them at risk for developing cervical cancer. 

How is cervical cancer treated?

Depending on the stage, cervical cancer may be treated with surgery alone or with radiation, chemotherapy or a combination of both.

How can you prevent cervical cancer?

  • Delay first sexual intercourse
  • Be in a monogamous relationship, have fewer sexual partners
  • Practice safe sex, use condoms or diaphragms
  • Get vaccinated against HPV
  • Consult a doctor and undergo regular pap smear examinations
  • Avoid smoking
  • Build up your immune system

Who and when should you get vaccinated against HPV?

The Centers for Disease Control and Prevention recommends vaccination of both boys and girls as early as 11 years of age before they become sexually active. Even those already sexually active can benefit from the vaccine. However, pregnant women should wait after delivery to get vaccinated.

Does vaccination promote sexual activity in young women?

This is a misconception. Studies have shown that vaccinated women still practice safe sex and engage in sexual activities at the same rate as the unvaccinated. Therefore, this false impression should not hinder women from receiving the vaccine.

Are vaccines against HPV safe?

HPV vaccines are proven effective and safe with usually only mild side effects.

Cervical cancer is a preventable serious disease. Ask your doctor about receiving vaccination for this dreaded condition.

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