Get your teenager vaccinated against HPV and go for a pap smear test

Do you also know that cervical cancer is one of the most preventable types of cancer?  Do you also know that if cervical cancer is caught early it is highly treatable, associated with long survival and a good quality of life?  DO NOT WAIT FOR SYMPTOMS. A simple test like Pap smear can save your life from cervical cancer. Because women in America and Europe get regular pap smears tests, cervical cancer is very rare in those countries. Here's how to protect yourself from cervical cancer.

What is the cervix?

The cervix is the opening of the uterus (womb).

What causes cervical cancer?

It is now known that the Human Papilloma Virus (HPV) causes cervical cancer.

How does Human Papilloma virus spread?

There are hundreds of types of human papilloma virus.  There are some specific types of human papilloma virus that can cause cervical cancer.  These are spread by intimate sexual contact.

Whereas most women's bodies are able to fight and overcome an HPV infection, others may not be so lucky and have aggressive forms of the virus which invade their cells and eventually cause the cells to be cancer forming cells.

How can I protect myself from Human Papilloma virus infection?

Primary prevention:

There are several was to do this.  (1) get vaccinated (2) Use of condoms (3) Avoid sexual contact.

The vaccine against HPV has now been available for over 10 years.  In countries such as Australia and New Zealand, where vaccination, was introduced in 2008 the incidence of cervical cancer, genital warts and abnormal pap smears has reduced substantially.

Because HPV lives in the skin, the use of condoms in preventing HPV infection is not very effective, compared to condoms preventing other sexually transmitted infections such as HIV, Gonorrhea and Chlamydia.

HPV can also lie dormant for many years. Thus, one can be infected without symptoms for many years before showing signs of HPV related diseases. It is estimated that one in three women below the age of 30 will be infected with HPV.

Most international health organizations recommend vaccination to girls between age 9-15. This is meant to target girls and women before they are potentially exposed to the virus in future. However, it should be noted that the vaccine may be administered to anyone until age 45. The effectiveness of the vaccine cannot be ascertained after sexual activity has begun as you may have already been exposed.  Vaccines are meant to prevent infection. Just in the same way, there is little benefit to giving a chicken pox vaccine to someone who had chicken pox as a child.

There are several HPV vaccines available. Talk to your doctor about which one may be best for you.

Secondary prevention:  Screening tests

There are 3 ways to do this (1) pap smears (2) HPV testing (3) Visual inspection

Pap smears are tests done in the clinic by a health care provider.  Although uncomfortable, this should not be painful.  During a pap smear, the clinician will take a sample of cells from the cervix using a brush. In effect, something similar to brushing the inside of your cheek with a toothbrush.  The cells from the brush are placed on a slide and sent to the lab.

HPV testing is now the most recommended test. As discussed, HPV is the known cause of cervical cancer. This test is done using a swab. This may even be done by a patient herself! If the test is negative, no further testing is needed. If positive, the patient will be asked visit a gynaecologist for further testing.

Visual inspection of the cervix may also be done to check for any early changes that may lead to cancer. During this procedure, the clinician examines the cervix after it has been soaked in acetic acid which is also known as vinegar.  If abnormal areas are seen, a simple freezing treatment (cryotherapy) is usually offered on the spot with a 10-minute procedure. A patient may also be referred to a gynaecologist for further treatment.

I'm afraid of going for a cervical cancer test, what if I have it?

It takes on average 5 to 8 years do develop cervical cancer.  Thus, even when a pap smear, HPV or visual inspection test is abnormal, it is likely to show dysplasia or “pre-cancerous" lesion changes.  These precancerous lesion changes are highly treatable, with minor out-patient surgery and you will continue your life normally and even carry pregnancies to term.  With regular screening tests every 3-5 years (pap smears, visual inspection, HPV tests) it is almost impossible to get cervical cancer as any abnormal changes will be detected and treated in a timely fashion.

If you are unfortunate to have cancer, early stage cervical cancer is treatable, and many patients will have a long life.

What are the symptoms of cervical cancer?

These will include abnormal bleeding - especially after sex, lower abdominal pain and discomfort, and abnormal discharge are all signs of late stage disease. Do not wait for these symptoms. Late stage disease is hard to treat with a short life expectancy.

What is the best way forward?

Teenagers and young girls need to get vaccinated

Adults need to go for routine screening tests (Pap smear, HPV test, Visual inspection) every 3-5 years from the age of 25. For those who are HIV positive, these screening tests are recommended every year.

By Dr Angela Migowa, Consultant Paediatrician, Rheumatologist and Adolescent Health Expert at Aga Khan University Hospital Nairobi

This article was first published in Business Daily on January 9, 2023