CERVICAL CANCER – A PREVENTABLE DISEASE

CERVICAL CANCER is the 4th most common cancer in women worldwide, and the second most common in women in Jamaica after breast cancer.

In 2020, it was estimated that over 600,000 new cases were diagnosed and over 300,000 deaths occur annually from the disease worldwide. Because of a lack of organised screening programmes, 85-90 per cent of these new cases and deaths occurred in less-developed countries like Jamaica.

The cervix is the narrow lower end of the uterus and connects the uterus to the vagina. An important role of the cervix is to keep the baby in the uterus to grow and then open to allow the baby to be delivered at term. Almost all cases of cervical cancer occur at the junction between the outer (ectocervix) and inner (endocervix) aspect of the cervix, known as the transformation zone.

Risk factors for the development of cervical cancer include, starting sexual intercourse at a very early age, cigarette smoking, and promiscuous activity. The most important risk factor for cervical cancer is infection with the Human Papilloma Virus (HPV).

Up to 80 per cent of women will acquire an HPV infection in their lifetime, as this is a very common virus. While most women will clear the infection, it is the persistence of the infection which leads to pre-cancerous changes on the cervix and, if left untreated, over time can become cancerous.

In the early stage of the disease, most women will have no signs. However, as the disease advances, some women will present with bleeding after sexual intercourse, a malodorous vaginal discharge and, in more severe cases, they may have pelvic pain and difficulty passing stool and urine.

The management of cervical cancer often involves removal of the uterus (womb) along with the cervix, once amenable to surgery. In advanced cases, the treatment is usually chemotherapy with radiation. In very early cases in young women, the cervix or part thereof can be removed and fertility is still feasible.

The cervix, by virtue of its anatomical location, is amenable for screening, which provides a window of opportunity to detect pre-cancerous changes so that these can be treated before cancer develops. Over 50 per cent of women with cervical cancer in Jamaica have never had a Pap smear and, if they did, it was more than five years earlier.

Screening can be done using the traditional Pap smear, but primary HPV testing can be performed alone or in conjunction with the Pap smear, which will improve detection of early cervical abnormalities. Screening should begin by age 21, once the woman is sexually active, and every 1 to 2 years thereafter.

Primary prevention strategies to reduce cervical cancer incidence and deaths include educating women about safe sexual practices and stopping smoking.

HPV vaccination is important to reduce the acquisition of high-risk HPV types involved in the development of cervical cancer. This has been shown to reduce the incidence and deaths from cervical cancer in countries where it is widely used.

January marks World Cervical Cancer Awareness Month, and it is therefore important to emphasise that cervical cancer is a preventable disease, and no woman should die from it.