Giving schoolgirls a jab that can halt cervical cancer
It could save thousands of women’s lives
NEARLY 8 000 South African women are diagnosed with cervical cancer every year, the leading cause of deaths from cancer among women in general.
It’s also the most common cancer in South Africa and is normally contracted between the ages of 14 to 44.
The cause of cervical cancer is the Human Papillomavirus and has no symptoms until it has established itself.
This is according to a report released by the ICO Information Centre on HPV and Cancer. The cervix is the lowest part of the uterus where it opens into the vagina, forming the initial mouth of the birth canal.
“Because of its position, it is extremely vulnerable to infection by HPV, a virus that can be sexually transmitted and that is responsible for a variety of cancers in men and women, and also for genital warts,” said Dr Beth Weaver from the Ludwig Institute for Cancer Research.
Weaver explained that all people will be exposed to the virus at some time after they become sexually active, and those at the highest risk of becoming infected were young adults between the ages of 15 and 24.
“Although only a minority of people who are exposed to the virus will go on to develop cancer, at present there is no way of telling who that might be.
“Most people who are infected do not develop any symptoms, so they can pass the virus on to somebody else without even being aware that they have it,” she said.
The interval between acquiring the virus and progression to a cancer usually takes 10 years or longer.
It has been found that women needed to prevent cancer from occurring by going for regular pap smears and treating cells that were not yet cancerous by having a pap smear every three years.
HPV, however, is not always transmitted sexually. The virus can be passed on by skin-to-skin contact and sex does not need to occur.
There are other factors that can increase the risk of developing cervical cancer. These include, but are not limited to smoking, other illnesses or medication that lowers immunity, other sexually-transmitted infections, a diet low in fruit and vegetables, being overweight, having a first pregnancy before the age of 17 and having a family history of cervical cancer.
In 2014, the Department of Health introduced a national plan to vaccinate girls in Grade 4, aged nine and older, at public schools.
Vaccination against HPV is believed to be 90% to 100% effective in causing immunity against the most important viral strains that cause disease. In this way it helps to prevent precancerous changes in the cells of the cervix.
Professor Hennie Botha, head of gynaecological oncology at the University of Stellenbosch, said in order to obtain good protection of the population as a whole, “we need to vaccinate at least 70% of schoolgirls”.
“It’s essential that parents understand how important it is to allow their daughters to be vaccinated. Myths that the vaccine is unsafe, causes infertility or leads to increased promiscuity have no basis and are simply not true,” Botha pointed out.
In contrast, Botha said that not vaccinating one’s child leaves them at risk for devastating and potentially fatal disease in later life. “At the moment only girls are receiving the vaccine, but there are plans to extend the vaccine also to boys in the future.
“Although the risk of cancer from HPV is lower in boys, young men can transmit the virus to their partners, so vaccinating them not only protects their own health, but adds to protecting the health of young women and those who are not vaccinated,” he said.
Joburg-based gynaecologist Dr Trudy Smith agreed, saying: “It would be ideal to vaccinate both boys and girls, but to have a significant impact on cancer, the most important and cost-effective strategy for the government is to start with girls.”
It gives them the best possible protection against future disease
Smith emphasised that the vaccine offered in schools helps to protect against two strains of the virus commonly responsible for cancer. “This is known as the the bivalent vaccine.
“However, there are also two other strains of HPV that cause genital warts and a different vaccine that covers all four of these strains known as the quadrivalent vaccine, which is available and can protect against both cancer and genital warts.
“Because genital warts are common, boys benefit mostly from receiving the quadrivalent vaccine and the bivalent vaccine should not be used in boys,” she advised, adding that HPV-associated cancer is relatively rare in men.
The quadrivalent vaccine that protects against the four HPV strains that are most commonly responsible for anogenital warts and cervical cancer is recommended for girls and women between nine and 45, and boys and men between nine and 26.
With the vaccine not available for free at private schools, parents of girls who not at government-run schools are advised to take responsibility for their child’s health, as it is up to them whether the child receives an HPV vaccine or not.
“I strongly recommend they speak to their local private vaccination clinic or general practitioner about vaccinating. It can be done from the age of nine and ideally before age the age of 14, so that adolescents and young adults have the best possible protection long before they start any kind of sexual activity and are exposed to HPV,” she said.
Smith added that HPV was so common that almost everyone will be exposed at some point and most never know they are infected.
“So even if your daughter waits until marriage to have sex, or only has one partner in the future, she could still be exposed if her partner has been exposed to HPV.
“I would also advise older women to speak to their doctor about vaccination if they have not already done so.”
PREVENTION: Health Minister Dr Aaron Motsoaledi administers a Human Papillomavirus vaccine to a schoolgirl as part of a government vaccination programme at Gonyane Primary School in Mangaung in the Free State. Private schools are urged to follow suit.