Giv­ing school­girls a jab that can halt cer­vi­cal can­cer

It could save thou­sands of women’s lives

The Star Early Edition - - NEWS - ILANIT CHERNICK

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.

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