JANUARY is cervical cancer awareness month. Cervical cancer, or cancer of the cervix, is cancer of the neck of the womb. The baby grows in the body of the womb (the upper part). The cervix connects the body of the womb to the vagina (birth canal). In other words, the cervix is the door of life. Sadly, when cervical cancer occurs, this door of life becomes the door to death. Cervical cancer is the easiest of all cancers to prevent; yet it is the second most common cancer killer in Nigerian women.

This high mortality is partly due to some misunderstandings and false beliefs surrounding the disease. To mark this year’s Cervical Cancer Awareness Month, this article would attempt to demystify cervical cancer with focus on 20 common myths.

MYTH 1: We do not know the cause of cervical cancer. TRUTH: Infection with the Human Papillomavirus (HPV), is an absolute requirement for cervical cancer to develop. HPV is the root cause of more than 5% of cancers, including cervical cancer and cancers at other sites such as vagina, vulva (the outer part of the female genital organs), penis, scrotum, perineum, anus, head/neck, mouth, throat, nose, tonsil, skin, nail-bed, and conjunctiva (eye). There are over 150 types of HPV but the four that cause most of the diseases are Types 6, 11, 16 and 18. HPV is the most common sexually transmitted infection (STI) in the world, with the highest prevalence in sub-Saharan Africa.

MYTH 2: I am not promiscuous, so I can’t have cervical cancer. TRUTH: Although HPV can be spread during sex − including vaginal intercourse, anal intercourse, and oral sex − sex doesn’t have to occur for the infection to spread. All that is needed to pass HPV from one person to another is skin-to-skin contact with an area of the body infected with HPV. Therefore, even never having sex doesn’t guarantee that one cannot get infected. Recently, a woman presented at the National Cancer Prevention Programme (NCPP) with complaint of post-coital bleeding (bleeding after sexual intercourse). She was investigated and confirmed to have cervical cancer. The news was received by her with utter disbelief, because she has had only one sexual partner – her husband. This story buttresses the point that having only one partner does not preclude one from being infected with HPV. However, it is important to note that women who get sexually exposed at an early age and those with multiple sexual partners have higher risk of developing the disease.

MYTH 3: Cervical cancer cannot be prevented. TRUTH: Cervical cancer is virtually 100% preventable, through screening and vaccination. Vaccines are now available to protect against HPV infection. Preventing HPV infection dramatically reduces a woman’s risk of cervical cancer. In addition, cervical cancer usually develops slowly after persistent infection with HPV and will first appear as a precancerous condition called dysplasia or cervical intraepithelial neoplasia (CIN). It usually takes several years for cervical pre-cancer to change to cervical cancer, but it can happen in less than a year. Cervical Screening detects these precancerous conditions which could be effectively treated to prevent cervical cancer from developing.

Other protective measures include sexual discipline, non-smoking, balanced diet, and optimal feminine hygiene. Each of these behaviours relates to known risk factors for this disease.

MYTH 4: I don’t have intercourse, so I don’t need the HPV vaccine. TRUTH: to get the most out of the HPV vaccine, it needs to be taken before any type of sexual contact with another person and therefore, exposure to HPV. The recommended age-range for routine immunisation against HPV is nine years to 26 years. However, studies have shown that Gardasil also protects women between 27 years and 45 years.

MYTH 5: Cervical Cancer prevention does not concern men. TRUTH: As noted earlier, the disease is caused by infection with the sexually transmitted HPV. This implies that men are involved with its transmission. Besides, every woman that is affected by cervical cancer is a man’s wife, sister, aunt, daughter or niece. Therefore men should encourage and support their female relatives to take advantage of the available preventive measures.

MYTH 6: HPV vaccine is meant for females alone. TRUTH: There are three types of HPV vaccines – a bivalent vaccine (Cervarix), a quadrivalent vaccine (Gardasil) and a 9-valent vaccine (Gardasil 9). The bivalent vaccine protects against only 2 types of HPV (16 and 18) and is recommended for females alone for prevention of cervical cancer. The quadrivalent vaccine protects against 4 types of HPV (6, 11, 16 and 18). Gardasil 9 protects against the same 4 types of HPV as the quadrivalent vaccine, plus 5 other high risk types: 31, 33, 45, 52 and 58. The Gardasils thus prevent most cases of cervical cancer, and other cancers caused by HPV infection, including a proportion of genital, anal, oral and throat cancers. The Gardasils also prevent genital warts and Recurrent Respiratory Papillomatosis (RRP). The Gardasils are approved for both males and females. Vaccinating boys against HPV might also help protect girls from the virus by decreasing transmission. The US Centre for Disease Control (CDC) recommends that people should get the same vaccine brand for all three doses i.e. Cervarix and Gardasil should not be used interchangeably.

MYTH 7: I use condoms during sex, so I don’t need HPV vaccine. TRUTH: The use of condom does not give full protection against HPV, since it could be transmitted through skin – skin contact. A person can get infected with HPV even with the correct use of condom. Condoms are more effective in protecting against other STIs like HIV/AIDS.

MYTH 8, I have had HPV vaccine, I do not need to get screened for cervical cancer. TRUTH: As mentioned earlier HPV vaccine does not protect against all the types of HPV that can cause cervical cancer, so it’s still important to continue regular screenings. According to the America Cancer Society, the most important thing you can do to prevent cervical cancer is to be screened.

MYTH 9: Contraceptives increase cervical cancer risk. TRUTH: The Intrauterine Device (IUD or coil) reduces the risk of cervical cancer. Conversely, Oral contraceptive pill can increase the risk of cervical cancer. The hormones in oral contraceptives may change the susceptibility of cervical cells to HPV infection, affect their ability to clear the infection, or make it easier for HPV infection to cause changes that progress to cervical cancer. However, cervical screening can detect cervical changes before they develop into full-blown cancers. And in women who have had HPV vaccination, the vaccine reduces the risk of developing cervical cancer by helping prevent infection by HPV.

MYTH 10: I don’t have symptoms of cervical cancer, so I don’t need cervical cancer screening. TRUTH: Cancer screening means testing for cancer before symptoms develop. Moreover, cervical cancer is usually asymptomatic in the early stage, hence it is known as the silent killer. Therefore, the fact that a woman is asymptomatic is not an excuse for not carrying out screening.

MYTH 11, I’m too young to worry about cervical cancer and its screening. TRUTH: Cervical cancer kills more 24-35years old women in developing countries than any other cancer in any other part of the world. HPV infection and the precancerous condition are common in younger women. In Nigeria, therefore, a woman’s first cervical screening should be done when she turns 18 or three years after she begins having sex, whichever comes first. We have seen teenagers with cervical cancer in Nigeria.
• To be continued tomorrow
• Dr. Abia Nzelu (Executive Secretary, CECP-Nigeria) can be reached via [email protected] or [email protected].