Routine cervical cancer vaccination can prevent 80% related deaths, says WHO

Recommends immunisation for girls aged nine to 13 

EARLY treatment through the introduction of cervical cancer vaccine, Human Papillomavirus (HPV) Vaccine, into the routine national immunisation programme can prevent up to 80 per cent of cases in the country, according to World Health Organisation (WHO)

  It recommended vaccination for girls aged nine to 13 years as the most cost-effective public health measure against the disease.

  Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected.

  According to a Fact Sheet on HPV by the WHO, the peak time for acquiring infection for both women and men is shortly after becoming sexually active. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognised mode of transmission.

  According to the WHO, HPV vaccination does not replace cervical cancer screening. In countries where HPV vaccine is introduced, screening programmes may still need to be developed or strengthened.

  Several studies have shown that cervical cancer control is achievable through aggressive primary prevention through vaccination HPV vaccine, trained human resource for PAP smear, sustained and regular cervical cancer screening, pathological diagnosis, prompt management, among other strategies.

  However, the most important challenge facing the use and effectiveness of this effort in Nigeria is the availability and affordability of the vaccines.

  The Guardian reliably gathered that each dose of the vaccine still costs between N10,000 to N20,000 with the three doses totalling about N30,000 to N60,000 depending on the region. With the prevailing rate of poverty and unemployment in Nigeria, the average Nigerian woman is unable to afford this and so there is a gaping divide among women who have received the vaccine and those who have not.

  To address this challenge, the Federal Ministry of Health (FMoH) had in 2008 through the National Cancer Control Programme (NCCP) introduced a five-year vaccination programme that targeted girls nine to 15 years old, which ensures that they develop primary immunity against the HPV. HPV is the causative agent of herpes, which has been primarily linked to cervical cancer. Under the programme, beneficiaries were given three of the vaccine at below one, under two and six years.

  According to WHO, cervical cancer is the fourth most frequent cancer in women in the world and represents 7.5 per cent of all female cancer deaths. Many more women die of cervical cancer in the developing world than in wealthier countries. Of the estimated more than 270,000 deaths from cervical cancer every year, more than 85 per cent occur in developing countries.

    A public health expert and Director at FMoH, Dr. Patience Osinubi, said cervical cancer is the second most rampant cancer globally, after breast cancer, as 10,000 new cases are recorded yearly in Nigeria alone.

  More worrisome, according to her, is that cervical cancer is the reason for over 70 per cent cancer mortality, with about 90 per cent of most cases seen in Nigeria and other parts of sub-Sahara Africa being late case presentation.

  “This is basically due to lack of awareness, less access to cervical cancer screening services, just as treatment facilities are expensive,” Osinubi said.

   On why many people are unable to effectively deal with cervical, she said, “Cancer is subject to superstitions, cultural myths, religious excesses, which had caused low survival rate and high mortality among sufferers.”

  The WHO noted that in developed countries, programmes are in place to enable women get screened, making most pre-cancerous lesions identifiable at stages when they can easily be treated and early treatment prevents up to 80 per cent of cervical cancers in these countries.

  However, the WHO said in developing countries such as Nigeria, limited access to effective screening means that the disease is often not identified until it is further advanced and symptoms develop. In addition, prospects for treatment of such late-stage disease may be poor, resulting in a higher rate of death from cervical cancer in these countries.

  According to the WHO, the high mortality rate from cervical cancer globally, which is put at 52 per cent, could be reduced by effective screening and treatment programmes.

Signs and symptoms

  Symptoms of cervical cancer tend to appear only after the cancer has reached an advanced stage and may include: irregular, inter-menstrual (between periods) or abnormal vaginal bleeding after sexual intercourse; back, leg or pelvic pain; fatigue, weight loss, loss of appetite; vaginal discomfort or odorous discharge; and a single swollen leg. More severe symptoms may arise at advanced stages.

How HPV infection leads to cervical cancer

  Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer.

  It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only five to 10 years in women with weakened immune systems, such as those with untreated HIV infection.