A panel of doctors and a patient advocate recently appealed to the public to stop spreading wrong information that having cervical cancer immediately means a death sentence.
This was the main message of the media forum titled “#TimeToTalkAboutHPV: A health forum” organized by the Cervical Cancer Prevention Network of the Philippines (CECAP), together with the Asia and Oceania Federation of Obstetrics and Gynecology (AOFOG), the Philippine Obstetrical and Gynecological Society (POGS), and MSD in the Philippines. It also served as a reminder that cervical cancer is preventable with regular screening tests and the HPV or human papillomaviruses vaccination.
Cervical cancer is largely preventable through both vaccination and screening for precursor lesions like pap smear at least once every three years and HPV DNA testing for women starting age 30, with appropriate follow up and treatment. With access to accurate information, preventive services and routine gynecological care, most cases of the disease can be prevented and successfully treated at an early stage.
In spite of this, cervical cancer ranks as the 2nd most frequent cancer among women in the Philippines and the 2nd most frequent cancer among women aged between 15 and 44 years of age. Current estimates indicate that every year, 7,897 women are diagnosed with cervical cancer and 4,052 die from the disease.
Transmission modes
Cervical cancer develops at the entrance to the uterus from the vagina and around 99 percent of the cases are linked to HPV. Modes of transmission include sexual contact, skin-to-skin contact and rarely, through objects exposed to the virus.
It is a highly treatable disease if detected at its early stages. The precancerous stage provides enough window for detection and treatment, and it could take as long as 30 years before it reaches malignancy. However, it is one of the most common types of cancers and a common cause of cancer-related deaths, worldwide, affecting mostly young, uneducated women from poor countries.
But more recently, Covid-19 has taken a toll on women’s health as studies have shown a gap in missed routine preventive exams and screening visits. “I think the world has been focused on Covid for the past two and a half years and we have overlooked other health concerns,” said Dr. Anna Lisa Ong-Lim, professor and chief of division of infectious and tropical disease in Pediatrics, UP Manila College of Medicine. “It is only recently when vulnerabilities to vaccine-preventable diseases are being noticed once again.”
Huge burden
One life-altering issue that deserves focus is the huge burden that continues to threaten women and men, including teenagers worldwide, caused by HPV. “HPV is a virus that causes a wide-range of diseases,” said Dr. Mel Kohn, MSD executive director of medical affairs for vaccines and infectious diseases.
“Apart from cervical cancer, HPV can give men head and neck cancer, anal cancer for both sexes and a variety of less common but also devastating kinds of cancers like vaginal and vulvar cancer and penile cancer,” he enumerated.
“Genital warts, while it doesn’t kill you, can be quite devastating. It is quite common and very difficult to eradicate. Imagine the psychological toll on the patient. Again, prevention is the best approach here,” he added.
HPV is common. It is passed from one person to another during sexual contact. “It’s a quiet epidemic unlike Covid,” he warned. Unlike the measles that have obvious expression, “you don’t immediately see it when you meet somebody but it’s there and has been growing rather insidiously.”
The Philippines has a population of 37.8 million women ages 15 years and older who are at risk of developing cervical cancer. About 2.9% of women in the general population are estimated to harbor cervical HPV-16 or 18 infection at a given time, and 58.6% of invasive cervical cancers are attributed to HPVs 16 or 18.
Although some of the infections usually go away on their own, at least 14 types of HPV have been found to be cancer-causing.
The age indication for HPV vaccines is as young as nine years old to both girls and boys. Teens and young adults through age 26 years who didn’t start or finish the HPV vaccine series also should have HPV vaccination. Women up to age 45 may be eligible for vaccination after discussing with their provider.
Dr. Ong-Lim said they are targeting the young ones because of their increased susceptibility to infections.
“That particular age group demonstrates optimal immune response. Also, only two doses are needed to achieve protection,” she shared.
But more importantly, giving the vaccine at a younger age ensures that they are already protected before they become sexually active. “HPV vaccines work best when given before exposure to the virus. We must try to catch that window when the immune system really responds very well to it,” Dr. Ong-Lim explained.
Manila Declaration: Call to Action Against Cervical Cancer chair and practicing OB-Gynecologist Dr. Jean Anne Toral mentioned that the young and adult fertility study done recently, indicates that the average age Filipina women become sexually active is 18.2 years old. “Giving the vaccine at age nine to 15 would be beneficial as there is no life event that exactly pinpoints exposure to HPV apart from age of sexual debut,” she said.
There will be seven to eight out of 10 women who would be exposed to HPV at one point in their life, “But not all women will develop cervical cancer,” Dr. Toral assured. The probability of HPV exposure developing into cancer increases if a patient smokes, is exposed to other sexually-transmitted diseases and has HIV.
Towards a cervical cancer-free future
The elimination of cervical cancer has been defined as achieving an incidence rate low enough for the disease to be considered controlled as a public-health problem; this threshold has been defined by the WHO as fewer than 4 cases per 100,000 women per year.
Carmen Auste, Chief Executive Officer of Cancer Warriors Foundation Inc. said that the Philippines is among the countries that declared commitment together with WHO to finally eradicate cervical cancer in the country by 2040, and by 2030 worldwide. “There is already one type of cancer that we can delete or ‘block’ like social media,” she humored. “To attain that goal, we must augment HPV vaccine uptake and educate the Filipinos on HPV, vaccines and cancers caused by HPV,” she said.
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