by Mia Malan

Service the cervix

A guide to cervical cancer and how to protect yourself against it

Cervical cancer kills thousands
Servicing the cervix

Cervical cancer is almost entirely preventable through regular screenings. Yet, it is the most common cause of cancer-related deaths in southern Africa. Here's a guide to the disease and how to protect yourself against it.

Cervical cancer is caused by the human papillomavirus (HPV), which is almost always transmitted through genital skin contact during sex. However, penetrative intercourse is not required and the virus can be contracted during oral sex. HPV is therefore an extremely contagious virus – much more so than, for instance, HIV.

Professor Greta Dreyer of the University of Pretoria's Gynaecological Oncology Unit says there are at least 30 types of HPV that affect the skin of the lower genital tract. About 15 of them are associated with cancer, of which HPV 16 and 18, 45 and 35 are the most common cancer-causing types in South Africa.

"More than half of the women diagnosed are between the ages of 35 and 55. It rarely occurs in women under 20 and only 20% of the infected women are more than 65 years of age," according to the Cancer Association of South Africa.

Dr Yasmin Adam of Chris Hani Baragwanath Hospital's Obstetrics and Gynaecology Department says South Africa has 5 743 new cases of cervical cancer a year and 3 027 annual deaths from the disease. These figures were published by the international cancer project, GLOBOCAN. The numbers were extrapolated using the Zimbabwe National Cancer Registry, as South Africa does not have an up-to-date cancer registry. Statistics South Africa estimates that 16.84 million South African women over the age of 15 are at risk of cervical cancer.

HPV can cause normal cells on infected skin in the cervix to become abnormal. Such cells grow in an uncontrolled manner because some of the proteins produced by HPV interfere with the normal functions of cells. Most of the time you cannot see or feel these cells change.

Doctors refer to the damage that HPV infection causes as 'lesions' that can range from 'low-grade lesions' (not so dangerous) to 'high-grade lesions' (more dangerous, as the virus has inserted its DNA into more cells) and even cancerous lesions.

In nine out of 10 cases, the body fights off HPV naturally and the infected cells and even the precancerous lesions can revert to normal. But when the body fails to do that, the lesions can progress to cancer. Only about half of even high-grade lesions progress to cervical cancer.

Symptoms can take years to appear because it is such a 'slow-growing' cancer. It is often only discovered at a late and painful stage. It can take between 10 and 20 years from the time of an initial HPV infection until a tumour forms.

About 80% of all sexually active women and men in South Africa will contract HPV in their lifetime. Most people, however, do not know they have the virus, as it is rarely accompanied by any symptoms. HPV will remain dormant, or the infection will clear up naturally in nine out of 10 people.

HPV can cause cancer of the penis, anus or back of the throat in men. Gay and bisexual men are about 17 times more likely to develop anal cancer than men who have sex only with women. HIV-infected men have a bigger chance of developing anal cancer because they have weaker immune systems. As with women, most men who contract HPV never develop any problems.

The United States National Cancer Institute says HIV-infected women are five times more likely to develop cervical cancer.

HIV infection makes a woman's immune system less able to fight off HPV infection. South African data shows that HIV-positive women get cervical cancer at a much younger age than women who are HIV-negative. Moreover, studies have demonstrated that women with HIV are more likely to smoke than HIV-negative women – smoking doubles a woman's chance of getting cervical cancer.

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