Cervical cancer: Prevention is simple

HIGHLIGHTS:

• Each year, around 6,000-8,000 Thai women contract cervical cancer and mortality rates are 8-10* women per day on average. 1
• Any woman who has had sexual intercourse has an 80-90% risk of contracting the HPV virus during her lifetime. (However, the virus may or may not be the type that causes cervical cancer.)
• All women who are at sexual maturity should undergo screening for cervical cancer. If all these women were to be screened, up to 15% of them would test positive for the high risk HPV virus (they would, therefore, also be at risk of developing cervical cancer).

Did you know that for Thai women, cervical cancer is second only to breast cancer in terms of the number of sufferers? However, cervical cancer is a form of cancer that if found in its pre-cancerous cells can be prevented from developing, and cured. This is done through care and attention to one’s health, regular internal checkups, and last but not least, HPV cancer screening. Once completed, HPV DNA cancer screening can alleviate any anxieties about this form of cancer.

While cervical cancer is exclusively caused by the HPV virus, only certain strains of the virus cause cancer. There are only 15 strains which cause the cancer from a total of 100 strains of the HPV virus, with strains 16 and 18 being particularly dangerous.

Each year, between 6,000 and 8,000 Thai women develop cervical cancer, with 8 -10 women losing their lives to the disease each day.2  All women who have engaged in sexual intercourse are at risk of developing cervical cancer as almost 100% of cervical cancer cases are caused by the HPV virus because of how easily it is contracted. Aside from being sexually transmitted, the virus is also transmitted through contact alone (this contact is possible through a carrier bringing the virus into contact with the vagina). What is worrying is that once contracted, the virus may not display any outward symptoms such as pain, aches or any form of scarring, which means that by the time women find out they have the HPV virus, it may have taken hold for some years already.
² Source: National Cancer Institute

Since HPV virus infection and precancerous cells are symptomless, most people will be unaware they even have it unless they undergo screening. This means that precancerous change may be left untreated for years with the patient only finding out about it once they already have cervical cancer. Hence, undergoing HPV DNA screening and carrying out a Pap Smear test will help to identify the virus and precancerous cells, which if treated appropriately, will definitely reduce the chances of developing into cervical cancer.

Two key factors that have an effect on the development of cervical cancer:

• Contracting the HPV virus: This virus causes cervical cancer, but it must be a particularly high-risk strain of the virus in order to do so. There are 15 such strains of the HPV virus, and of those 15 strains, some are stronger and therefore higher risk than others. Hence, if someone has already contracted the HPV virus, the chances of recovery are dependent on the severity of the strain they have contracted.
• Our immune system: With regard to ‘viral infections’, there are usually no forms of medication available that directly attack the virus. Whether it can be defeated depends on when our immune system is able to kill the virus off by itself, just as when we suffer from a common cold. Factors which will slow our immune system’s response to infections include not getting sufficient rest, a weakened physical state, and stress. For example, when people who suffer from herpes start to feel stronger, get enough rest and drink plenty of water, they will see the herpes disappear. Fortunately, this type of infection has clear signs that we can see developing and subsequently clearing up after we have recovered from them, whereas the HPV virus has no outward signs. Moreover, it takes months or even years for the body to defeat this particular type of infection, with 60-70% of people being able to control the virus without treatment.

Men can also contract the HPV virus but the chances of identifying the virus in males is very low. They are actually only carriers of the infection. So HPV screening is currently not a mandatory screening in men.

• Women who have never engaged in sexual intercourse may have a low risk of developing cervical cancer.
• The primary form of prevention available is to protect against contraction of the virus through a HPV virus vaccination. This type of vaccination has been available for over 10 years in Thailand. Recently, the vaccinations have been targeting the 2 most aggressive forms of the virus which are responsible for causing over 70% of all forms of cervical cancer, namely strains 16 and 18. Therefore, prevention prior to contact with either of these 2 forms is the best option with vaccines available that can be administered to children as young as 9-10 years old. Furthermore, from research into the virus over the last 10 years, it has been found that children do not need to receive the full course of 3 vaccinations which adults must receive to be fully protected. If the child is under 15 years of age, she only requires 2 HPV vaccinations and this gives her 100% protection against the 2 strains of the virus which cause cervical cancer.
• However, if the child is over the age of 15, it is still recommended that the full course of 3 vaccinations be carried out.
• Secondary prevention refers to cervical cancer screening techniques which may be carried out in order to identify the disease or virus before it can develop into cancer.
  • A Pap Smear test is an assessment which can identify all changes before the development of cancer, and therefore can provide a chance to seek treatment and cure the irregularity.
  • HPV virus screening, which is commonly referred to as a HPV Test, are capable of identifying the HPV virus through examining the DNA or MRNA. After examining the DNA or MRNA of the virus, if results come back positive, this shows that a strain of the virus, which causes cervical cancer has been found, whereas a negative result shows that these strains are not present. HPV Tests or HPV screening are currently capable of determining the exact group or strain of the virus found.
  • Identifying the HPV virus via a urine analysis is a new form of cervical cancer screening. It has been developed to take cells found in urine and screen them for HPV DNA. Such an assessment can be a viable alternative for women who may be too embarrassed or scared to undergo a lithotomy examination.
• Prior to an internal examination you are only required to avoid making an appointment during the menstruation period, refrain from sexual intercourse and cease the use of medication used to treat vaginal dryness for a period of at least 1-2 days prior to the examination. These examinations should be carried out annually and, in cases where an irregularity of risk factor has been identified, it is highly recommended that all follow-up doctor’s appointments be attended.

Since the development of the precancerous cells are particularly slow and sometimes takes years to fully develop to cancer, this is the only viral consequence that can be directly treated and cured if caught early enough. For this reason, patients who develop cervical cancer include those who have not undergone screening in a long while, those who underwent screening but failed to receive their results, or those who underwent screening and received results that identified an irregularity but failed to undergo any treatment because the change was symptomless. Some people even believe that just screening and getting back normal results once is enough to cover them for the rest of their life.

When carrying out an HPV test, the doctor will place a special device inside the vagina and inspect both the cervix and the vagina paying careful attention to the area of the cervix, which the virus prefers because it is where the cells actively reproduce. The virus will take over this area and cause some irregularities but the effects will be negligible and invisible to the naked eye. Symptoms of the irregularity will not present themselves: no bleeding will occur and any pelvic pain will be completely unrelated.

An assessment called a Pap Smear should be carried out alongside to identify the changes or any irregularities in the cells. This test is good for finding cancer cells or cells that may become cancer. However, Pap test alone will not be able to identify the virus itself and there is a chance too that 15–20% of pre-cancer signals will also be missed. Nevertheless, innovations in medical techniques mean that evaluations of HPV testing are possible and where the HPV virus is found, doctors can now identify exactly which strain it is and whether or not it has the potential to cause cervical cancer.

Nowadays, many countries carry out HPV DNA screening as their standard form of screening for cervical cancer. Those who return negative results do not have the strain of virus which causes cervical cancer and do not need to screen again until 3 years later, during which time no assessments are necessary because cancer is unlikely to develop within those 3 years. Once the 3 years have elapsed and it is time to screen again, any irregularity that may be found will only be minor and will likely be completely treatable. As a rule, it is advised that Pap Smear test and pelvic examination be carried out annually, whereas HPV Tests are not as frequently required.