Over my mother’s long career of taking care of patients with gynecological disorders, she recalls one case that left a strong impression on her — a 58-year-old woman was brought in by her neighbour for evaluation of a six months history of vaginal bleeding and malodorous discharge.
Dr Zohra Samad, my mother, recalls that when she examined her, it was obvious that the patient had cervical cancer that had spread to the adjoining organs. The patient who had never undergone Pap smears had been suffering from complaints for several months and had been isolated by her family into a room outside the house because of the odor. The patient was referred to the inpatient cancer unit and treated.
According to her “there is poor awareness and stigma around the disease which makes patients present late and with advanced stages of cancer. It’s quite unfortunate to see women still suffering from an ailment that can be caught in early stages through screening and which is now largely preventable with vaccines.”
Cervical cancer is a disease of the female genital tract, and it develops slowly after the initial infection with human papillomavirus (HPV). Every year, half a million women are diagnosed with cervical cancer, and close to a quarter of a million women die from the disease. Of the total global burden, a major proportion is endured by developing countries.
Factors that contribute to this burden and high mortality rate include, lack of knowledge regarding the disease and its prevention, lack of resources for early cancer detection and inadequate screening. There are several factors associated with cervical cancer that include poor socioeconomic status, low educational level, unprotected and early sexual debut and high-risk HPV infection.
In Pakistan, cervical cancer is the 3rd most frequent cancer among women. According to the most recent World Health Organization (WHO) estimates, every year 5,008 women are diagnosed with cervical cancer and 3,197 die from the disease. In Pakistan, it is estimated that more than 60 million females aged 15 or above are at risk of cervical cancer with a crude incidence rate of 5.97 per 100,000.
Although women do not experience any symptoms in the early stages, it can be identified and prevented with a simple screening process which can be helpful in detecting precancerous lesions. The Pap smear test is a screening test used to identify precancerous lesions in the cervix by taking a sample of cervical cells and testing it for any abnormalities which could indicate cervical cancer. And once detected, effective treatment approaches can be used to cure the cancer.
In one study conducted in Pakistan, out of all the cervical cancer cases, 88.3% were reported to have HPV type 16 and 18, which are high-risk varieties that account for 75-80% of cervical cancers globally. The HPV vaccine was approved from the US Food and Drug Administration in 2006, and so far approximately 84 countries have already incorporated this into their national vaccination and immunization programme. But according to the Human Papillomavirus and Related Diseases Report in 2015, there is still a lack of any HPV immunization and vaccination programme in Pakistan.
Lack of awareness is a major issue that contributes to this trend. Not only are patients unaware of symptoms, they do not get regular check-ups or vaccines for preventative use. Once the cancer is in an advanced stage, its treatment is costlier with greatly reduced chances of survival. A study conducted in 2020, to assess the knowledge of women regarding cervical cancer showed that although 50% of the female study participants in Karachi were aware of the term cervical cancer, only 34% knew about the Pap smear screening test and just 40% knew about the availability of HPV vaccines as a preventive measure.
In order to reach WHO targets of less than 4 cases per 100,000 population a multi-pronged strategy will need to be adopted. This includes better surveillance, health system and community level approaches to raise awareness, de-stigmatization of the disease, screening programmes to detect disease in curative stages, and making vaccines available and accessible to the population. Now is the right time for policymakers to include cervical cancer awareness and nationwide immunization programmes in their national action plans to ensure a steady decline in this disease in the years to come.
(Professor Zainab Samad is Chair of the Department of Medicine and Sehar Rahim, a research associate in Department of Medicine at Aga Khan University, Karachi, Pakistan)
Copyright Business Recorder, 2022
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