The festive season is behind us at last. The New Year comes with a feeling of a fresh start and renewed energy to get things done. Therefore I find the fact that January is cervical cancer awareness very befitting. Beating cervical cancer should really be first on our agenda every year because of the next statement I write.
‘Cervical cancer despite being a preventable and curable cancer is the leading cause of cancer deaths in women in Zambia’.
The World Health Organisation shared that every 2 minutes a woman dies from cervical cancer. Specialists estimate that 85% of those deaths occur in low and middle-income countries like Zambia.
The primary prevention for cervical cancer is the HPV vaccination. This is a vaccination against the virus that is responsible for 99% of cervical cancer cases. The vaccination has been shown to be very effective as demonstrated last year by Australia declaring freedom from cervical cancer after decades of herd immunization. This year I am going to feature someone special spear heading this immunization program in Zambia so stay tuned.
One of the first articles I wrote last year was on cervical cancer. To remind yourself please visit our 100 % home grown Zambian cancer information website Oncocurae.com to read this article. Risk factors were discussed broadly. Today I would like to hone in on a couple to enhance the understanding of some of the risk factors of cervical cancer. A prudent word of caution as per usual is it takes multiple factors to cause a disease. This information is not intended for stigmatization of those already with the disease but should be applied to prevent any women from getting cervical cancer.
Early sexual debut, high parity and multiple sexual partners have been implicated as contributing factors predisposing a female to developing cervical cancer. Here is the science behind it.
From article 1 on cervical cancer you will remember that a cervix has an area called the transformation zone. This is the area where HPV persists and where most cervical cancers will arise. The position of the transformation zone in relation to the vagina, where infection will happen during sexual intercourse, changes through out a woman’s life. Girls who are sexually abused or ‘consensually’ engage prematurely in sexual intercourse are prone because the area where this virus likes to live is closer to the vaginal space than in adults. In literature the age of 19 years has actually been drawn as a cut off point that qualifies as early.
With this fact I start thinking about our young girls who are defiled or forced into early marriage. It is as if this trauma is not enough for them to develop cervical cancer later in life.
These girls are not the only ones I think about. Nineteen years is also the age that most of our young ladies start gaining their independence by leaving home for college and so on. Having completed secondary school most of them also feel mature enough to make sexual reproductive choices. Well science is telling us maybe it is still too early to do certain things. That being said safe sexual practices must be known to reduce any risk.
High parity is the next implicated factor. In the strictest of terms parity is the number of pregnancies a woman has carried beyond 20 weeks gestation. This includes live and not. A study I referenced this information for you from found the association to the number of actual births through the vagina. The mechanism for developing cervical cancer is related to a couple of things. Firstly the now familiar transformation zone after childbirth stays exposed to in the vagina longer after childbirth. Secondly the process of childbirth causes a traumatic state, which facilitates HPV conversion of healthy cells to pre-cancerous ones. Thirdly pregnancy lowers the immunity of a woman and repetitively this can allow persistence of HPV and evolution infected cells towards cancer.
Again my mind takes me back to why childhood marriages should be discouraged. Other than being wrong on so many moral levels, it endangers the health of these young girls.
There was mention of contraceptive use and lowering the risk but I failed to draw a convincing conclusion to give a definite recommendation in this regard.
Lastly I address the issue of multiple sexual partners and risk of cervical cancer. This conversation cannot be had without throwing male circumcision into the mix. The bottom line to understanding this situation is that a sexually transmitted virus called HPV is responsible for 99% of cervical cancer cases. HPV tends to reside in the foreskin. Therefore if a man with previous sexual mileage with foreskin settles into a monogamous relationship and before engaging into sexual intercourse with this monogamous partner gets circumcised he then reduces the chances that he will transmit HPV to this lady eliminating her risk of cervical cancer. However, there are many other infections that transmit with HPV like HIV and Herpes which circumcision does not circumvent. As such good sexual practices are paramount and the best advice is abstinence and monogamy in that order as one travels the journey of life. Another article you may want to follow on Oncocurae.com previously featured here to consolidate knowledge is on the relationship between sex toys and cancer.
Dear faithful readers of this column, here we go again with a new year in our Gregorian calendar. However, we also know that we have our cancer calendar that we follow, raising awareness on different types of cancers.
This year, if you haven’t already, take on the cancer baton and help us kick this beast out of Zambia. Remember you are the change you want to see. Cancer is preventable, treatable and beatable.