Demystifying cervical cancer

January is cervical cancer awareness month. Cervical cancer, or cancer of the cervix, is cancer of the neck of the womb. The baby grows in the body of the womb (the upper part). The cervix connects the body of the womb to the vagina (birth canal). In other words, the cervix is the door of life. Sadly, when cervical cancer occurs, this door of life becomes the door to death. Cervical cancer is the easiest of all cancers to prevent; yet it is the second most common cancer killer in Nigerian women.

This high mortality is partly due to some misunderstandings and false believes surrounding the disease. To mark this year’s Cervical Cancer Awareness Month, this article would attempt to demystify cervical cancer with focus on 20 common myths.

MYTH 1: We do not know the cause of cervical cancer. TRUTH: Infection with the Human Papillomavirus (HPV), is an absolute requirement for cervical cancer to develop. HPV is the root cause of more than 5% of cancers, including cervical cancer and cancers at other sites such as vagina, vulva (the outer part of the female genital organs), penis, scrotum, perineum, anus, head/neck, mouth, throat, nose, tonsil, skin, nail-bed, and conjunctiva (eye). There are over 150 types of HPV but the 4 that cause most of the diseases are Types 6, 11, 16 and 18. HPV is the most common sexually transmitted infection (STI) in the world, with the highest prevalence in sub-Saharan Africa.

MYTH 2: I am not promiscuous, so I can’t have cervical cancer. TRUTH: Although HPV can be spread during sex − including vaginal intercourse, anal intercourse, and oral sex − sex doesn’t have to occur for the infection to spread.

MYTH 3: Cervical cancer cannot be prevented. TRUTH: Cervical cancer is virtually 100% preventable, through screening and vaccination. Vaccines are now available to protect against HPV infection. Preventing HPV infection dramatically reduces a woman’s risk of cervical cancer.

MYTH 4: I don’t have intercourse, so I don’t need the HPV vaccine. TRUTH: to get the most out of the HPV vaccine, it needs to be taken before any type of sexual contact with another person and therefore, exposure to HPV.

MYTH 5: Cervical Cancer prevention does not concern men. TRUTH: As noted earlier, the disease is caused by infection with the sexually transmitted HPV. This implies that men are involved with its transmission.

MYTH 6: HPV vaccine is meant for females alone. TRUTH: There are three types of HPV vaccines – a bivalent vaccine (Cervarix), a quadrivalent vaccine (Gardasil) and a 9-valent vaccine (Gardasil 9).  The bivalent vaccine protects against only 2 types of HPV (16 and 18) and is recommended for females alone for prevention of cervical cancer. The quadrivalent vaccine protects against 4 types of HPV (6, 11, 16 and 18). Gardasil 9 protects against the same 4 types of HPV as the quadrivalent vaccine, plus 5 other high risk types: 31, 33, 45, 52 and 58. The Gardasils thus prevent most cases of cervical cancer, and other cancers caused by HPV infection, including a proportion of genital, anal, oral and throat cancers.

MYTH 7: I use condoms during sex, so I don’t need HPV vaccine. TRUTH: The use of condom does not give full protection against HPV, since it could be transmitted through skin – skin contact. A person can get infected with HPV even with the correct use of condom. Condoms are more effective in protecting against other STIs like HIV/AIDS.

MYTH 8, I have had HPV vaccine; I do not need to get screened for cervical cancer. TRUTH: HPV vaccine does not protect against all the types of HPV that can cause cervical cancer, so it’s still important to continue regular screenings.

MYTH 9:  Family planning increases cervical cancer risk. TRUTH: The Intrauterine Device (IUD or coil) reduces the risk of cervical cancer. Conversely, Oral contraceptive pill can increase the risk of cervical cancer. The hormones in oral contraceptives may change the susceptibility of cervical cells to HPV infection, affect their ability to clear the infection, or make it easier for HPV infection to cause changes that progress to cervical cancer.

MYTH 10: I don’t have symptoms of cervical cancer, so I don’t need cervical cancer screening. TRUTH: Cancer screening means testing for cancer before symptoms develop. Moreover, cervical cancer is usually asymptomatic in the early stage, hence it is known as the silent killer. Therefore, the fact that a woman is asymptomatic is not an excuse for not carrying out screening.

MYTH 11, I’m too young to worry about cervical cancer and its screening. TRUTH: Cervical cancer kills more 24-35years old women in developing countries than any other cancer in any other part of the world. HPV infection and the precancerous condition are common in younger women. In Nigeria, therefore, a woman’s first cervical screening should be done when she turns 18 or three years after she begins having sex, whichever comes first. We have seen teenagers with cervical cancer in Nigeria.

MYTH 12, I’m too old to need a cervical screening any longer. TRUTH: There is an increase in cancer incidence including cervical cancer in older populations.

MYTH 13, I can’t go for screening because if cancer is diagnosed, I can’t deal with it. TRUTH: Cervical screening can pick up the precancerous stages of cervical cancer which could be effectively treated with cryosurgery, a 15 minutes procedure.

MYTH 14, I have been screened for cervical cancer; I don’t need to repeat the screening. TRUTH, in our environment, Cervical Cancer Screening should be repeated yearly.

MYTH 15: My cervical screening was abnormal, which means I must have cancer. TRUTH: This is not necessarily so. There is need for follow-up tests, including colposcopy and a biopsy to test for cancerous cells. An abnormal screening could indicate a precancerous condition that can be treated.

MYTH 16: My cervical screening was abnormal; Vaccination can treat the problem. TRUTH: HPV vaccination helps to prevent pre-cancers and cancers of the cervix but does not treat HPV infection or the abnormal changes.

MYTH 17: Cervical cancer has no symptoms. TRUTH: While cervical cancer may show no symptoms at the early stage. Symptoms will occur later. These include bleeding after intercourse, bleeding between menstrual periods or bleeding after menopause. MYTH 18: If I am diagnosed with cervical cancer, I am going to die. TRUTH: Survival after cervical cancer caught in its earliest stage is 92 percent.

MYTH 19: After I finish treatment, I will live the rest of my life worried about cancer returning. TRUTH: In most cases early cervical cancer never returns, once it is properly treated. However, if cervical cancer is going to recur, it is most likely to happen in the first two years after treatment. The risk of recurrence is extremely low after five years following treatment. However, it is important to continue regular screening.

MYTH 20: I must have a hysterectomy (surgery that removes the cervix and womb) to treat cervical cancer. TRUTH: It is true that early cervical cancer is typically treated with a hysterectomy. However, it is not the only option. Radiation and chemotherapy are used to treat more advanced disease and may also be options for women with early stage disease who cannot have surgery.

Dr. Abia Nzelu, Executive Secretary, CECP-Nigeria