Vaccination, responsible sexual behavior, early detection best preventive measures | Sunday Observer

Vaccination, responsible sexual behavior, early detection best preventive measures

16 January, 2022

This month has been devoted to raising awareness on Cervical Cancer which according to health specialists across the world is currently a national public health problem which urgently requires attention from the state sector and more education and awareness raising among the public as a whole especially those who engage in unsafe sexual practices which is the leading causative factors.

The Sunday Observer spoke to a Consultant Community Physician of the National Cancer Control Program ( NCCP) Dr Suraj Perera to tell our readers how exactly this cancer is caused and transmitted, how it can be prevented and what the Health Ministry and NCCP is providing by way of free advice, screening tests and vaccination to eliminate Cervcal Cancer or bring it down to almost zero level.

Excerpts …

Dr. Suraj Perera

Q: Starting from January 1 till the end of the month, all cancer specialists and those caring for cancer patients will devote their time to raising awareness on Cervical Cancer. Why is it important to spend an entire month for raising awareness on this particular type of Cancer when women also suffer from other cancers such as breast cancer, thyroid cancer and colorectal cancer ? .

A. The reason is that Cervical Cancer is one of the commonest cancers among women. It is true that breast cancer is commoner than cervical cancer among women through out the world. But cervical cancer is one of the leading preventable cancers in the world. This is the reason why health care professionals the world over are currently working towards eliminating cervical cancer which is considered as a public health problem. That means minimising the incidence of cervical cancer to less than four cervical cancers per 100,000 population.

Q: Compared to world figures where does Sri Lanka stand in the incidence of Cervical Cancer?

A. Cervical cancer is the 4th commonest cancer among females in Sri Lanka, the incidence of breast cancer, thyroid cancer and colo rectal cancer being higher than cervical cancers in Sri Lanka. According to the Sri Lanka Cancer Registry in year 2019 a total of 1114 females were diagnosed having cervical cancer giving a crude incidence rate of 9.9 per 100,000 population.

Q: Have you seen an increase in the number of cases in the past decade?

A. Over the past decade there was no increase or decrease of cervical cancer in Sri Lanka and number of new patients detected per year was around 1000-1200

Q: In a previous interview with the Sunday Observer you said that according to figures by the National Cancer Registry Data of National Cancer Control Program about 1000 -1200 patients with cervical cancers are newly detected yearly. Do these figures still remain the same? Or do you see a spike?

A. As I mentioned the figures remain virtually the same.

Q: What is the age group that is most vulnerable to developing it? Can schoolgirls and teenagers get it?

A. According to the distribution of age at the point of diagnosis, cervical cancers are detected from age 35 years and above. The maximum incidence rates of diagnosing cervical cancer are reported in 65-69 & 70- 74 age groups.

Q: Can schoolgirls and teenagers get it?

A. Schoolgirls and teenagers are not affected.

Q: In general, what age do you advise women to get themselves screened for Cervical Cancer even though they may not have any signs or symptoms?

A. At the age of 35 years and 45 years. The World Health Organization advises each member countries to organise cervical cancer screening programs targeting 35 years and 45 years age groups expecting to achieve at least 70 percent coverage. In Sri Lanka also cervical cancer screening is offered free for all married (sexually active) women at the age of 35 and 45 years through the Well Women Clinic Program. This program is nationally coordinated by Family Health Bureau of Ministry of Health and more than 1000 Well Women Clinics are functioned throughout the country under the supervision of the area Medical Officer of Health (MOH)

Q: We are in the midst of a Covid-19 pandemic and the imminent spread of the new Delta variant Omicron,which has already been detected in around 47 patients.. How vulnerable are patients with Cervical Cancer to these viruses considering their already compromised immune systems?

A. All cancer patients are vulnerable to Covid 19 infection. That’s why it is important to take maximum measures to prevent the infection among cancer patients. Also, priority is given for cancer patients for Covid 19 vaccination. Therefore with the recommendation of treating cancer specialists, Covid 19 vaccine including booster dose are given to cancer patients at the each cancer treatment centre.

Q: What are the risk factors to getting Cervical Cancer?

A. The main risk factor is Human Papilloma Virus (HPV).

Q: How is it caused ?

A. HPV is transmitted through sexual contacts. Persistence of HPV in female cervix for more than 10 years may lead to carcinogenic changes in epithelial cells of female cervix. . In addition to that HPV can cause Vulval and vaginal cancers among females.

Q: Is cervical cancer found in different sites of the body and can it be found in males as well? If so what are the different sites for 1) females and 2) males?

A. Females can develop Vaginal cancers through sexual contacts. Among males HPV can cause cancer of the penis and anal cancers in homosexual situations. Those who practise oral sex , HPV can lead to the occurrence of oropharyngeal cancers.

Q: What is the most common method of transmission in Sri Lanka?

A. Sexual contact

Q: Is HPV contagious? Is it a notifiable disease ?

A. HPV is contagious. But in some instances HPV may not persist in long duration leading to carcinogenic changes and resolve (natural shredding) gradually without any intervention. HPV is not a notifiable disease.

Q: Can Cervical cancer be cured if detected early?

A. Yes-if we can detect it during pre-cancerous stages, which is now our target..

Q: Are there different stages before the pre-cancerous stage develops into cancer?

A. Before converting to cancerous stage, during the pre cancer stage, affected females are asymptomatic.

Q: What does that mean?

A. It means that during the pre-cancerous stage, the female will not be having any clinical symptoms or clinical signs.

Q: So when do the symptoms begin to show?

A. When pre cancer stage converts to cancer the symptoms will gradually begin to show.

Q: What are the symptoms to lookout for if a woman suspects she has Cervical Cancer?.

A. l Irregular per vaginal bleeding among reproductive age females ( 20 -50 year age group)

* Post menaupasal per vaginal bleeding or spotting (prevaginal bleeding even after reaching menopause)

* Pervaginal bleeding or spotting after sexual intercourse (Post coital bleeding) at any age

* Excessive vaginal discharge (may be foul smelling)

Q: What happens if a woman gets Cervical Cancer and does not go for treatment? What are the sites to which it will spread and how will it impact on her body as a whole?

A. If cervical cancer is not detected early and not treated, cervical cancer will be spread locally. It may spread to ureter, bladder or urethra and may disturb urination. Also cervical cancer may spread to the rectum and the anus. Then it may lead to obstruction of faeces. Leading to frequent constipation. Also fistula may be formed between rectum and vagina leading to leakage of faeces through vagina.

Q: Do all women have the same reactions?

A. The progression of the disease may be different in different females due to variation of characteristics of cancer cell type and variation of immunity levels of the females

Q: Are there different stages in progression of the disease? What are they?

A. According to the level of progression, cervical cancer is staged at Stage I, Stage II, Stage III Stage IV

Q: Treatment wise - how is Cervical cancer treated? ? Surgery? Drugs? What are the options?

A. Cervical cancer is treated using Surgery, radiotherapy and drug treatment according to the stage of the disease.

Q: Can Cervical Cancer be prevented? If so how? Is there a vaccine?

A. Yes. Through universal vaccination. HPV vaccine is available

Q: The World Health Organization (WHO) has declared a ‘Global initiative on elimination of cervical cancer as a public health problem’. The interim targets are (i) Achieve 90% coverage of vaccination of HPV vaccine of girls before the age of 15 (ii) Coverage of 70% of females at the age of 35 and 45 year using a quality assured cervical cancer screening test (iii) 90% comprehensive treatment coverage of females with cervical cancer or pre- cancer. How far is Sri Lanka ready to meet this new challenge? What are the services that have been put in place for achieving this target?

A. Sri Lanka is ready to face this challenge. The Ministry of Health launched National Strategic Plan for achieving interim targets of cervical cancer elimination as a public health problem linking all Ministry of Health institutions including Epidemiological Unit, Family Health Bureau, NCCP, Health Institutions in curative and preventive sector and other stakeholders.

Q: Are these services available and accessible to women in all parts of the country?

A. Yes

Q: Are they free?

A. All the are free

Q: Your message to all Lankan women on preventing and minimising risks of Cervical cancer?

A. Avoid unsafe sexual practices. Avoid smoking. Receive HPV Vaccination by all girls at the age of 10-11 years. The vaccination is conducted through the School Health Program by Ministry of Health in collaboration with Ministry of Education. All married women and females with sexual exposure need to attend to the cervical cancer screening program through the Well Women Clinic Program organised by the local Medical Officer of Health (MOH). In addition, females can seek cervical cancer screening services free of charge through Cancer Early Detection Centres (CEDC) currently established and functioning at Narahenpita (Colombo 5), Jaffna (Premises of Teaching Hospital Jaffna) or at Matara (Premises of Institute of Palliative Medicine). In addition, services are available at the private sector too. In addition, all symptomatic women need to be investigated to detect cervical cancers.

Q. Do you have a contact number or a web site for our readers?

A. 0112368627. Visit our website . Also can visit our Cancer Early Detection Centre at Narahenpita junction in Colombo 5. The centre is open from Monday to Friday.

No. of Newly Diagnosed Cervical Cancers in Sri Lanka 2005 -2019