Prevent cervical cancer with healthy lifestyles, vaccination, early detection

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Ranked as one of the leading (fourth) causes of cancer in women in Sri Lanka, the number of people with cervical cancer is on the rise despite the Ministry of Health’s awareness, vaccination and screening programs. health.

Officials from the National Cancer Control Program (NCCP) have repeatedly said that it is also one of the most preventable cancers, provided those most likely to fall victim to it adopt. a healthy lifestyle, get vaccinated and get tested regularly.

Human papillomavirus (HPV) infection which is transmitted to women as a sexually transmitted infection is the most common risk factor leading to cervical cancer and can be easily avoided with precautions appropriate, said an NCCP oncologist.

The Sunday Observer spoke to a community doctor consulting with the National Cancer Control Program (NCCP) of the Ministry of Health, Dr Suraj Perera, to learn more about the origin of the disease, how it is spread and how to prevent it.

Excerpts

Q: Cervical cancer has been identified as one of the leading causes of cancer in women around the world. What is the incidence rate among Lankan women?

A: According to the Sri Lanka National Cancer Registry in 2019, 1,114 cervical cancer patients were detected in Sri Lanka. In 2005, 881 new patients with cervical cancer were detected. Over the years, the number of people with cervical cancer detected annually varies between 732 cases and 1,246 cases.

Q: Is it high compared to ten years ago?

A: Based on the crude incidence rate (CR) per 100,000 population, over the years there is a slight increase in the incidence rate of cervical cancer. In 2005, the incidence rate of cervical cancer was 8.9 per 100,000 people and in 2019 it was 9.9 per 100,000, as shown by the National Cancer Registry of Sri Lanka .

Q: Who is the age group most vulnerable to this cancer? Why?

A: According to Sri Lanka’s National Cancer Registry, when age-specific rates were calculated for newly diagnosed cervical cancers in the past five consecutive years, it showed that the majority of women with cervical cancer were detected after 45 years and the highest number of people with cervical cancer were detected between 65-69 and 70-74 age groups five years.

Q: According to mortality data released by the Department of the Registrar General, around 200 deaths occur each year due to cervical cancer. It has been said that the actual number may be higher due to the underreporting of these deaths to the registration system. Could most of these deaths be prevented if caught early and treated on time? If so, how?

A: Yes. Cancer of the cervix is ​​preventable. It is treatable and curable if detected in the pre-cancer stage or in the early stages of cancer.

Q: What are the causes of this cancer in women?

A: Human papillomavirus (HPV) infection is the most common risk factor leading to cancer initiation. HPV is transmitted to women as a sexually transmitted infection.

When HPV is transmitted, the infection resolves over time. When there are factors such as persistence of other sexually transmitted infections, immune suppression, HPV persists in the cervix. When HPV persists, it can progress to the initiation of pre-cancer of the cervix. Over the years, this pre-cancer can turn into cervical cancer at an early stage if it is left unchecked.

Q: Is there a vaccine to prevent this cancer?

A: Yes. The HPV vaccine is available.

Q: I understand that the HPV vaccine is given to girls when they are 11 years old. What is HPV? How does this affect young girls? Why was it introduced to schoolgirls?

A: Yes. HPV is administered at the age of 10-11 years in the 6th grade of school. The human papillomavirus vaccine is given to prevent cervical cancer.

Q: Are there any side effects? If this is true, what are they?

A: Minor and transient side effects may be present.

It can be classified into two types. (i) Minor transient local reaction – redness, swelling, pain at the injection site. (ii) Transient systemic effects – fatigue, headache, myalgia and fever. Major side effects, such as anaphylaxis or anaphylactoid reactions are extremely rare

Q: How successful is this school program? Do you have feedback? Are vaccinated people monitored?

A: The school vaccination program was a success. It is coordinated by the Epidemiological Unit of the Ministry of Health at the national level. The program is also monitored at the district level and at the level of the medical officer of health.

Q: What about older women? I understand that all women over the age of 35 and 45 with cervical cancer or precancerous cells who attend Well Women clinics across the island are provided with comprehensive smear and smear screening. free cervical screening. What’s the feedback? Are these women now more willing to have these tests than before? Are these tests compulsory?

A: Cervical cancer screening is offered at Well Women’s clinics across the country, coordinated by the medical officer of health in each region. Married women are invited by public health staff to attend cervical cancer screening at the age of 35 and 45. The service is free.

Q: Young mothers are admitted to hospital for complications related to childbirth or pregnancy. are they also tested for precancerous cells?

A: Not during pregnancy.

Q: Is there a tracking system to track these women once they return home?

A: The cervical cancer screening program is offered through the Department of Health’s Well Women Clinic program. It is coordinated nationally by the Family Health Bureau in conjunction with the National Advisory Committee on Well Women Clinic Program. Testing of HIV-positive women is monitored through a follow-up register by the staff of the regional medical officer of health.

Q: What if they move to another district?

A: Ideally, the woman should also be followed in the new environment.

Q: Is stage 3b cervical cancer curable? How? ‘Or’ What? What is the survival rate? Studies on this?

A: Stage 3b cervical cancer is locally advanced cancer. For these patients, external beam radiation therapy to reduce tumor mass by intracavitary application (brachytherapy) is necessary. Survival rates in 3b cancers are relatively low. A study by Dr Chiranthika Vithana and her team found that deaths from cervical cancers are 3.5 times higher in women diagnosed with stage 3 and 4 cancers compared to those with stage 1 and 2 cancers in the Western Province.

Q: What are the symptoms of advanced stages of cervical cancer?

A: Purulent cervical discharge, vaginal bleeding, difficulty urinating and defecating.

Q: What happens in the later stages of cervical cancer?

A: In advanced stages, cervical cancer can spread to adjacent organs, including the urethra, bladder, rectum, and regional lymph nodes.

A: At what stage of cervical cancer do you need a hysterectomy? Radical hysterectomy and pelvic lymph node excision for stage I and II cervical cancer

Q: The World Health Organization (WHO) has declared a “Global Initiative to Eliminate Cervical Cancer as a Public Health Problem” and has advised member countries to meet milestones by 2030. Is this a realistic goal given the current health challenges around the world, including Sri Lanka? What is the NCCP doing to achieve this goal?

A: The following milestones are to be achieved by 2030 as part of the global initiative to end cervical cancer as a public health problem ”

1 90 percent of girls fully vaccinated with human papillomavirus (“HPV”) vaccine before the age of 15 2 70 percent of women are screened with a high-precision test (Pap test / HPV test) at 35 and 45 years 3 years 90 percent of women identified with cervical disease receive treatment and care by 2030 Goal 1 has already been achieved by ensuring HPV vaccination coverage by the Epidemiological Unit of the Ministry of health. The cervical cancer screening program is enhanced to achieve 70 percent cervical cancer screening coverage.

Target 2 and Target 3 should be monitored by creating colposcopy units covering the whole country and ensuring a good management information system within the colposcopy unit, the pathology laboratory, the gynecology unit and cancer treatment centers.

Q: Is there a link between sexually transmitted diseases (STDs) and cervical cancer?

A: Human papillomavirus (HPV) infection is a sexually transmitted disease. In most women, the HPV infection goes away thanks to the immune system.

Q: Are cervical cancer screening tests available at the STD clinics that dot the island?

A: Yes. Pap tests are offered at STD clinics.

Q: Tell us about the main activities of the NCCP in cancer prevention in general?

A: The National Cancer Control Program (NCCP) is the Ministry of Health’s national focal point for cancer prevention and control in the country. It is also responsible for cancer prevention and control policy, advocacy, planning, monitoring and evaluation, including cancer surveillance and cancer-related research facilitation. The NCCP coordinates activities related to cancer prevention and control in accordance with the “National Policy and Strategic Framework on Cancer Prevention and Control-Sri Lanka” which was approved in 2015.

Q: Your plans for the future?

A: Each year, all activities are based on the National Strategic Plan for the prevention and fight against cancer 2020-2024. (www.nccp.health/gov.lk)

Q: Do you have a message for our readers regarding cervical cancer prevention?

A: Avoid unsafe sex. Avoid smoking. Vaccination at the age of 10-11 years.

All married women and those with sexual exposure should participate in the cervical cancer screening program through the Well Women Clinic program run by the local medical officer of health. All symptomatic women should be studied for cervical cancer.


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