Cervical cancer is the growth of cells that starts in the cervix. The cervix is the lower part of the uterus that connects to the female external genitals.
Various strains of the human papilloma virus also called HPV play a role in causing most cervical cancers. HPV is a common infection that’s passed through sexual contact. When exposed to HPV, the body’s immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years. This contributes to the process that causes some cervical cancer cells to become cancerous.
Anyone with a cervix is at risk for cervical cancer. It occurs most often in people over the age of 30. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer.
You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection. When cervical cancer happens,it’s often first treated with surgery to remove the cancer. Other treatments may include medicines to kill the cancer cells. Options might include chemotherapy and targeted therapy medications. Radiation therapy with powerful energy beams also may be used. Sometimes treatment combines radiation with low dose chemotherapy.
Globally, cervical cancer is the fourth most common cancer in women with 604,000 new cases in 2020. In Uganda, cervical cancer ranks as the first most frequent cancer among women between the age of 15 and 44 years. About 90% of the 342,000 deaths caused by cervical cancer occurred in low and middle income countries. The highest rates of cervical cancer incidence and mortality are in sub-Saharan Africa and south East Asia.
The low and middle income countries bearing the brunt at 84% of new case and 90% of death. East Africa had the highestage standardized cervical cancer mortality of 30 per 100,000 and second highest incidence rate of 40/100000 in 2018. In Uganda, cervical cancer was the commonest cancer among women with age standardized rate incidence of 56.2 per 100000 and cancer related death rate of 41.4 per 100000 in 2020.
Regional differences in the cervical cancer burden are related to inequalities in access to vaccination, screening and treatment services. Risk factors including HIV prevalence and social and economic determinants such as sex, gender biases and poverty. Women living with HIV are 6 times more likely to develop cervical cancer compared to the general population and an estimated 5% of all cervical cancer cases are attributed to HIV. The contributionof HIV to the cervical cancerdis proportionately affectsyounger women and as a result,20% of children lose their mothersto cervical cancer according to WHO report of November 17 2023.
Other than HIV, other risk factorsexist that spike the chancesof acquiring cervical cancer.Smoking increases the risk of cervicalcancer. When HPV infectionhappen in people who smoke, theinfection tend to last longer andare less likely to go away. This is due to immune suppressive role of tobacco keeping HPV infectionthriving. Increased numberof sexual partners and earlysexual activities also influencethe prevalence. The greater yournumber of sexual partners, thegreater your chances of gettingHPV. Having other sexually transmittedinfections also called STIsincreases the risk of HPV whichcan lead to cervical cancer. Thesemay include herpes, Chlamydia,gonorrhea and syphilis.
Majority of sexually active women are infected with HPV in their life time but nearly all clear the infection in a year. Unfortunately, 12% of acute HPV infections become persistent and may progress to precancerous lesions or invasive cervical cancer over decades. This known cause plus the long natural history of HPV infection allows an opportunity for effective interventions to manage cervical cancer. Cervical cancer can be prevented by HPV vaccination. Additionally, screening for cervical cancer aids timely intervention to treat precancerous lesions.
Papanicolaou (PAP) smear testing has been used as a screening test for cervical cancer for more than 50 years in Uganda.Ministry of health (MoH) recommends screening with visual inspection with acetic acid (VIA) for all women aged 25-49 years. The screening is scheduled every after 3 years for HIV negative women and yearly for HIV positive women. However, screening uptake has been low due to limited resources or unwillingness to commit financial resources. HPV vaccination was scaled up in Uganda in 2015 after 2 successful pilot studies in 2008 and in 2012 and is now part of the national routine immunization program.
Despite these measures, the incidence of cervical cancer is still unacceptably high. There is limited documentation of trends and geographical distribution of cervical cancer in Uganda.
The month of January serves as the cervical cancer awareness month worldwide. With this year 2024, themes being LEARN. PREVENT. SCREEN, the International Agency for Research on Cancer (IARC) marks cervical cancer awareness month by highlighting the work that remains to be done for the world to eliminate this disease by the end of this century and by promoting the tools that are available to achieve this goal.
Only 6 years left until 2030 to meet the world health organization(WHO) targets that will help make cervical cancer elimination a reality within this ambitious timeframe. Recent research by IARC and partner institutions suggests that these targets will be missed unless countries scale up screening programs, improve coverage of HPV vaccination and expand access to affordable treatment.
To eliminate cervical cancer as a public health problem by 2100, an incidence rate of fewer than 4 new cases of cervical cancer per 100000 women per year must be attained. Achieving that goal rests on three key pillars and their corresponding targets which include:
- Vaccination; 90% of girls fully vaccinated by the age of 15years that’s all young girls aged 10-14 years old should get vaccinated against the human papilloma virus. This is a 2 dose vaccine given six months apart, with full vaccination against HPV ensures protection against cervical cancer.
- Screening; 70% of women screened using a high performance test by the age of 35 years and again by the age of 45 years. T
- reatment; 90% of women with precancerous treatment and 90% of women with invasive cancer managed. With the country meeting the 90-70-90 targets by 2030, Uganda would be on the path towards eliminating cervical cancer by the end of this century
This article is written by (DR.MATOVU RICHARD) and sponsored by Specialist Doctors International