January marks cervical cancer awareness month, the disease is the fourth most common cancer in women according to WHO. In an interview with Dr. Khaled Kouteich, Consultant Obstetrics & Gynaecology and Dr. Alaa Younus Mohammed​ Specialist Obstetrician and Gynecologist from Fakeeh University Hospital we discuss how preventative measures are key.
What causes cervical cancer and what are the major symptoms that can be giveaways of the ailment?Â
Dr. Khaled:Â Cervical cancer occurs in the cervix of a woman, the entrance to the uterus from the vagina. It happens when the cells in a woman's cervix undergo mutation. This cancer can damage the cervix's deeper tissues and spread to other areas of the body (metastasise), most often the lungs, liver, bladder, vagina, and rectum. Cervical cancer develops slowly, so it is generally detectable and treatable, before it causes major complications.
According to WHO, almost 99% of cervical cancer cases are associated with infection of high-risk human papillomaviruses (HPV), a very common virus transmitted through sexual contact. Although most HPV infections resolve spontaneously with no symptoms, chronic infection can lead to cervical cancer in women.
Cervical cancer in its early stages usually has no symptoms. However, following are the signs and symptoms of advanced cervical cancer:
- Vaginal bleeding between periods, after sexual intercourse, or after menopause
- Pelvic discomfort or pain during intercourse
- Vaginal discharge that is watery, bloody, and has a bad odor
- Having difficulty peeing, fatigue, kidney failure, loss of appetite, and uninitiated weight loss
Dr. Khaled Kouteich and Dr. Alaa Younus Mohammed
What are the necessary steps in the prevention and detection of cervical cancer?Â
Dr. Alaa: A variety of steps can help lower the risk of developing cervical cancer, such as:
- Vaccine against human papillomavirus (HPV)Â - Cervical cancer is clearly linked to some types of HPV. Getting vaccinated against HPV may lower your risk of cervical cancer and other HPV-related cancers.Â
- Cervical cancer and safe sex - The HPV vaccination can effectively protect against nine strains of the virus. Cervical cancer can be also caused by other strains. HPV vaccination should be taken before first sexual activity. Using protection during intercourse protects against HPV infection.Â
- Cervical cancer screening - Regular cervical screening may assist a person in identifying and dealing with cancer symptoms before the disease develops or spreads too far. Screening does not diagnose cancer, but it does detect mutations in the cervix's cells.
- Having fewer sexual partners -Â The more sexual partners a woman has, the greater her chance of HPV virus transmission. This can increase the chance of acquiring cervical cancer too.
- Delaying the first sexual encounter -Â The younger a woman is when she has her first sexual encounter, the greater her chance of HPV infection. The longer she waits, the lesser her risk becomes.
- Quitting smoking -Â Women who smoke and have HPV are more likely to acquire cervical cancer than those who do not.
While the detection steps include regular screening, after consultation with your doctor and identifying the symptoms as listed above, in time. Generally, diagnostic options include Pap smear, colposcopy , biopsy and different modalities of treatments.
In line with cervical cancer awareness month, how important is it to start a conversation and encourage preventative methods?Â
Dr. Khaled: Cervical cancer has a high prevalence, but it is still a taboo subject and is not openly discussed by many women. They suffer in silence, while the cancer cells mutate within their body. It is time to raise awareness regarding the disease, especially as the survival rate is close to 100 per cent when precancerous or early cancerous changes are detected and treated early.
WHO has developed an ambitious, concerted and inclusive strategy to guide the elimination of cervical cancer as a public health problem. To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below four per 100,000 women. In UAE, a national level vaccination programme has been launched in 2019. And so far 2 in 10 girls in the primary target cohort in 2020 have received their final HPV vaccination dose. In addition to this, the Government has launched a national screening programme for cervical cancer in 2021 with the aim to strengthen early detection of first symptoms at primary health care level.
Many other countries should also take and encourage similar preventive methods.Â
How often, and from which age should women screen for cervical cancer?
Dr. Alaa: The screening for cervical changes should start as early as the age of 13-15.  Women in the age group of 25 to 50 should get a HPV test every 3 years and in the age group 50-65 every 5 years. After 65 years of age, screening can be stopped if three previously done pap smear tests are negative. In the absence of an HPV test, other alternatives, like the Pap Smear Test can also be used.
What forms of treatments exist for those with cervical cancer?
Dr. Khaled: Treatment for cervical cancer is determined by a number of variables, including the stage of the cancer, any other medical issues you may be undergoing, and your personal preferences. It is possible to utilize surgery, radiation, chemotherapy, or a combination of the three. Treatment for early-stage cervical cancer, while the disease is still limited within the cervix, has a high success rate. The further a cancer spreads from its original place, the lower the success rate.
Following are some treatment modalities:
- Surgery - Surgery is often used to treat early-stage cervical cancer. The best procedure for you will depend on the extent of your cancer, its stage, and if you want to become pregnant in the future.
- Radiation therapy - It kills cancer cells by using high-powered radiation beams such as X-rays or protons. It can also be administered after surgery, if the cancer is likely to return. It can be administered internally, externally or both.
- Chemotherapy - Chemotherapy via drug treatment that involves the use of chemicals to kill cancer cells. It can be injected into a vein or swallowed as a tablet. Both strategies are employed at times.
- Immunotherapy - It is a drug that boosts the immune system's ability to fight cancer. Immunotherapy for cervical cancer may be used if the cancer has progressed and previous treatments have failed.Â
Do certain patients carry a higher risk of contracting cervical cancer?Â
Dr. Alaa: Yes, they do. Women may be at a higher risk of cervical cancer if they:
- Have a weakened immune system
- Started having intercourse before age 16 or within a year of starting menstruation
- Have other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS
- Have multiple sexual partners
- Smoke cigarettesÂ
- The best person to guide women on their personal risk factors will be their doctor.Â
Introduction of HPV genotype for high risk patients, help improve the sensitivity of screening of cervical cancer