According to the World Health Organisation (WHO), cancer is a leading cause of death around the world. The organisation calculated the mortality of this deadly group of diseases as 7.4 million deaths in 2004 (or around 13% of all deaths world-wide).
The 4th of February marks an international effort by WHO and the International Union Against Cancer to promote ways to ease this global burden of cancer. The most important factor about cancer that needs to be brought to the forefront is that more than 30% of cancer deaths can be prevented.
One of the most preventable cancers in the world is cervical cancer. However, it remains the second most common cancer in women taking one life every two minutes. Breast cancer, being the most prevalent in the world, is often talked about and much is being done to spread awareness about the disease, but there is relatively little public knowledge about the risks of cervical cancer, especially in the developing world. Many women in these countries are unaware of how this cancer can easily be prevented and eventually eradicated.
Leading researcher from the UK Cancer Society, Dr Javk Cuzik, stated that it is possible to eradicate cervical cancer in 50 years with vaccines currently in use and their development in the years to come. Today's HPV vaccines can protect women from approximately 70% of cervical cancers by providing protection against the two main strains of the virus that causes the disease; Human Papilloma Virus (HPV). "If you can eradicate the virus, the cancer will not appear" said Dr Jack. An expert on cervical cancer screening, Cuzik clarifies that vaccinations must be used alongside HPV screening (Pap smear).
Cervical cancer incidence and mortality rates have rapidly declined since the 1960s in many developed countries like the United States due to widespread screening and intervention. However, it is still the third most leading cause of cancer deaths in women world-wide. Approximately 500,000 women are diagnosed with cervical cancer each year; half of which will die.
A staggering 80% of these deaths occur in the developing world. While developed nations are moving towards the eradication of cervical cancer, the developed world is moving in the opposite direction. According to a recent report published by the American Cancer Society, the incidence and mortality rates from cervical cancer remain high in many parts of Central and South America, Africa, and Asia. And the HPV vaccine can potentially play a major role in reducing these rates in the future.
According to the available data on Pakistan, a rising trend has been observed over the six year period 2002-2008 from 9 per 100, 000 people to 19 per 100,000 people. "This increase could be due to improvements in data collection or there could actually be a rapid increase in incidence," stated Dr Sadiah Ahsan Pal, Professor and Consultant Obstetrician and Gynaecologist from Karachi.
She warned that in either case the issue with increase needs to be addressed. What is more troubling for medical professionals at the forefront of cervical cancer awareness is that no data exists on the population prevalence of, or risk factors for, the Human Papillomavirus infection in Pakistan. The figures mentioned above are based on a very small portion of the population limited to one city. Therefore, real incidence could be much higher
About cervical cancer: Cervical cancer is a disease that affects the cervix or the neck of the womb of a woman, and it is caused by a persistent infection with HPV, which is a sexually transmitted infection. All married women who are sexually active are at risk of contracting this virus, while women who have been married more than once with multiple partners are at a higher risk.
In fact, HPV is so common that it affects around 75-80% of all women at some point in their lives. Because the symptoms of cervical cancer may not emerge for a long period of time - up to 15 to 20 years - many women often remain unaware of it until too late. Therefore, the asymptomatic nature of this silent killer is the reason why vaccination along with regular screenings is emphasised.
According to the Amercian Cancer Society nearly 100% of women with cervical cancer have evidence of cervical infection with HPV. There are more than 100 types of HPV, and two strains emerge as the most common among cervical cancer patients; HPV 16 and 18. According to Professor Yasmin Bhurgri, Professor of Pathology at Liaquat National Medical College Hospital, these two strains cause 88% of malignancies in Pakistan.
These are the strains that today's HPV vaccines target, and Dr Cuzik's predicts that with the development of the vaccine, preventative measures will be able to provide broader coverage to reduce cervical cancer incidence even more in the future. And eventually, in the next five decades with the help of screenings, cervical cancer can be eradicated completely like the case of small pox so many years ago.
Unfortunately, for developing countries like Pakistan, eradication of the disease is in the very distant future due to several reasons, such as lack of awareness about the disease and its preventative measures, poverty and poor public health care. Most women in Pakistan, both urban and rural, are oblivious to the fact that each one of them is potentially at risk of cervical cancer.
Therefore, if we hope to catch up with the developing world with regards to incidence, public and private institutions need to come on board the prevention boat. Also, for those mothers whose family's are privileged enough to have access to health care, they must protect their daughters by getting them vaccinated before marriage. And since the risk of this deadly cancer increases with age, married women must also look after their cervical health through regular screenings and vaccinations.