Fayola K J Fraser
According to the World Health Organization, cervical cancer is the fourth most common cancer in women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020. In T&T during the same year, 28.5 per cent of the female population was diagnosed with cervical cancer, resulting in 97 deaths. January is now known as Cervical Cancer Awareness Month, an opportunity to raise public awareness about the known causes of the disease and ways it can be prevented. The campaign aims to encourage women worldwide to take preventative action to safeguard their gynaecological health.
Cervical cancer is caused by abnormal cells in the lining of the cervix growing in an uncontrolled way. The cervix is part of the female reproductive system and the lowest part of the uterus that connects the uterus to the vagina. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. Over time, if this is not noticed, it is not treated, and these abnormal cells may then become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.
Trinidadian Dr Vanessa Harry is a UK-trained gynaecological oncologist who provides surgical care for women with gynaecological cancers such as cancers of the cervix, uterus and ovary. Her expertise has brought her into contact with many cases of cervical cancer, and she recommends that all women take preventative measures from very early to reduce the risk of this preventable cancer.
HPV vaccination
Dr Harry encourages women to have regular Pap smear screening tests, ensure any necessary follow-up checks with the doctor if test results are abnormal, and take the HPV vaccine as three of the most important measures to follow.
HPV or the Human Papillomavirus is a common virus that can affect different parts of the body, and it is passed from one person to another through skin-to-skin contact. Only some types of HPVs are considered “high risk” because they can progress to cervical cancer, and nearly all people who are sexually active will become infected with HPV at some point in their lives.
Most HPV infections go away on their own within a year or two as the immune system controls the infection. These short-term infections do not cause cancer. However, when a high-risk HPV infection lasts for years (a long-lasting HPV infection), it can lead to changes in the cervical cells, resulting in a precancerous lesion. If the precancerous lesion is not found and removed, it may eventually develop into cervical cancer.
Dr Harry, along with gynaecologists worldwide, recommend the HPV vaccination as a critically important primary prevention method against cervical cancer. It is suggested that women between 11-26 receive the HPV vaccine and that women aim to receive it before engaging in sexual activity.
In T&T, although the vaccine is available and recommended by many doctors, according to the World Health Organization, “among girls turning 15 years old in 2020, fewer than one in ten received their third and final HPV vaccination dose.” Since 2013, the HPV vaccine has been included in the national vaccination programme, meaning that it is available and accessible through public health centres.
Secondary measures to lower risk
Women who have not taken the HPV vaccine can take secondary measures to lower their risk of cervical cancer. According to Dr Harry, ensuring regular Pap smears every three years, especially once sexually active, is crucial to ensure that there are no abnormalities in the reproductive system. Smoking also presents a high risk to the likelihood of the development of cervical cancer, and she urges young women not to smoke.
Often, cervical cancer may silently develop without any signs or symptoms early in the disease. However, there are some symptoms that women should be alert to, such as vaginal bleeding outside of periods, menstrual bleeding that is heavier and longer lasting than usual, watery discharge that may be heavy with a foul odour, or pelvic pain during intercourse. These unusual occurrences should immediately warrant a visit to your gynaecologist.
It is most important to note that anyone with a cervix is at risk for cervical cancer. Although it occurs most often in people over 30, taking preventative measures from a young age is very important.
Cervical cancer is life-changing, not only physically but emotionally and with increasing awareness around the disease, women who have not yet dedicated themselves to preventative screening measures or vaccination, where possible, can do so to reduce their risk.
Who is Dr Harry?
Dr Harry is a UK-trained gynaecological oncologist who provides surgical care for women with gynaecological cancers such as cancers of the cervix, uterus and ovary. She was awarded a Doctorate of Medicine in 2012 following recognition of her research in the field of gynaecological cancers. Dr Harry has presented her work internationally and is well published in many medical journals. She returned to Trinidad in 2013 following 12 years in the UK to assist in providing expert gynaecological care to all women.