Malaysia has more cases of cervical cancer compared to other developed countries, even though the disease is preventable and has the potential to be eradicated. THANKS to the tireless efforts of the Health Ministry, various NGOs, patient support groups and medical professionals, the level of public awareness about breast cancer in Malaysia is incredibly high and many women are becoming increasingly educated about ways to detect and treat breast cancer early.
Now, I hope that we can do the same for cervical cancer – a less talked-about cancer, even though it is the second most common cancer in women after breast cancer. Cervical cancer is a disease in which cancer cells are found in the tissues of the cervix (the lower part of the uterus that connects the uterus to the vagina). It saddens me to tell you that Malaysia has more cases of cervical cancer compared to other developed countries, even though the disease is preventable and has the potential to be eradicated. All women should be aware of this and do their very best to prevent developing cervical cancer.
HPV and the cervix
Cervical cancer can occur at any age in a woman’s life, beginning in adolescence (although uncommon). About half of all women diagnosed with cervical cancer are between 35 and 55 years of age.
Many of these women were most likely exposed to HPV during their teens and 20s. The crude incidence rate for cervical cancer in 100,000 female population in Peninsular Malaysia is 13.4 out of 100,000 for girls/women between 15 and 49 years of age, and 62.9 out of 100,000 for women between 50 and 69 years of age. (Source: Second Report of the National Cancer Registry Cancer Incidence in Malaysia (2003); Ministry of Health Malaysia.)
You could be one of them. That is why it is important that you know more about this disease to protect yourself from it. Your cervix is lined with scalelike cells called squamous cells, while your cervical canal is covered with another kind of cell called columnar cells. These two cells meet in an area called the T-zone – this is the most likely area for abnormal cells to develop. But what causes these abnormal cells to develop? Most commonly, it is the work of a virus called HPV, or human papillomavirus.
There are actually more than 100 types of HPV. Some of them cause genital warts, while others cause cervical cancer. HPV infection is very common and often goes away on its own without needing treatment. In fact, not every woman who has a HPV infection will develop cervical cancer. This is because your immune system will kill off the abnormal cells and so prevent them from becoming cancerous. But sometimes, the abnormal cells can turn into pre-cancerous cells, and later, develop into cervical cancer. Therefore, it’s important to detect the infection early, so that you can monitor it and treat any abnormal cells that develop.
Are you at risk?
HPV is transmitted through sex. So women who have many sexual partners (or who have sex with men who have had many partners) have a greater chance of getting HPV. There are also a few other factors that put you at risk of developing cervical cancer. These are: Smoking: If you smoke, you are twice as likely to get cervical cancer. Tobacco smoke can produce chemicals that may damage the DNA in the cells of the cervix and make cancer more likely to occur.
HIV infection: HIV (the AIDS-causing virus, different from HPV) can also be a risk factor for cervical cancer. Being HIV-positive weakens the immune system, and makes a woman less able to fight HPV infection and early cancer. Chlamydia infection: Chlamydia is a sexually-transmitted bacteria that infects a woman’s genitals. Some research suggests that women who have chlamydia infection (or have had it in the past) are at greater risk for cervical cancer.
Although we can’t confirm this research yet, it is still a good idea to avoid getting chlamydia infection or to have it treated quickly to avoid other health problems.Having many pregnancies: Woman who have had many fullterm pregnancies have an increased risk of cervical cancer. Low income: Poor women are at greater risk for cervical cancer. This may be because they cannot afford good health care, including Pap smear tests.
Family history: If your mother or sister has had cervical cancer, you may be more likely to get the disease yourself. This means it’s even more important that you go for regular Pap smears. Partner’s hygiene: Some people believe that women whose partners were circumcised were less likely to get cervical cancer. However, research shows that uncircumcised men are no greater a risk of causing cervical cancer, as long as they are careful about keeping their genitals, particularly the foreskin, clean.
Poor diet: There is no food that can single-handedly cause, or prevent, cervical cancer, of course. But diet plays an indirect role in cervical cancer – if you have poor nutrition and become infected with HPV, your body may not be strong enough to fight off the virus. This can cause more cells to undergo the genetic changes that can lead to pre-cancerous cells, and then to cervical cancer. You should eat a diet rich in fruits and vegetables, as they have plenty of nutritional components that can protect your health. You should also maintain healthy body weight, as overweight women are at higher risk of cervical cancer.
Although HPV is sexually transmitted, it is not correct to say that women get cervical cancer because they are promiscuous. After all, you could have been with only one man, but if he has had lots of other partners and carries the virus, you can still get it from him.
If you have many partners or have a partner who has been with many other women, you must be extra cautious about checking yourself for HPV infection. Condoms do not protect against HPV transmission – but it is still important to use them because they protect against AIDS and other sexually transmitted diseases.
Can cervical cancer be prevented?
So what can you do to protect yourself against cervical cancer? For a long time, there were only two ways: prevent pre-cancer; or detect HPV infection early. You can prevent pre-cancer from developing if you delay having sex until you are older. As much as possible, you should also have few sexual partners, and be cautious with men who have had sex with many other partners. You should also quit smoking, as this not only protects against cervical cancer but many other cancers and diseases.
The second way to prevent cancer of the cervix is to have regular Pap smear tests to detect HPV infection and pre-cancers. If you can treat these problems early, you can stop the infection before it fully develops into an invasive cancer. Now, thanks to a tremendous advance in research, we have a third way to prevent cervical cancer – a new vaccine. I will discuss the vaccine and the Pap smear test in the next few articles in this column.
Next article in Women’s World: The importance of your Pap smear n Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). She is co chairman of Nur Sejahtera, Women & Family Healthcare Program, Ministry of Women, Family and Development.
The Star Newspaper, Sunday November 18, 2007
BY Dr NOR ASHIKIN MOKHTAR
