One woman dies of cervical cancer every two minutes and mortality rates are three times higher in Latin America and the Caribbean than in North America, according to the Pan American Health Organization.
However, gynaecological oncologist, Dr Vishal Bahall, believes cervical cancer could be eradicated in ten to 20 years if, from the age of nine, both boys and girls were vaccinated for HPV (Human papillomavirus). TT conducted a HPV vaccination programme among primary school girls in 2013. An attempt by the Health Ministry to have the girls vaccinated in schools caused a public uproar and parents were instead advised to go to health centres and hospitals.
At the Caribbean Association of Oncology and Haematology (CAHO) conference at Hyatt Regency, Port of Spain yesterday, Bahall stressed that the cause of cervical cancer was HPV, which was contracted through sexual contact. The primary prevention for HPV was the vaccine.
“We need to get people away from thinking that this is a vaccine to encourage women to have sex. It is not. This is a vaccine that protects you against the high risk-HPV you get from skin-to-skin contact.” Speaking to Sunday Newsday, Bahall explained there were over 100 strains of HPV and it was present in 80 per cent of men and women. He said not all strains caused cancer as our bodies naturally clear the virus from our systems. However, he said, strains 16 and 18 caused 70 per cent of cancer, and there were other high-risk types. “Some people, they don’t clear it and it lingers on, causing changes in the cells that are picked up by a pap smear.”
He said the primary method in screening cervical cancer in TT was the pap smear, which was a scrape cytology test. “The problem is not a lot of women go to do their pap smears. It’s either because they don’t know they need to have it done or they don’t know where to get it done. We usually start when women become 21 years of age and they are sexually active. If she’s not sexually active there is no need to do a pap smear.”
He said in the conventional pap smear, if an abnormality was noticed, another pap smear had to be done to retrieve another sample to test for HPV. However, there are other ways to test for the virus. He said in the case of liquid-based cytology, which is not available at public hospitals, if the doctor saw an abnormality, they could test for HPV immediately with the same sample.
In addition, women could conduct self-HPV testing where they swab themselves and mail it to a lab but he did not recommend it. “The problem with that though is that, if you are HPV positive, that doesn’t mean you are going to get abnormal cells. You could be positive and then your body could clear it. Only a small percentage of people who have HPV would remain with those abnormal cells.” This was not yet available in TT.
Bahall said he noticed higher incidences of cervical cancer in older women, mainly because of poor screening. He said it took approximately ten years between the time someone contracts HPV and the time the cells develop into cancer. He said it was recommended that women stop screening at age 65, however he said that was only applicable for women who had been getting regular pap smears over the years, ideally every three years. “A lot of women don’t screen so they may have HPV and not know, and so they develop cancer later in life, maybe when they are 70 because it was there before.” He added that there were several risk factors for cervical cancer, anything that causes the body to be immune compromised, including smoking, HIV, and being severely diabetic. This was because these inhibited the body’s inability to clear the virus.