Vaccination alone not sufficient to prevent cervical cancer, seminar told

Cervical cancer ranks as the 3rd most frequent cancer among women in Pakistan and the 2nd most frequent cancer among women between 15 and 44 years of reproductive age group.

A major cause of most cervical cancers is an infection called human papillomavirus (HPV), a virus that is transmitted through sexual contact. There are more than 100 strains of HPV virus, but only 20 strains are known to cause cervical cancer. The two most common are 16 and 18 causing approximately 70 per cent of all invasive cervical carcinoma.

Moreover, the majority of HPV infections get cleared from our body due to our immune system within two years. Cervical cancer usually develops slowly, during which time the cells in the cervix undergo changes.

These findings were shared by Dr Tahira Yasmeen, consultant gynecological oncologist and assistant professor at Liaquat National Hospital at a public awareness seminar held in connection with the cervical cancer awareness month, which is observed in January of every year.

“Symptoms of cervical cancer includes vaginal bleeding in between the menstrual cycle, and after sexual contact as well. Symptoms like persistent pain in the back, legs, or pelvis, weight loss, fatigue and loss of appetite also denotes cervical cancer,” she said.

The seminar was held on Friday in collaboration with Dr Essa Laboratory & Diagnostic Center that emphasizes the necessity of educating people with knowledge about minimizing cervical cancer risks and the life-saving importance of regular screenings as the disease remains silent and does not cause any major symptoms in the initial stages.

Risk factors for cancer progression include the grade of oncogenicity of the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking, she further explained. “Cervical cancer causes no symptoms in early stage in majority of females, and when symptoms occur, it’s usually stage II/III. So, it’s very important to go for the regular screening test for early detection. Secondary prevention means regular screening to detect precancerous lesions on cervix by visual inspection. Pap smear and HPV DNA testing are the other tests used for early detection and prevention of cervical cancer,” explained Dr Sonia Naqvi, an eminent consultant gynecologist, obstetrician and fertility expert.

“A precancerous lesion like dysplasia grade1 may take 15-20 years to progress to cancer. It can be treated by surgical approach to prevent cervical cancer,” added by Dr Naqvi.

“Treatments of pre-cancers are quick and generally painless causing infrequent complications. Treatment steps include colposcopy or visual inspection of the cervix to locate and assess the lesion followed by: thermal ablation, which involves using a heated probe to burn off cells; cryotherapy, which involves using a cold probe to freeze off the cells; LEETZ (large loop excision of the transformation zone), which involves removing your abnormal tissues with an electrically heated loop,” she elaborated.

“Over the past two decades, there has been significant advancement in the management of cervical cancer, particularly in the domain of definitive chemo radiotherapy for locally advanced cervical cancer. Indeed, radiation treatment paradigms have shifted from a two-dimensional (2D) approach solely based on anatomical bony landmarks to an image-guided three-dimensional (3D) approach, with the goal of delivering doses more precisely to clinical targets with an increased sparing of organs-at-risk,” said Dr Adeel Ahmed Memon, consultant radiation and clinical oncologist at KIRAN while giving a radiation oncologist’s perspective. “Tumors larger than four centimeters, commonly seen among Pakistani women because of late diagnosis are considered to be of advanced stage. A combination of chemo and radiation therapy works better in advanced cervical cancer tumors as compared to chemo followed by surgery, suggests recent large-scale studies worldwide,” added Dr Adeel.

Talking on the sidelines of the seminar, Dr Farhan Essa Abdullah, Infectious disease expert and CEO of Dr Essa Laboratory, said that in Pakistan, cervical cancer continues to be a challenge, as it contributes to 6-29% of all cancers in women.

He said about 68.6 million women over the age of 15 are at risk of developing cervical cancer, and more than 7,300 women lose their lives, while this disease is highly preventable.

Currently, there are 6 HPV vaccines available globally. All protect against the high-risk HPV types and have been shown to be safe and effective in preventing HPV infection and cervical cancer.

“As a priority, HPV vaccines should be given to all girls aged 9–14 years. The vaccine may be given as 1 or 2 doses. People with reduced immune systems should ideally receive 2 or 3 doses. To meet the World Health Organization’s target of cervical cancer elimination by 2030 and achieve 90% vaccination of girls by the age of 15, it is imperative that we take strong initiatives. We must ensure the availability, affordability, and accessibility of the HPV vaccine for our population while working to eliminate barriers that contribute to vaccine hesitancy. Vaccination alone is not sufficient in preventing cervical cancer and measures to promote screening via pap smear should be coupled with these efforts,” advised Dr Farhan Essa.