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Sunday 21 July 2019
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No Woman should die of cervical cancer….

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Cervical cancer is a cancer arising from the cervix, which is the lower part of the womb. It is still the most common cancer of women on the African continent.
It is estimated that in 2012 alone 528 000 cases of cervical cancer have occurred, with 266 000 deaths. About 80 % of these cases occurred in the
developing countries. Mortality remains high worldwide mainly because of late presentation at     diagnosis. The etiological link     between human papillomavirus (HPV) infection and cervical cancer has been well established.
HPV infection is one of the most common sexually transmitted infection (STI) in the world today – up to 80% of sexually active females will harbor HPV at some point in their lives. The good news is majority of the women will experience natural elimination of HPV infection because of a healthy immune system.
Persistent infection with a high-risk type HPV puts women at risk to develop precursors of cervical cancer or carcinoma itself. HIV-Positive women have an increased risk of persistent HPV infection compared with uninfected women.
The precursors of cervical cancer can be detected and treated. The most important aspect of detection is screening of asymptomatic women, the Pap smear is generally used for this purpose.

Signs and Symptoms

  • Usually asymptomatic in the early stages
  • Bleeding after sex

Late symptoms include:

  • Loss of weight & appetite
  • Fatigue, pelvic pain, back pain, leg pain, bone fractures

Who’s at risk of cervical cancer?

  • Age > 40 years old
  • Smokers
  • HIV positive women
  • Early age sexual activity debut
  • Having multiple sexual partners
  • Family history of cervical cancer

Prevention
HPV Vaccine: There are currently two vaccines (Gardasil & Cervarix) available offering high protection against persistent infection with HPV 16 and 18. Both vaccines are available in Namibia. The important issues to address include who and when to vaccinate. HPV Vaccines are most effective if administered to individuals who have not previously been exposed to HPV. Most guidelines recommend vaccination of girls from age 9 and older, with ‘catch up’ vaccination to include women up to 26 years old. HPV vaccines are given in three shots over 6 months
Pap smear: Secondary prevention of this disease has been available for over 5 decades and it has significantly the prevalence of the disease. In Namibia Pap smears are available in private at General practitioners and gynecologists. Pap smears are also offered for free at public clinics and hospitals countrywide. A Pap smear is performed as an office short procedure (<5 minutes). Usually not painful but uncomfortable, the cervix is visualized using an instrument known as a speculum and the surface of the cervix is scrapped using a wooden spatula or brush.

Treatment
Depending on the stage of the disease it may include removal of the cervix or the whole womb. Advanced cases will require chemotherapy and radiotherapy. To conclude HPV is not unique to women, in men its found to be associated with penile cancer and genital warts, circumcision is preventative.

Dr David N. Emvula is a qualified medical doctor who holds a MBChB degree from the University of Pretoria. He is currently a fellow in Obstetrics and Gynecology at the University of Pretoria and co-runs Westcare Medical Center in Windhoek.




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