Cervical cancer-that affects the cervix, the lowest part of the uterus- is the deadliest among South African women, and the second most common behind breast cancer. Although highly treatable if detected early on, the country’s high prevalence rate is a huge concern.

According to the National Cancer Registry (NCR) South Africa’s incidence rate of 22.5 cases per 100 000 women is  well above the global rate of 15.8/100 000. Women in rural areas are more affected than those in urban areas. The annual burden is 10 000 new cases in SA per year, with 5900 deaths.

Besides COVID-19 wreaking havoc on day-to-day medical procedures, SA women also have to face high costs of cancer treatment and difficulty in accessing services.

Health-e spoke to Dr Helen Weber, Senior Medical Adviser at Sanlam, about the importance of getting screened for cervical cancer, and vaccinated against the HPV virus that causes it.

Why is cervical cancer an uncomfortable subject?

A cervical cancer diagnosis has both emotional and mental effects on a woman.

This is due to the low self-esteem which affects relationships due to the nature of the disease. There may be a loss of sexuality, anxiety, fear and depression; as well as uncertainty of the outcome. Besides physical pain, there may be a sense of embarrassment caused by the odours associated with tumours in this area. The bladder and bowel may also be affected due to the disease spreading.

Side effects of surgery, chemotherapy and radiation therapy, also contribute to the physical effects that a woman can experience.

Why is cervical cancer so prevalent in South Africa?

South Africa’s high prevalence of cervical cancer is linked to the country’s high burden of HIV since these are at a higher risk.

Limited screening is another factor causing the high cancer incidence rate. A significant proportion of the population is dependent on state resources, which has negative implications for access to screening and detection. Screening hesitancy stemming from lack of awareness is an additional issue.

Why are women living with HIV so vulnerable?

Women who are living with HIV are more vulnerable to cervical cancer due to the state of their immune system. The clearance of HPV is less, placing them at a much higher risk for cervical, vulva and vaginal cancer.

The lack of access to medical treatment for people living in poverty also makes them more vulnerable.

What does HPV have to do with it?

Two types of HPV (16 and 18) are responsible for nearly 50% of high grade cervical pre-cancers.

It’s important for young boys and girls to get vaccinated against the infection. Although the government offers free HPV vaccinations to young girls aged 9-14,  the rollout should accommodate boys too. Approximately 91% of sexually active men and 85% of women will be infected with HPV during their lifetime.

Why are HPV vaccinations a must?

Cervarix and Gardasil are the two types of vaccinations that are currently being administered in SA. They offer protection against both strains.

It’s especially important for girls to get this vaccination because of the possible devastating burden. Most cervical cancers, that are detected early, are managed with fertility-sparing procedures. However, these can cause an increased risk of a miscarriage or preterm labour as the cervix plays a critical role in protecting the growing baby.

Why must stigma around the HPV vaccination be addressed?

We have everything we need to eliminate HPV associated cancers from our country and save countless lives. All it takes is a strong vaccination rollout and willingness from families to participate. These injections can protect our girls from the psychological, physical, and financial toll of cancer. One decision early on could save a life later.

Are older women more at risk?

Cervical cancer is most common in women aged 35-44 years, but can also occur in younger women.

Smoking is ranked as a lifestyle risk factor for cervical cancer among women. Multiple sexual partners, and no or limited condom use, are the risk factors for HPV infection which can lead to pre-cancerous cervical lesions.

What does the WHO recommend?

HPV-DNA detection is recommended as the primary screening method – starting at the age of 30 years, with regular testing every 5–10 years. For women living with HIV, WHO recommends HPV-DNA detection starting at the age of 25 years, with regular screening every 3–5 years.

What are some of the financial sacrifices that women have to make?

The high cost of treatment and management of cancer has a major impact on women. The increased loss of income for families during the pandemic added to the financial burden.

Treatment side effects may also mean a person needs extended leave, meaning no income for several months. There are also various unforeseen expenses such as childcare, scans, blood tests, a nurse or carer and transport.

What impact did COVID-19 have?

The WHO indicated a global decline in screening since the beginning of the pandemic.

In South Africa, the numbers of new diagnoses for the six most common cancers (breast, prostate, cervix, large bowel, oesophagus and stomach) dropped by 36.2% when comparing 2019 to 2020. There was a 7% decline in cervical cancer diagnoses.

This is because many could not access care facilities and medication due to the reprioritisation of medical services. Some also didn’t have transport. During lockdown, there was also less staff available, so appointments had to be rescheduled. There was also the fear of being infected with COVID-19 when visiting a hospital or clinic, as well as fear of missing out on curative treatment when skipping appointments.”

In addition, there was a delay in treatments allowing diseases to progress. In some instances, the delay in repairs of broken equipment played a role in the delay of services.– Health-e News