We asked gynaecologist Dr Sebolelo Mojaki to share what she wishes she could tell all South African women this Cervical Cancer Awareness Month.
Cervical cancer is a serious topic of discussion that should be on everyone’s lips. However, here in South Africa, many women are scared or embarrassed to talk about it. As a doctor, I see so many women who come into my office not knowing anything about this very serious disease.
But first things first… What is the cervix and where is it located?
The cervix is part of the female reproductive organs. It is found at the transition of the external and internal genital system in women. The cervix connects the vagina with the womb. It can be divided into the exocervix and endocervix, as the two have different cell linings. It is important to note that most cervical cancers develop from the transitional zone, where these two cell linings join.
Is cervical cancer really that prominent in South Africa?
The answer is yes! According to World Health Organisation (WHO 2012) Cervical Cancer Report, cervical cancer is the fourth most common cancer globally but the second commonest female cancer in South Africa (SA), and this is echoed in research by The Cancer Association of South Africa (Cansa). The National Cancer Registry (NCR) 2014 reported cervical cancer to be the third most common female cancer diagnosed by tissue specimen in laboratories in South Africa. Cansa goes on to report that one in 39 women will be diagnosed with cervical cancer. The devastating trend that we are seeing, in South Africa, is the increased frequency of young women from the age of 30 years old being diagnosed with cervical cancer.
Why is cervical cancer such a crisis in South Africa?
This is not an easy question to answer, but it largely boils down to poor health infrastructure for cervical cancer screening. So many women do not have access to effective screening programmes. The state of our public healthcare system does not make it easy for women to get their pap smears, so they may have one test and then not go back for a number of years. This puts women at risk.
But how do you actually get cervical cancer?
About 98% of cervical cancer is caused by high risk Human Papilloma Virus (HPV). This virus is transmitted by skin contact including sexual contact. Most sexually active people will have this infection, and in most immune competent persons it will be cleared by the body. However, if the high-risk HPV infection (commonly types 16 and 18) is persistent on the cervix, it can lead to transformation of healthy lining cells into pre-cancer cells. If these pre-cancer cells are not picked up with screening there is a risk of progression to cancer cells. So, not all HPV-infected persons will develop cancer, but they are at risk of cancer. It is important to note that all women who are sexually active are at risk of getting cervical cancer, which is why it is so important to get regular pap smears. But women who are HIV positive are at an even higher risk of this type of cancer, as they are found to have higher prevalence of HPV infection and higher risk of the persistence of an HPV infection.
What can I do to protect myself?
SCREENING! I cannot highlight this point enough. Screening is the cornerstone for preventing this devastating disease. The important thing is to see your gynaecologist as soon as you become sexually active to discuss a prevention strategy throughout your life. I would highly recommend that girls between the ages of nine and 13 years old get the HPV immunisation vaccine. Screening for HIV infection is also important, as this means that your gynaecologist will need to adjust your preventative screening plan for cervical cancer. The disease is preventable, which is why I cannot stress enough that women need to ensure that they get their pap smears done regularly. As per the South African HPV Advisory Board’s recommendation, a woman should begin having pap smears when she becomes sexually active or turns 21. She should have one each year until the age of 30, and then every three years after the age of 30.
I want to encourage you as South African woman to take charge of your health, educate yourself and take the necessary precautions to protect yourselves! If you are looking for a gyneacologist to help you or to do your pap smear, you can contact Advanced Health on 012 346 5020 or visit the website www.advancedhealth.co.za. There are a number of gyneacologists around the country at the different Advanced Health’s day clinics.
Got more questions? Email our online editor and we will ask Dr Mojaki to answer. #AskAGynae