Cervical Cancer: Stop before it starts

Cervical cancer is the most common cancer in women of Bangladesh. In spite of claiming thousands of women's lives every year, it hardly receives due attention. The cancer that affects the cervix (lower part of the uterus) is highly preventable with regular screening and vaccine — both are available locally.

January is the cervical cancer awareness month. It is time to remind women to pay attention to their cervix by checking or screening for deadly cancer and its catastrophic consequences.

Almost all women are at risk of cervical cancer! It occurs most often in women over age 30. The Human Papillomavirus (HPV) is the main cause of cervical cancer. It passes from one person to another during sexual intercourse. At least half of sexually active women will have HPV at some points in their lives, but few women will ever get cervical cancer. In most cases, HPV will go away naturally; however, if it does not, there is a chance that — over time, it may cause cervical cancer.

In addition to HPV, other cofactors can increase the risk of cervical cancer including having sex at an early age, multiple sex partners or partner who has multiple partners, smoking, repeated pregnancies, weak immune system, exposure to the hormonal drug Diethylstilbestrol, hormonal contraception for a longer period of time, Chlamydia infection, family history of cervical cancer, poor economic status etc.

Early on, cervical cancer may not manifest with signs and symptoms. However, the following symptoms may be associated with cancer:

• Abnormal vaginal bleeding between periods or after intercourse 
• Bleeding after menopause 
• Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody or foul-smelling 
• Pelvic pain or pain during intercourse 

Cervical cancer is diagnosed through a series of examinations. A simple procedure called VIA test (done free of cost at government hospitals) and Pap smear are most commonly used techniques for screening cervical cancer. Recently, an HPV DNA test is widely used to determine the high-risk strains of HPV that will most likely lead to cervical cancer. The good news is if the cancer is diagnosed early, it is almost 100 percent curable.

Along with the screening, we have powerful preventive tool — HPV vaccine to prevent this cancer. Ideally, females should get the vaccine before they are sexually active, but it can be taken ever after starting sex, if the HPV DNA test is negative. The vaccine is given in three shots over six-months which helps the body to develop immunity against HPV. If you are eligible and can afford the vaccine, you should get vaccinated. Remember that you are never old to get shots.

In this month, along with the international community, Bangladesh can also commence special campaign to raise awareness on cervical cancer. This is a much needed campaign that can save thousands of lives every year who are unnecessarily dying from cervical cancer.

Published in The Daily Star on 21 Jan, 2012

HPV: The Puzzling Virus

The Human Papillomavirus (HPV) is considered as a major health threat for women worldwide. The majority of cervical cancer cases, by far, are thought to result from chronic infection with certain strains of HPV. The virus can be hidden for years from a woman's immune system with no apparent symptoms — then awaken and create the deadly disease. This is called shy virus that puzzled scientists for many years. In 1983, Dr Harald zur Hausen of Germany discovered the association of HPV with cervical cancer for which he was awarded the Nobel Prize in Medicine in 2008.

HPV infects predominantly the cervix (lower part of uterus) and also can affect vagina and anus. Although it causes cancer in women, it can lead cancers of the anus and penis in men. It can also infect the mouth and throat. Over 100 different types of HPV have been identified so far. Some HPV types cause warts, but do not cause cancer; whereas, other types cause cancer, but do not cause warts. However, the majorities of viruses are considered harmless and have no symptoms. Most infected individuals do not know that they are infected and are passing the virus on to their sex partner. Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery.

About 40 types of HPV are typically transmitted through sexual contact. Persistent infection with high-risk HPV types (HPV-16,18,31,33 etc.) different from the ones that cause warts — may progress to pre-cancerous lesions and invasive cancer.

Most HPV infections in young females are temporary, 70 per cent of infections are gone in one year and 90 per cent in two years. But when infection persists, 5-10 percent of infected women develop pre-cancer, which can eventually progress to invasive cervical cancer. This process usually takes 15–20 years, providing opportunities for detection and potential treatment with high cure rates. There are several ways that one can lower the chances of getting HPV — practice of safer sex, faithful relationship and vaccines.

Visual Inspection using Acetic Acid (VIA) and Pap test are used to detect abnormal cells which may develop into cancer. A cervical examination also detects warts and other abnormal growths. Abnormal and cancerous areas can be removed with a simple procedure, typically with a cauterising loop or cryotherapy. New HPV DNA tests are now available that is more sensitive than Pap or visual inspection.

Cervical cancer screening has reduced the incidence and fatalities in the developed world, whereas, substantial death tolls are still associated with HVP infections in the developing countries like Bangladesh where the cancer ranked number one among cancers that affect females.

Published in The Daily Star on 20 Feb, 2010

Chain Up For Cervical Cancer Awareness

Although cervical cancer is the leading cancer in women of Bangladesh, it is still a less spoken issue. The ironical thing about cervical cancer is that many women cannot access the free service to screen cervical cancer simply because of not knowing about the service. Many women detected at end stage of cervical cancer when apparently physicians have nothing to do. Unlike many cancers, we have vaccine and chap cancer test called VIA (Visual Inspection using Acetic Acid) to prevent and detect the disease at early stage. Still it remains one of the top ranked killers. There is an urgent need to promote these services throughout Bangladesh.

Cervical cancer is caused by genital infection with Human Papillomavirus (HPV), a common virus that can be passed from one person to another during sex. Among 100 different strains of HPV, type 16 and 18 are responsible for about 70 percent of cervical cancer worldwide. HPV is so common that most women get it at some time in their lives. HPV usually causes no symptoms and go away in course of time. However, if it does not, there is a chance that, over time, it may cause cervical cancer.

According to World Health Organisation, 12,931 women are diagnosed with cervical cancer every year and 6,561 die of this disease. This number will be more than double by 2025. Unfortunately, no study has been done yet to determine the prevalence of HPV infection in the population of Bangladesh. To reduce the death toll, nationwide cervical cancer screening programme should get strengthen to reach the hard to reach women.

In order to screen more women in our resource-poor settings, the government of Bangladesh offers most cost effective VIA test as free of cost in any government setting. It offers a real-time advantage over other screening methods with the distinct improvement of diagnosis at early stage to provide rapid treatment.

Another test called Pap test (or Pap smear) is also used to screen cervical cancer. It looks for pre-cancers cell changes on the cervix that might become cervical cancer, if it is not treated appropriately.

Women should start getting regular screening at the age 21 or within three years of the first time they have sex — which ever happens first. Cervical cancer is a preventable disease; unfortunately many women are still unaware about it. In order to raise cervical cancer awareness four key messages need to be developed for dissemination among the general population.

1. Cervical cancer is preventable
2. VIA test is easy and given free of cost
3. Screening saves lives
4. HPV vaccines are available for prevention who can afford it

To achieve these goals, Bangladesh should designate January as “Cervical Cancer Awareness Month” along with the international communities. During the campaign Ministry of Women and Children Affairs, Ministry of Health and Family Welfare, Obstetrics and Gynecology Society, Cancer Society, popular women celebrities, Media, NGOs, Universities, Colleges, High Schools, Army, BRD, Girls Scout, Women’s club, Rotary Club, Lions Club etc. can act as a chain to organise special programmes to raise much awareness about cervical cancer.

Women are generally considered as the heart of our family. Family falls apart when they get sick. To sustain tranquility and prosperity should not we strive to keep them happy and healthy?

Published in The Daily Star on 01 Jan, 2010

Opportunity for Bangladesh in the Health Care Business

After nearly sixteen years, I recently travelled Bangladesh and stayed more than three weeks-travelling, meeting people and examining the immense changes in Bangladesh. I had the opportunity to view not through the eyes of a tourist, but through the eyes of an experienced healthcare scientist who felt and saw the tremendous accomplishments that Bangladesh has been made despite all negative movement. I was amazed seeing all signs of a robust and thriving economy.

What stroked me was the anxiety with the hospitals being built and their standard of services to the patients. Quality management remains an elusive dream. The cost of treatment varies very much from hospital to hospital. There was not enough historical data of what it costs for the treatment of a particular condition.

Healthcare is very expensive in western countries. Therefore, the insurance companies and private hospitals in the USA are encouraging patients to travel to India, Abu Dhabi, Thailand, Singapore, Greece and Italy for treatment. The USA based healthcare companies are now outsourcing their healthcare services in the overseas either through joint venture initiative or opening their own state-of-the-art hospital facilities. The goals are to provide comparable healthcare services to their own patients as well as to the international communities with a reasonable cost.

Like call centers and IT business; healthcare services are promising field especially the diagnostic and imaging services, cosmetic and regular surgery, and short-term treatments. It is time to act and develop clear strategies to motivate these potential healthcare companies to expand their services in Bangladesh. It will not only create thousand of new jobs but also provide better treatment opportunity to the local people. Here are few suggestions to be considered:

1. The ministry of health, doctors, nurses, pharmacists, hospitals and business schools should work together and develop clear plan for getting attention to the potential healthcare companies.
2. Send highly trained professionals to the international professional meetings and potential healthcare companies to promote our ability to the international community.
3. Revise the curriculum in medical, nursing and pharmacy schools that train healthcare professionals, so that they are trained according to the new international paradigm.
4. Encourage business schools to develop executive training programmers in healthcare, which will effectively reduce the talent gap for leadership in this area.
5. Develop and implement international standard examination by which doctors, nurses and pharmacists are qualified for employment in the Joint Commission International (JCI) accredited organisations.
6. Encourage local hospitals to evaluate their services by JCI and meet their compliances.
7. Utilise and apply medical information systems that encourage the use of evidence-based medicine, guidelines and protocols as well as electronic prescribing in inpatient and outpatient settings.
8. Develop partnerships between the western and local hospital that design newer ways to deliver healthcare.
9. The government should appoint a commission, which makes recommendations for the healthcare system and monitors its performance.

It is time to think, commence the debate, develop a clear plan and execute it. It has been done in many countries and I am confident it can be done in Bangladesh too.

http://www.thedailystar.net/newDesign/news-details.php?nid=119251
http://www.thedailystar.net/story.php?nid=65878 

Protected From Cervical Cancer

Cervical cancer is cancer of the cervix — the lower part of the uterus, which opens into the vagina. Cervical cancer is the second-most-common type of cancer that strikes women worldwide after breast cancer.

It is estimated that nearly 250,000 deaths are associated with cervical cancer globally every year. According to the World Health Organisation, there were 500,000 new cases of cervical cancer in 2005.

The tragedy of cervical cancer is that it often strikes when a woman is still young. It tends to happen in women between the age of 35 and 55 years. She may be trying to raise her family or may be she has not had children yet.

A population-based survey reported that the coverage of cervical cancer screening in Bangladesh is less than 1%. Older and poor women are at the highest risk of developing cervical cancer in Bangladesh.

Cause of Cervical Cancer
99% of cervical cancers are caused by Human Papillomavirus (HPV), which spreads through sexual contact. There are over 100 different types of HPV. The majorities of viruses are considered Low Risk and do not cause cervical cancer. However, HPV-16 and HPV-18 often referred to as High Risk HPV types are associated with more than 70% of cervical cancer cases.

The body’s immune system usually fights off the infection as a result most women never suffer from HPV infection. However, in some women the infection does not go away. When the virus remains active in the body for a long period of time, cervical cells begin to change and the risk of cervical cancer increases.

There are other factors can increase the risk that an HPV infection develops into cervical cancer:

• Sexual intercourse at an early age
• Multiple sexual partners
• Multiple full-term pregnancies
• Chlamydia, gonorrhoea, syphilis, or herpes simplex virus type 2 infection
• Cigarette smoking
• Use of oral contraceptives for a long period of time
• Weakened immune system or HIV infection • Mother or sister with a history of cervical cancer
• Low levels of folic acid (a type of Vitamin B)

Symptoms
Cervical cancer is usually a slow-growing cancer, typically takes 10-15 years before invasive cancer develops. Once cervical cells begin to change, it first becomes “pre-cancerous” a condition also known as “dysplasia” or Cervical Intraepithelial Neoplasia (CIN).

In the early stages cervical cancer often causes no symptoms. However, when symptoms do occur, they may include:

• Bleeding between regular menstrual periods
• Bleeding after sexual intercourse
• Bleeding after douching
• Bleeding after a pelvic exam
• Pelvic pain not related to your menstrual cycle
• Heavy or unusual discharge that may be watery, thick, and possibly have a foul odor
• Increased urinary frequency
• Pain during urination

These symptoms can be caused by cervical cancer, or by a number of serious conditions, and should be evaluated promptly by a medical professional.

Diagnosis
Cervical cancer is diagnosed through a series of examinations. A Pap test is most commonly used to screen and detect the possibility of a cervical cancer or dysplasia.

An HPV DNA test is used to determine the high-risk strains of HPV infection, which is most likely to lead to cervical cancer. If an abnormality is found during a Pap and HPV DNA tests, a Colposcopy is performed.

Finally, a Cone biopsy is performed by removing a cone-shaped piece of tissue from the cervix for microscopic examination. A pathologist examines the sample for confirmation of precancer or cancer cells.

Treatment
Options for treating cervical cancer depend predominantly on the stage of disease — the size of the tumor, the depth of invasion, and whether the cancer has spread to other parts of the body.

Other factors that are considered are the patient’s age and if she wishes to have children. The primary forms of treatment are surgery or combined radiation therapy and chemotherapy.

• Surgery to remove the uterus
• Radiation therapy to kill the cancer cells
• Chemotherapy to stop the growth of cancer cells

Vaccine
The vaccine is now available for prevention of HPV infection. Studies show that women who receive cervical cancer vaccine between the ages of 15 and 25 have 100% protection against the HPV-16 and HPV-18.

The vaccine is given in three shots over six-months. Centers for Disease Control and Prevention (CDC) recommended this vaccine for girl’s ages 11 to 12, although it may be used in girls as young as age 9.

Ideally, females should get the vaccine before they are sexually active. The vaccine is also recommended for 13-26 year-old girls who have not yet received or completed the vaccine series. This allows a girls immune system to be activated before she encounters HPV. Vaccinating at this age also allows developing the highest antibody levels. The higher the antibody levels the greater the protection.

http://www.healthwikipedia.com/womens-health/protected-from-cervical-cancer.html
http://health.evergreenbangla.com/get-protected-from-cervical-cancer/