SEXUAL HEALTH: An easily preventable cancer

The sexology clinic can be a hot seat some days. Last Tuesday was one such day. A lady called Neema walked in and demanded an hour of my time. She described herself as a women’s rights activist.

“And I am not paying you any damn consultation fees,” she announced as she took her seat, her long dreadlocks forming meaningless patterns on her oversized spectacles. I sat back, not sure how to respond.

“A matatu crashes each day, killing seven women and severely injuring seven others; what would you do?” 

She had caught me off guard; I did not know what to say in response. I was convinced this was a trick question. And so I just smiled. After a series of analogies, Neema finally got to her point; it was all about

the ravage that cancer of the cervix is causing

on women in this part of the world.

Her point was that over half a million new cases of the cancer are diagnosed worldwide annually, 85 per cent of these in developing countries, with Africa being the most affected. This cancer causes about 260, 000 deaths worldwide annually.

In Kenya, 4, 800 new cases are diagnosed each year and 2, 450 deaths occur – about seven deaths each day, hence the analogy of the matatu. Cervical cancer is only second to breast cancer among cancers affecting most women in Kenya.

“I agree that is a crisis that we need to attend to urgently,” I said.

“What annoys me is that this is a totally preventable condition; whenever our women die of diseases we can prevent, I see it as a total injustice that should not be tolerated in the 21st century,” she said.

I nodded in affirmation. She was right. We can actually prevent cervical cancer. Risk factors associated with the condition are well known. Early sexual debut is one of them. A number of girls indulge in unprotected sex rather early in life, increasing their

risk. Similarly, multiple sexual partners, failure to use a condom, and pregnancy and delivery at a young age are all risk factors that we have capacity to prevent.

“I have heard all this said but sometimes I do not understand how these factors increase risk for the disease,” the lady interrupted. “I also do not believe that we should be too controlling of people’s sexuality. Everyone has a choice in how they enjoy their sexuality.”

Well, the link to these risk factors is the Human Papilloma Virus (HPV). This virus is very easily transmitted sexually. In fact about 50 per cent of the population is infected and unfortunately, they are not aware

since it carries no obvious symptoms. The virus is found in 98 per cent of all women with cancer of the cervix. It has been shown to be a trigger in the development of cancer.

In most cases, if you get infected with HPV, your immune system easily clears it from the body. In other cases the virus persists in the cervix and over time, causes abnormality in the cells, making them cancerous.

This can take many years – as long as 10 to 20. Those exposed to the virus in their teenage years will likely develop the disease after the age of 30.

The persistence of the virus in the cervix is more common when the immune system is weak. Pregnancy, smoking, malnutrition, HIV and other chronic illness weaken the immune system, increasing the risk of HPV persisting and derailing the cells of the cervix.

In case you are already infected, the good news is that we can easily detect HPV through laboratory tests. Even if we do not run tests to detect the virus since these can be costly, we are able to detect the changes it causes to the cells of the cervix quite early

before cancer develops. Any woman below the age of 30 should therefore have a Pap smear done at least once every three years to check the status of the cells of the cervix.

Those above 30 years should do both Pap smears and tests to detect HPV infection. These tests help identify women who may develop cancer in years to come.

Treating HPV infection as well as abnormal cells in the cervix is easy and effective in preventing cancer from developing, and has helped to nearly eradicate the cancer in developed countries.

“That is exactly what I mean; why is it not happening here? Can you talk to all the women you meet and tell your medical people to make them widely accessible?” Neema asked.

And so I made my commitment to Neema to spread this information as I took her Pap smear and HPV test samples, for charity begins at home.