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Cervical cancer

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For women in Jordan, cervical cancer is the 11th most frequent cancer and the 10th most prevalent in women between the ages of 15 and 44. (Photo: Shutterstock)
January is the month dedicated to cervical health awareness. Of the many cervical health issues, none is more important than cervical cancer. اضافة اعلان

It is currently estimated that 115 women in Jordan are diagnosed with cervical cancer and 71 will die from the disease. For women in Jordan, it is the 11th most frequent cancer and the 10th most prevalent in women between the ages of 15 and 44. Fortunately, the risk of this disease can be greatly reduced through the means of modern medicine and early detection.

What is cervical cancer?

The cervix is the lower part of the womb in the female reproductive system. Much like other cancers, cancer is the result of cells growing out of control, which places high demand on the body as these cells consume all the nutrients in the surrounding area.

What makes cancers particularly deadly is not the high demand they place on the body, but their ability to move to more vital areas of the body. Cancer cells undergo a process known as metastasis, through which cancer cells travel from their original location and begin to grow in a different area of the body. Some of the most common places for cervical cancer to spread are the lymph nodes, liver, lungs, and bones. This is specific of most other cancers; what is unique is the origin of the disease.

The majority of cancers have unknown triggers that result in coding errors in the DNA, leading to mutations. Typically, it is a multifactorial condition that involves environmental triggers, genetic predisposition, and sometimes just random chance.

Cervical cancer, however, is caused by a single virus in the majority of cases. According to the World Health Organization estimates, it is believed that the human papillomavirus (HPV) is responsible for over 95 percent of all cervical cancer cases.

HPV

HPV is a large family of viruses that can be further divided into specific types. Some may know HPV as the virus that causes warts on the skin, particularly on the arms, chest, hands, and feet. Some types of HPV are found on the mucous membranes of the body, such as the mouth, throat, anus, and vagina. These types of HPV are commonly referred to as genital HPV.

Genital HPV can be further classified into two categories. One is the low-risk HPV type, which can cause warts that form on or around the genitals and anus of both men and women. In some women, the warts may also form inside the vagina and on the cervix. These types of HPV are classified as low-risk because they rarely cause cancer.

High-risk HPV types are of greater concern. In most people, the immune system is able to fight off the infection, but in some instances, the virus remains. Chronic and long-standing infection, especially with the HPV 16 and HPV 18 types, may cause cancer over time. Cancer caused by HPV is not limited to the cervix, it may also include cancers of the mouth, throat, anus, and penis.

HPV is transmitted via skin-to-skin contact. Genital HPV is most commonly transmitted through sexual intercourse.

HPV is extremely common, and signs or symptoms do not have to be present in order to transmit the virus. Its prevalence is so great that it is believed that the majority of men and women who have ever partaken in sexual activity will contract the virus. Still, skin-to-skin contact of the affected area is all that is required to transmit; there may be other mode of transmission that are not known yet. As a result, even abstinence is not a complete guarantee that one does not get HPV.

Condoms may offer some protection, but do not guarantee full protection either.

Preventing cervical cancer

To date, there is no treatment for HPV, but in the majority of cases, the infection will resolve itself. Nevertheless, there are ways to prevent getting cervical cancer. The two most widely employed methods are regular screenings and vaccination.

According to the American Cancer Society (ACS), cervical cancer screening should begin at the age of 25 and those between the ages of 25 and 65 should get screened and tested every five years for HPV.

The Papanicolaou test, more commonly known as Pap smear, is specifically used to screen for cervical cancer. The test is simple and safe, and also highly effective. When pre-cancerous cells or cancer cells are found early, the chance of successful treatment is greatly improved.

Unfortunately, early cervical screening may be a concern in Jordan, as there may be stigma and lack of knowledge surrounding the procedure. One study found that 75 percent of women in Jordan never had a Pap smear. When asked why they did undergo early screening, 30 percent reported it was unnecessary as they do not experience and symptoms, an additional 30 percent reported they did not know, and 22 percent reported they were fearful or embarrassed. Furthermore, only 33 percent were aware that a Pap smear was used to screen for cervical cancer.

With earlier detection, the incidence of cervical cancer may not decrease, but the mortality rate may decrease significantly. This was demonstrated in the United States when the use of Pap smear became standard practice, resulting in a significant drop in mortality. Currently in the US, the majority of deaths due to cervical cancer are in women who have never had a Pap smear or who did not have one recently.

Currently there is only one vaccine with USFDA approval for preventing HPV, although there are other vaccines available outside of the US. Gardasil 9 is a vaccine used in the prevention of HPV-related cancers. It is formulated to provide protection against nine of the most common high-risk types, which include HPV 16, 18, 6, 11, 31, 33, 45, 52, and 58. Combined, these nine viruses are responsible for 90 percent of all cervical cancers.

The ACS recommends that boys and girls between the ages of 9 and 12 receive two doses of the vaccine and those between the ages of 13 and 26 receive theirs as soon as possible. The efficacy of the vaccine drastically falls with age and protection against the virus would not be as strong for those immunized as young adults compared to those immunized as adolescents. As a result, the ACS does not recommend that those older than 26 years of age, receive the vaccine.

Unfortunately, use of the vaccine in Jordan is limited, but may be purchased abroad. The Gardasil 9 vaccine costs around JD177, but a cheaper alternative is also available. Cervarix is available for JD21 and protects against the HPV 16 and 18 types, which account for 70 percent of cervical cancer cases alone.

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