HER EXCELLENCY THE FIRST LADY MRS ZAINAB YA YA JAMMEH’S LIFESAVING INITIATIVE ON DEADLY DISEASE OF CERVICAL CANCER IN THE GAMBIA

Tuesday, November 01, 2016

Fact every 10 minutes, a woman dies in Africa from the cancer of the woman’s womb.

Under the Leadership of Her Excellency The First Lady and Honorable Health Minister Mr. Omar Sey has been set up a committee with number of Senior Specialist  Gyneacologists, Health Directors from Ministry of Health, Senior Nurses and Health professionals to facilitated Cervical Cancer Screening, Diagnose and treatments throughout the country to fight against the deathly Disease of cervical cancer and save many lives of in particular young women in the Gambia.

What is Cervical Cancer           

Cervical cancer is a cancer arising from the cervix (neck of woman’s womb).  It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body.  Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

Human papillomavirus (HPV) infection it is involved in the development of more than 90% of cases; most people who have had HPV infections, however, do not always develop cervical cancer. Other risk factors include, a weak immune system, long term using  birth control pills, starting sex at a young age, and having many sexual partners. Cervical cancer typically develops from precancerous (early sings of cancer) changes over 10 to 20 years.

.HPV vaccines protect against may prevent up to 90% of cervical cancers. As a risk of cancer still exists, guidelines recommend continuing regular Pap smears. Other methods of prevention include:  the use of condoms.

Cervical cancer screening using the Pap smear or acetic acid can identify early changes which when treated can prevent the development of cancer.

Treatment of cervical cancer may consist of some combination of surgery, chemotherapy, and radiotherapy.  Five year survival rates in the United States are about 68%.  Outcomes, however, depend very much on how early the cancer is detected.

Worldwide, cervical cancer is both the fourth-most common cause of cancer and the fourth-most common cause of death from cancer in women. In 2012, an estimated 528,000 cases of cervical cancer occurred, with 266,000 deaths in the developing countries.  .

It is actually a very true fact that every 10 minutes, a woman dies in Africa from cervical cancer (cancer of the neck of womb), identified significant number of cases here in The Gambia, incidence about 14% too, despite the fact that almost every case and I wish to emphasise almost every single case could be preventable through a programme of screening by been screened at least every two years.

 Fortunately screening and treatment facilities are so far available here in The Gambia in Teaching Hospitals at EFSTH which sponsored by the “FRANCES DE GAULLE FONDATION” a Gambian Charitable Organisation, SOS Clinic and some NGO and Private clinics.

 The risk factors as in other cancer types, also cervical cancer, and the onset of disease can be prompted by specific risk factors such as infected with HPV and these may be Genetically, environmentally or the commonest, the high risks of vaginal washing so called vaginal douching with water, locally made soaps, very often local and different herbal liquids, Dettol and many other harmful products which unfortunately sold in the various pharmacies.

 Also some products recommended by friends and beauty salons, even use of several different perfumes to please the husbands, confirmed this harmful habit in the clinics, possibly over up to 90%.

 Using any of these motioned harmful products on God given a very natural and healthy tissues in the vagina of every woman destroys the healthy and protective tissues and makes these area extremely vulnerable for developing millions of harmful bacteria, fungal, viral, HPV (human papilloma Virus) and in particular for extremely easy transmission of sexually transmitted diseases and certainly and undoubtedly for HIV virus.

 The outcome can end up not only with repeatedly serious symptoms of

Pelvic infections, long standing infertility (childless) and finally preventable death of very young women.in the Gambia.

 Cervical cancer symptoms

When present, common symptoms of cervical cancer may include:

§  Vaginal bleeding: This includes bleeding between periods, after sexual intercourse or post-menopausal bleeding.

§  Unusual vaginal discharge: A watery, pink or foul-smelling discharge is common.

§  Pelvic pain: Pain during intercourse or at other times may be a sign of abnormal changes to the cervix, or less serious conditions.

All of these cervical cancer symptoms should be discussed with your doctor.

Signs of advanced stages of cervical cancer

Cervical cancer may spread (metastasize) within the pelvis, to the lymph nodes or elsewhere in the body. Signs of advanced cervical cancer include:

§  Weight loss

§  Fatigue

§  Back pain

§  Leg pain or swelling

§  Leakage of urine or feces from the vagina

§  Bone fractures

Cervical Cancer - Diagnostic Procedures

 Cervical cancer is one of the most common types of cancer among women worldwide. The good news is that 92% of the cases in early stage can be detected and treated if a woman undergoes regular pelvic examination and Pap Smear tests. Many methods currently exist to detect cervical cancer and to treat.

 What is Smear test

The most common diagnosis for detecting cervical cancer in its early stages is a harmless and painless performed just in few minutes procedure called a Papanicolaou test or Pap smear. This test can be performed in any clinic with a trained doctor or nurse.

 Women who are 16 (early marriage) or older or who are sexually active are recommended to undergo Pap smear tests every 2 to 5 years.

 The procedure is performed while a woman is lying on her back on a gynaecological table. The trained doctor or a trained nurse will insert an instrument called a speculum inside her vagina collecting some cells from the neck of the womb using a swab a small brush.

 The cells are prepared then sent to the EFSTH laboratory where they are studied under a microscope to determine if any precancerous (early signs) or cancerous cells exist. If the tests show any abnormalities, the patient will be asked to return to the Gynaecologist so an additional test can be performed called Colposcopy If the test results are negative, women can schedule a 2-5 years appointment to repeat the test.

 Colposcopy

Another method used to detect cervical cancer is called colposcopy which is fortunately available at EFSTH and some other Clinics. This procedure involves the use of a special binocular microscope that is called a colposcope and is very similar to a Pap smear and can recognise any abnormal cells on the neck of the womb.

 The doctor can then view the cells using the high-powered microscope to detect any abnormal cancerous cells.

Some women are more at risk than others. Following factors increase the chances of Cervical Cancer in women:

 Human Papilloma Virus: HPV infection is a widely spread sexually transmitted agent. HPV infection has been identified as the most common risk factor by about 98% for cervical cancer.

 Multiple Sex partners:

Polygamy and women who have more than one sex partner are at higher risk by increasing the chance of a Human

 Early Sexual activity:

Women who have had early sexual activity before 18 years of age are more at risk as the vaginal and cervical cells are very fragile at this young age.

 Sexually transmitted Diseases (STI)

Women who have had some other Sexually Transmitted Disease (AIDS, GONORRHOEA) are more prone to Cervical Cancer. Family history of cervical cancer: Some families show a higher incidence of cervical cancer. Some scientists believe they might carry a genetic condition making them more sensible for the negative effects of HPV infections.

Age seems to play a definite role as this cancer is more common in very young women age 18-35 in the Gambia and quite rare in the older women.

 Contraceptive Pills:

Women who are regularly on the pills for many years may get Cervical Cancer faster as they do not use condoms which are more suited

to prevent STI’s. 

Income/socio-economic status:

 Since the earning levels are directly related to the living standards, lower income women are almost 5 times more at risk than higher income groups.

Race: African Asian women are at higher risk of having cervical cancer and are more likely to have an advanced stage at the time of detection than Caucasian Women.

 Unhealthy diets:

Improper diet is also a reason that can put women at risk. Malnutrition is also recognised as a cause.

• High fasting blood sugar levels: Incidences of cervical cancer are more in the women who have 140mg/DL levels of Glucose Sugar.

 Multiple pregnancies:

High number of pregnancies and multiple child birth may also increase the risk of cervical cancer in the women.

So summarising the risk factors, besides these which cannot be influenced such as age, race and family history, some of them can be positively modified, like sexual habits, smoking or diet, to lower the risk for cervical cancer.

 How cancer Cells spreads

Cancer cells often travel to other parts of the body where they can grow and form new tumours that crowd out normal tissue. This happens when the cancer cells get into the body’s bloodstream or lymph vessels. The process of cancer spreading is called metastasis.

No matter where a cancer may spread, it’s always named based on the place where it started. For instance, bowel cancer that has spread to the liver is called metastatic colon cancer, not liver cancer. In this case, cancer cells taken from the liver would be the same as those in the bowels.

 Vaccination

Vaccination against HPV is advised for females age 9-14 and up to 26 of women age without sexual activities before for prevention of HPV infection, cervical cancer, as well as genital warts. It’s only effective when given to people before they become infected with the virus. This is why it’s recommended that you get it before you’re sexually active.

Gardasil is one such vaccine, and it guards against the two most common high-risk types of HPV, strain 16 and 18. These two strains are responsible for 70 percent of cervical cancers. It also guards against strain 6 and 1, which cause 90 percent of genital warts.

Because men can carry HPV, they should also talk to their doctors about being vaccinated. According to the CDC preteen boys and girls should be vaccinated at age 11 or 12. They get the vaccine in a series of three shots over an eight-month period.

The good news is that now the vaccine is available in the Gambia at Ministry of Health through the support and initiated by The First Lady and Honourable Health Minister.  

When to seek medical advice

You should contact a specialist Gynaecologist if you experience:

bleeding after sex (postcoital bleeding)

bleeding outside of your normal periods

new bleeding after the menopause

Vaginal bleeding is very common and can have a wide range of causes, so it doesn’t necessarily mean you have cervical cancer. However, unusual vaginal bleeding is a symptom that needs to be investigated by specialist Gynaecologist.

 Finally, what are your recommendations to reduce the risk of cancer

* Bear in your mind that prevention is always better than cure and remember it is never too late to start decreasing all the above motioned risk factors, in particular stop smoking and/or drinking.

* Obesity (overweight) is associated with marked increasing diseases such as diabetes, high blood pressure and some hormonal-dependent cancer, even such as breast and womb cancers. Studies have shown that population with diets high in fruits and vegetables and low in animal fat, meet, or calories have a remarkable reduced risk of some common types of cancers. Limit consumption of fat and refined carbohydrates, including pastries, sweetness, soft drinks, and limit sugars in tea, coffee and in particular too much of drinking Ataya drink counting tremendous amount of sugar. 

* Finally, while you are reading this article there are millions and millions of people suffering from cancer symptoms and complications worldwide. Be wise and do not join them as the risk of developing most types of cancer can be reduced by changing in person’s lifestyle and a healthy diet for every member of your family and as a nation as a whole.

For further information contact specialist Gynaecologists at EFSTH, SOS Clinic, Ministry of Health (Health promotion Departments) and number of Doctors in NGO and private Clinics, Frances De Gaulle Njie Foundation web site, E-mail to drhassanazadeh@gmail.com, or text only to DR AZADEH on 002207774469/3774469 between 3-6 pm

Author DR AZADEH Senior Lecturer in Obstetrics & Gynaecology at the University of the Gambia, Clinical Director at Medicare Health services.

Author: Dr Azadeh
Source: Picture: Dr Azadeh