Eradication of cervical cancer in the next century?

HPV vaccine can potentially eliminate cervical cancer by 2120

 

Cape Town, 4 March 2020: The World Health Organization (WHO) and experts in the field are hopeful that cervical cancer will go the way of smallpox and become a historical disease over the next 100 years. This is especially good news for low-and-middle-income countries like South Africa with a high incidence of this disease.

Cervical cancer is the leading cause of cancer deaths and the second most commonly diagnosed after breast cancer among South African women.

99% of cervical cancers are caused by the Human Papilloma Virus (HPV) infection. This infective cause means it is one of the few preventable cancers if one can prevent the HPV infection or detect the early signs before cancer is formed.

A global vaccine programme is being rolled out in more than 130 countries. This includes South Africa. Following the implementation of this programme there are already indications that there has been a decline in infections of the HPV-16 and HPV-18 strains, the strains that are the main culprits linked to cervical cancer.

Dr David Eedes, clinical oncology advisor of Icon Oncology, the biggest network of private oncologists in the country, explains that HPV is widespread and a high percentage of South Africans who are sexually active will become infected with HPV during their lifetime.

“HPV infection can often go undetected as it generally has no significant effects on a person’s health. In some cases, HPV can cause genital warts which are visible. Of greater concern is that HPV causes the growth of abnormal cells in the cervix which may then lead to cancer development.”

“The reason cervical cancer is so often fatal is that most women only have symptoms at a late stage of the disease. This means that it is much more difficult to treat and interventions including surgery, radiotherapy and chemotherapy are less effective” says Eedes. ‘Regular screening by means of a PAP test and other examinations can detect the HPV infection and early cell changes of the cervix. This can then be treated, often fairly simply, and this will prevent the development of cancer. Cervical cancer, even without HPV vaccination, is a preventable cancer. The vaccination prevents the cause of the disease, but the disease is still preventable even in women who are not vaccinated by early detection.’

Studies show women living in low-to-middle income countries are particularly vulnerable. This is often because of inadequate access to healthcare infrastructure for education, prevention and early detection. Lack of screening programs and early intervention leads to late diagnoses and so to the high mortality rates.

“We know that poverty and unemployment lead to lack of access to health education. Poverty is often associated with earlier sexual activity and young girls being sexually vulnerable. These factors are linked to unsafe sexual practices. In South Africa the very high prevalence of HIV/AIDS with its associated immune compromise is also strongly associated with the very high rates of cervical cancer locally.” explains Eedes.

The good news is that through its successful vaccination programme launched in 2014  by the  Department of Health (DoH) in partnership with the Department of  Education (DoE), South Africa could be one of the first  African countries to eradicate HPV related cervical cancer in the future.

The HPV vaccination programme implemented in public schools since 2014 by the DoH has already protected a high percentage of girls in South Africa and we are well on our way to ensuring a mostly HPV-free generation of young women.

From a healthcare provider’s point of view, this is even better news. “Icon strongly champions better access to quality cancer care in South Africa. Our protocols mainly aim to ensure high-quality cancer treatment that is clinically appropriate and evidence-based and to reduce wastage. By doing this we aim to ensure high-quality cancer care for the greatest number of patients. However, once the cancer is diagnosed, treatment has a major impact on the quality of life of a patient, causes suffering and is expensive to manage.”

“If we can eradicate, or at least limit the occurrence of cervical cancer many patients will be spared the pain, suffering and potential death from this disease, not to mention the financial and social impact. Women who could have been potential cervical cancer patients will instead remain economically active and healthy. The money saved can then be used to better manage other cancers that are not preventable.” says Dr Eedes.

Icon Oncology’s latest statistics show that the cost of treating cervical cancer patients in the private healthcare sector is costly. In the public healthcare system, where the vast majority of cervical cancer patients are managed, it is a major drain on healthcare resources. As patients often present with advanced and incurable disease, the socio-economic consequences are huge. Most of these women are economically active and support their, often extended, families. As the mortality rate from this disease is very high due to issues of late presentation, to be able to reduce or prevent this disease will be of major importance

The programme was launched in 2013 to introduce the HPV vaccine to grade 4 girls (between the ages of 9 and 13 years) in quintile 1-4 schools in 2014. In another proactive move, the DoH has also announced the extension of the programme to include girls in Grade 5 over the age of 9-years with the necessary consent, who did not receive the HPV vaccine in 2019 to have a second opportunity to be vaccinated.

The vaccination is safe and most effective when given at ages nine years and older or before girls become sexually active. In SA, the HPV vaccination was approved by the South African Health Products Regulatory Authority in 2008 for its efficacy and safety.

HPV statistics

  • The prevalence of cervical cancer in South Africa is reported to be between 22.8 and 27 per 100 000 women as compared to the global average of 15.8.
  • 5 743 new cases are reported each year.
  • Approximately 3 000 women die from cervical cancer each year in South Africa.
  • 99% of cervical cancers are associated with HPV.
  • Almost 7 in every 10 people will have HPV at some point in their lifetime.
  • 2 strains of HPV (HPV-16 and HPV-18) are found to cause over 70% of cervical cancer cases.
  • Cervarix® is the vaccination that will be administered in 2 doses for optimal cover. It protects against the HPV-16 and HPV-18 strains.

(Source: Western Cape Government)

 

4 March is International HPV Awareness Day. This aims to promote education about HPV and to raise awareness around prevention methods; “For those of us involved cancer care the focus is mainly on the treatment of cancers. Cancer prevention is not often part of our practice. For a highly preventable disease such as cervical cancer, it is vital that we highlight and support the wonderful work of the DOH’s vaccination programme. Icon strongly encourages parents to consider vaccination of their daughters and, where financially possible, their sons as well.” says Eedes.

For more information visit www.iconsa.co.za and www.health.gov.za.

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