Samantha Perry has a family history of breast cancer. With this in mind she went for regular check-ups. But then she received a call telling her to come to the doctor’s office to discuss her abnormal results. There was no breast cancer.
The concern was cervical cancer.
“When they tell you that you have precancerous cells, your entire body goes cold,” says Perry.
She was 31 at the time. She had no symptoms, nor was she in any kind of pain or discomfort.
“I was perfectly normal. Then I got the call.”
Perry is among the women who, because of regular check-ups and pap smears, had the advantage of early detection.
The Cancer Association of SA (Cansa) says cervical cancer is the second most common cancer in South African women.
This month, the organisation had a special focus on cervical cancer.
One in 42 women will be diagnosed with cervical cancer. Cervical cancer is primarily caused by the human papilloma virus (HPV). The most common cancer in women is breast cancer, with one in 35 South African women diagnosed.
Pap smears detect abnormal cells in the cervix, which lead to cervical cancer.
After being told about the abnormal result, she was biopsied. This confirmed that two thirds of her cervix was covered in precancerous cells.
“I was aware of it, but cervical cancer was something I’ve not ever thought of. It was a complete shock,” she says.
The first treatment option is to use laser to get rid of the cells. If it reoccurs, the cells must be cut away. The third option is a hysterectomy.
Perry’s doctor scheduled her for the laser out-patient procedure. She describes the actual biopsy as more painful than the procedure. She was sore and tender for about a week.
After her diagnosis, she realised many women had gone through the same thing, and that it was completely treatable and manageable, provided it was detected early enough. The trouble, however, is that nobody spoke openly about it. And because even after the laser and cutting procedures, there are no outward signs and it can go completely undetected by close family and friends.
Breast cancer does tend to get more air-time than cervical cancer, says Perry. But women must realise how important it is to get regular pap smears.
After the laser treatment, Perry went for a six month check-up. The precancerous cells were back. This time around, she would need to have them cut out.
Again, she went as an out-patient, had the procedure, and was discharged. Driving was painful because the seatbelt pressed against her lower abdomen which was still sore. But as was the case the last time, recovery time was about a week.
Perry was hit by another reality check. The doctor suggested that if she was wanted to have children, now would be a good time. If the cancerous cells came back one more time, she’d need to have a hysterectomy.
Perry is now 39 and healthy, and has been clear of cancer since the cells were cut out.
Even though she had been exposed to one cancer-causing strain, she opted to have the vaccination so that she could be protected against other strains.
For the first few years Perry had to be tested every six months. She’s back once every two years.
She stresses the importance of getting regular pap smears and vaccinations, if possible.
If you’ve had sex, chances are you’ve probably been exposed to a strain of HPV which is transmitted by skin-to-skin contact. There is a transmission risk even when condoms are used because it does not cover everything.
“Every woman must get tested. It must be done. It was frightening, but once it was explained I thought, let’s calm down. It’s treatable and manageable,” says Perry.
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Signs and symptoms
Early on, cervical cancer may not cause signs and symptoms. Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal, such as bleeding after sex.
If any of these signs are present, a medical doctor should be consulted.
The cause may be something other than cancer, but the only way to know is to consult a medical doctor.
Progression of the disease is slow and may take as long as 10 to 20 years before the disease becomes invasive.
All women over the age of 25 must have a pap smear at least every three years.
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Risk factors:
HPV infection is the major cause of cervical cancer, but several other risk factors are linked to the development of cervical cancer. According to Cansa, these include:
Having sex at an early age.
Having many sexual partners.
Smoking tobacco products.
Using oral contraceptives.
Having a weakened immune system.
Poor economic status (may not be able to afford regular Pap smears or have limited access to screening services).
Sexual partners who have multiple partners or who participate in high-risk sexual activity.
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What is HPV?
HPV is very common with more than 130 strains, 40 which affect the genital area. Most people will clear the virus naturally, but others are not able to and it can lead to genital warts, and cancers of the cervix, vulva, vagina, anus, penis and throat.
The virus can spread easily through skin contact, even without sex.
Those with the virus won’t necessarily show symptoms for years, and can spread it to others. Those aged 15 to 24 carry the highest risk for HPV infection.
HPV can survive undetected on the skin and underneath fingernails. Eight out of 10 adults have come into contact with HPV.
There is no cure for HPV.
For more info on cervical cancer visit www.cansa.org.za or contact Cansa toll-free 080 022 6622.
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Men and women are at risk
Women and girls are often the central focus when it comes to HPV, but men and boys are also at risk.
Dr Trudy Smith, a gynaecologist and obstetrician, says there is little awareness around boys and men who can be infected with and transmit the virus. Smith says that studies show that genital HPV infection appears to be as high in men as in women.
Professor Hennie Botha, head of gynaecological oncology at the Stellenbosch University, notes that HPV screening programmes for boys and men are lacking.
Botha says HPV can be a silent killer, because those with the infection often only seek help when a resultant cancer is at an advanced stage.
“Many women are diagnosed with cervical cancer in their mid to late thirties. Many of these women were most likely exposed to cervical cancer-causing HPV types during their teens and twenties,” says Botha.
While he describes the development of the HPV vaccines as the most exciting development, he cautions that there is no one vaccine that protects against all of the subtypes.
The one vaccine protects against the subtypes which causes cervical cancer and related lesions, while the other protects against cervical cancer and genital warts in men and women.
“The best time to vaccinate both male and female children is between the ages of 9 and 13 years, because the younger someone is, the better their body’s ability to mount an immune response against HPV,” Botha says.
If enough boys and girls are vaccinated, HPV could be eradicated, he says.