60th Courier Anniversary Issue
     
60th Anniversary Issue
 
Supplement Articles
:: Mayoralty Candidates & their vision for Baguio
:: What have we done to our city?
:: Leadership a
la Sudcordillera
:: If I could vote,
I would vote for...
:: A look at the northern youth vote
:: Shanty Town: rethinking
our mountains' development
:: Ma Fok's Secret
:: Ibaloi in international media
:: Preventing cervical cancer
:: Prostate cancer:
a brief perspective
:: Baguio Midland Courier goes online
:: Courier in the '60s
:: Baguio media notes and anecdotes
:: When headline writers become headline makers
:: The History of Baguio City National High School
:: 60 things to do and places to see in Cordi
:: How to make Baguio a child-friendly city
:: Election Cartoons
 
trisha Preventing
Cervical Cancer
Dr. Yvonne Toquero-Soriano
 

My biggest frustration as a gynecologic-oncologist is to see newly diagnosed patients with cervical cancer. Why? Because it could have been prevented.

Despite it being preventable, the Philippines remains second to Indonesia in South East Asia in terms of incidence of cervical cancer. Cervical cancer is still the second leading cancer among Filipino women. An estimated 7,300 new cases are diagnosed in the country annually and about 3,800 die of the disease each year.

The development of cervical cancer is primarily being linked to an infection caused by the human papilloma virus, which is transmitted through sexual contact. About 40 types of HPV are known to infect the genital tract of men and women. It is a very common infection that at least 50 percent of sexually active people acquire the virus at some point in their lives. In the United States, about 6.2 million people get infected with HPV every year. Most HPV types cause no symptoms and the infection resolves by itself. However, some HPV infections persist and cause abnormal changes in the cervical cells that, if left untreated, may lead to the development of cervical cancer. Cervical cancer associated with HPV infection has been documented in 99.7 percent of the cases worldwide.

Preventing cervical cancer can be achieved at two levels. The first is by avoiding risk factors that predispose a woman to developing the disease. Certain sexual behaviors can increase the risk of acquiring HPV infection such as having sex at an early age, having many sexual partners, having a partner who has had many sex partners, and having sex with uncircumcised males. Such sexual behaviors also increase the incidence of other sexually transmitted diseases including human immunodeficiency virus infection, which again increases the risk for cervical cancer. Smoking is another risk factor because cancer-causing tobacco by-products have an effect on the cervical mucus and may damage the cells in the cervix. The use of condoms, meanwhile, can reduce the infection rate of HPV by as much as 70 percent. Thus, by changing sexual practices (delaying onset of sexual intercourse and having a monogamous sexual relationship), avoiding smoking, and using the condom, a woman could decrease her chances of developing cervical cancer.

The second level of prevention is by detecting precancerous lesions and treating them early. The most widely used method for screening cervical cancer is the Pap smear, which involves taking a sample of cells from the cervix to determine whether abnormal cells are present. It is a simple procedure that requires insertion of a speculum into the vagina to access the cells of the cervix.

All women should start having their Pap smears three years after the onset of sexual intercourse and it should be done every year thereafter. Beginning at age 30, women who have had three normal Pap test results in a row may get screened every two to three years. Women who have certain risk factors such as diethylstilbestrol exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually. Women 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening.

Contrary to popular belief, the Pap smear is not meant to diagnose cervical cancer, but rather to detect precancerous lesions in the cervix. Precancerous lesions are precursor  lesions that could later on progress to cervical cancer. It takes about 10 to 15 years for precancerous lesions to develop into cervical cancer. Thus, having regular Pap smears would allow detection of these lesions earlier, making them easier to treat than cervical cancer. Treating precancerous lesions only involves simple ablation and excision procedures such as electrocautery, cryotherapy, and conization that do not necessitate removal of the uterus. On the other hand, the treatment of cervical cancer would sometimes  involve radical surgical procedures and/or combination chemotherapy and radiation, which have a great impact on the physical, emotional, psychological, spiritual, and economical well-being of the patient and her family.

A recent breakthrough in the prevention of cervical cancer is the introduction of the HPV vaccine. It was developed to prevent cervical cancer and other diseases in females, caused by certain types of genital HPV. Two brands of the vaccine are available so far. One is a bivalent  vaccine, which protects against two types of HPV (16 and 18). The other is a quadrivalent vaccine, which protects against four types of HPV (6, 11, 16, and 18), which together cause 70 percent of cervical cancers and 90 percent of genital warts.

The vaccine is recommended for females aged 9 to 26 years old, because the vaccine is most effective in those who have not yet been infected by any of the HPV types covered by it. Thus, it should ideally be given prior to the onset of sexual           contact. Females who are sexually active may also benefit from the vaccine, but they may get lesser benefits from the vaccine if they have been infected by one or more HPV types covered by the vaccine. Research has recently begun on the vaccine’s safety and efficacy on women older than 26 years old.

The vaccine is given through a series of three shots over a six-month period. It has been shown by studies to have no serious side effects, and the most common side effect is soreness at the injection site. The length of time that the vaccine offers protection or immunity is not yet known. However, studies have demonstrated that women are still protected after five years from receiving immunization. Further research is being conducted to determine how long protection will last and if a booster vaccine is needed years later.

Preventing cervical cancer is not a complicated process. A little lifestyle change and a simple test could save many women from suffering from this dreaded disease. With all the available options for prevention, every woman should consciously make an effort to protect herself from cervical cancer. If that happens, and I hope it would, I look forward to the day when I will no longer be treating even a single case of cervical cancer, ever!


Dr. Yvonne Soriano is a graduate of the University of the East Ramon Magsaysay College of Medicine. She had her residency training at the OB-GYNE department of the Saint Louis University Hospital of the Sacred Heart and underwent further  training on Gynecology at University of the Philippines - Philippine General Hospital in Manila. She is a fellow of the Philippine Obstetrical and Gynecological Society and Society of Gynecologic Oncologists of the Philippines. She is pre sently affiliated with several hospitals and holds her clinic at the Notre Dame de Chartres Hospital in Baguio City.

 
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