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Saturday, May 28, 2005
Women's silent killer
By Henrylito D. Tacio
CERVICAL cancer kills an estimated 274,000 women annually. Every year, some 80 percent of the world's new cervical cancer cases -- and a similar proportion of the deaths from the disease -- occur in developing countries.
"In many of these countries, cervical cancer is the leading cause of cancer deaths among women," says the new report, 'Preventing Cervical Cancer Worldwide,' published by the Washington-based Population Research Bureau (PRB).
In the Philippines, there are about 5,000 new cases of cervical cancer each year. Even more alarming is the fact that there are between 10,000 to 25,000 women walking around who never know they have the deadly disease.
"For every four survivors of breasts cancer, there are less than 3 women who survive cervical cancer, which shows how virulent cervical cancer is," says Dr.
Philip Chua, a medical practitioner who writes a column for a national daily.
Rina Jimenez-David, a recognized advocate in reproductive health, agrees. "While breast cancer is the most common form of cancer for women in the country, it is not the most deadly," she writes in her widely read Inquirer column. "The death toll from cervical cancer is higher than for breast cancer, and this is mainly because by the time its victims come for treatment, it is already too late."
The PRB report said that if it is not detected and treated in a timely way, cervical cancer is nearly always fatal. Hong Kong pop star and actress Anita Mui announced in September 2003 that she had cervical cancer.
But she assured her fans that her condition was stable and that she had no fears and would win the fight. "I am not a weak person... I can tell you that I have never had any fears and I will win this fight," she said during a news conference in Hong Kong.
Unfortunately, she lost. Four months after the announcement, she was admitted to the Hong Kong's Sanitarium Hospital after slipping into a coma. She died on the early morning of December 30.
In the Philippines, cervical cancer ranks as the second most common type of cancer prevalent among women. The cervix, the lowest portion of the uterus, juts into the vagina where it can be felt, seen, and examined by the gynecologist. Its lips surround an aperture that opens into a canal leading into the interior of the uterus. That's the route the sperm follows for its rendezvous with the egg. During pregnancy, the cervical lips become progressively softer so that they can dilate sufficiently when it is time for the baby to exit the womb.
"The cervix sees lots of action in the lifetime of most women, from the trauma of innumerable penile thrusts to a variety of infections," notes Dr. Isadore Rosenfeld, the author of bestselling 'The Best Treatment.' "No small wonder, it is often the seat of cancer."
About 85 percent of cervical cancers are squamous cell carcinomas, which develop into the scaly, flat, skinlike cells covering the outside of the cervix. Most other cervical cancers develop from gland cells (adenocarcinomas) or a combination of cell types (adenosquamous carcinomas).
"Cervical cancer can penetrate deep beneath the surface of the cervix, enter the rich network of small blood and lymphatic vessels that line the inside of the cervix, and then spread to other parts of the body," explains 'The Merck Manual of Medical Information.' "In this way, the cancer can spread to distant areas as well as to areas near the cervix."
The vast majority of cases are caused by human papilloma virus (HPV), a sexually transmitted agent that infects the cells of the cervix and slowly causes cellular changes (dysplasia) that can result in cancer. These changes can be relatively mild ones which often do not progress, or regress. Larger, deeper lesions (severe dysplasia) are more likely to progress to cancer.
"Women generally contract HPV in their teens, 20s or 30s, and cervical cancer can develop 20 years or more after HPV infection," the PRB report states.
There are several other factors that may trigger to develop cervical cancer among women. These include tobacco use; an impaired immune system, particularly related to human immunodeficiency virus infection; and hormonal factors, including early age at first birth, use of hormonal contraceptives, and having many births.
"Other factors, such as early age at first intercourse and multiple sex partners, can indirectly heighten the risk of cervical cancer by increasing
a woman's likelihood of contracting an HPV infection," the PRB report notes.
"Cervical cancer begins on the surface of the cervix and can penetrate deep beneath the surface," the Merck manual informs. "The cancer can spread directly to nearby tissues, including the vagina. Or it can enter the rich network of small blood and lymphatic vessels inside the cervix, and then spread to other parts of the body."
If detected early, cervical cancer is curable. "There is no reason for any woman to die of cervical cancer," deplores Noe Tuason, a Filipino research scientist at the University of San Francisco Comprehensive Cancer Center.
One of the many ways to detect cervical cancer is through the Pap smear test. Developed by Dr. George Papanicolaou, the procedure involves scraping cells from the cervix onto a glass slide and sending the sample to a laboratory to be examined by technicians trained to analyze cell structure. Women usually receive the results within several weeks.
"If the woman is healthy and without any complaints or symptoms, and the Pap smear is negative, she will simply need to have a regular follow-up including another Pap smear, annually or sooner, depending on the advise of her gynecologist," says Dr. Chua.
Unlike in industrialized countries - where they have enough cytology laboratories, equipment, trained personnel and competent referral and follow-up system for the Pap smear program - the Philippines introduced a different screening approach using vinegar called acetic acid visualization. For comments, write me at tasyo2002@yahoo.com.
For Bisaya stories from Davao. Click here. (May 28, 2005 issue)
Write letter to the editor.Click here.
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