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Preventive measure

8 October 2008

If someone offered you a magic bullet for cancer, you probably wouldn’t even think twice about taking it. The creator would probably be awarded a Nobel Prize and lauded as one of mankind’s greatest heroes.

But why is vaccination for cervical cancer greeted with so much reluctance and shilly-shallying?

The biggest stumbling block to the prevention of this disease is probably its link to promiscuity. Just because it’s a sexually-transmitted disease, people presume that it is a reflection of one’s decaying sexual morals if one admits to having cervical cancer.

However, studies have shown that even young girls with only one sexual partner are at risk. In fact, the virus that causes the disease is so common that it can be passed on from just one sexual encounter or by mere contact via the fingertips (through genital touching).

In 2002, nearly half a million new cases of cervical cancer worldwide were reported with 275,000 deaths. Almost 80% of all cervical cancers occur in the developing world.

Virtually all cervical cancers are caused by some type of human papillomavirus (HPV), a common virus that infects about half of all people at some point in their lives. More than two-thirds of cervical cancer cases are attributed to high-risk types 16 and 18.

In an international study of women with cervical cancer in 22 countries, more than 90% of women in South Asia (India, Indonesia, the Philippines and Thailand) were infected with HPV, primarily types 16 and 18.

“The vaccination is most effective for girls between the ages of nine and 26, who are not yet sexually active,” said Dr Gerry Wain, director of gynaecological oncology, Westmead Hospital in New South Wales, Australia, during a workshop on cervical cancer prevention in Kuala Lumpur last month.

“The vaccine protects against four types of HPV (6, 11, 16 and 18); two of which cause 70% of cervical cancer. It has a 99% efficacy against cervical pre-cancers and cervical intraepithelial neoplasia (CIN) II and III, which is pretty close to a definition of a miracle,” he added.

In Australia, Dr Wain said that the government invested A$450mil (RM1.4bil) in a cervical cancer prevention campaign over the last two years, which included offering free vaccination through schools for 12-year-old girls.

“Considering the price of medication for cancer treatments, the government concluded that it was more cost-effective to pay for preventive measures.”

Even after getting a vaccination, women must still be screened (with pap smears) regularly as it is only a preventive measure and doesn’t offer total protection against the disease.

“HPV affects both sexes. Men tend to be carriers or acquire HPV infection that might result in penile or anal cancer, genital warts or other forms of cancer,” said Dr Wain.

In the United States, the rate of cervical cancer has been reduced drastically thanks to better awareness and screening. What’s different is the rise of anal cancer, also caused by HPV.

Gay and bisexual men are 17 times more likely to develop anal cancer than heterosexual men. In the States, they have introduced anal pap tests where the doctor collects cells from the anus, and then has them checked for abnormalities in a lab. Men with weak immune systems, including those who have HIV, are also more susceptible to developing anal cancer.

This article was first published in The Star on 10. July 2008

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