GYN CHRONICLES
Cervical Cancer : Prevention Strategies
Dr . Maureen Owiti
It ’ s my hope that 2023 is taking all of you well thus far . The title for my column on this edition is rather gloomy but so is medicine and such is life . When there is a bad situation , it is the role of the healthcare provider to support the patient regardless of the prognosis .
2022 ended on a rather miserable note as on 29th December 2022 , our celebrity media personality , Catherine Kasavuli , breathed her last . It was quite unfortunate and an even bigger tragedy as cervical cancer is one of the few cancers that can be prevented .
They say there is always a silver lining behind every dark cloud or if life gives you lemons make lemonade . So the silver lining in this sad saga is what can we do to prevent further deaths from cervical cancer . As January is the cervical cancer awareness month , I ’ am taking this opportunity to delve into prevention strategies .
To understand why cervical cancer is preventable you have to understand what causes it in the first place , and how the disease progresses . Unlike many other cancers , it has been confirmed that cervical cancer is caused by the Human Papilloma Virus ( HPV ). If you know the cause then it means you can try to find a modality to treat it . The link between cervical cancer and HPV was discovered in 1983 by Harald zur
Hausen , a German virologist and professor emeritus , that earned him the Nobel prize for Physiology or Medicine in 2008 .
This discovery led to the development of a vaccine which is responsible for a 26 % reduction in cases of cervical cancer and 51 % reduction in deaths from cervical cancer . HPV vaccine is available free of charge in all vaccination centers to girls aged 10-13 years courtesy of the Government of Kenya . I would encourage parents to have their children vaccinated .
The vaccine can still be given to older girls and women , but this is not catered for in the vaccination schedule so for this one has to pay cash . Cost depends on the type of the vaccine . There are 3 types of vaccines based on the number of strains being protected . The most populous is bivalent ( against 2 strains namely 16 and 18 ). The quadrivalent vaccine vaccinates against 4 stereotypes of HPV and the nonavalent is effective against 9 types of HPV strains .
Sienna ( not her real name ) is a wonderful young lady like most of my patients . She was 35 years old and had come in for a general and fertility check . After the usual pleasantries and confirmation of what she wanted we proceeded to do a breast exam and pap smear for her , plus some fertility tests .
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We must remember that even if we have been vaccinated against cervical cancer , we still need to come in for regular screening . Vaccination and screening saves lives , and so we encourage all of you to get tested and vaccinated .
`As usual she was very apprehensive about the pap smear and made a huge fuss about it . She told me “ Doc I have a very low threshold for pain !!” Being the usual me I assured her that if she was sexually active procedure was at best only mildly uncomfortable especially if she was able to relax and allow for the examination . Jokingly I told her “ I call myself the papsmear whisperer !!!” Pun intended !!
Fortunately for her she believed me and to Sienna ’ s surprise the procedure was over in a matter of minutes and she actually asked me if I had finished . I laughed and asked “ I can repeat the procedure if you think I haven ’ t finished !” I bet we can all guess what her response was … A BIG NO in capital letters .
This is where the fun ended . Sienna ’ s results returned in one week and unfortunately , she had a high-grade lesion . Serious doctor mode kicked in straight away . We had to do a colposcopy with a biopsy . Colposcopy is just a procedure that means looking into the vagina where we obviously expect to find our cervix in normal women .
The biopsy results returned in 2 weeks and based on the results Sienna had a CIN II lesion . Based on this result the treatment options include cryotherapy , thermo ablation Loop electro-excision procedure ( LEEP ), Large loop excision of the transformation zone ( LLETZ ) or cone biopsy .
After counselling Sienna opted to have LEEP . This procedure is done on an outpatient basis under local anaesthesia . Under simple chemicals acetic acid , which is the proverbial vinegar and some iodine called Lugols iodine which are instilled on the cervix we are able to identify areas that have undergone precancerous changes .
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