I am attending a conference on cervical cancer. It is really educative, The conference ends today , I will post some of the information i get by friday. Cervical Cancer is Preventable and treatble if detected early. Having lost a siter and my mother to Cancer, It is an experience that noboby should have. Let us join hands and prevent more women from dying from cervical cancer. It the highest killer of women. I have to run now but by friday, i will post a comprehensive report

Early detection is via intermittent papanicollou(pap) smear.Cure is simple when detected early.Thanks aisha.Note also that a positive prognostic factor for breast cancer is early diagnosis.

Cervical cancer vaccination is the new frontier in the fight against this deadly disease.

In naija areas where kids start having sex very early, and often with multiple partners, the government and health care

providers should consider given this vaccine to every 12-15 year old girl.

have u heard of tahitian noni juice? okorojiemeka@gmail.com

My report is will be ready by monday but i think Karl, we have to work towards dy-mystifying cancer because to most people the word cancer means death

Thanks aisha.With the innovations in chemotherapy(cancer treatment)-drugs,radiotherapy,surgery or a combination,cancer no longer means death.early diagnosis via regular checkup is all thats important!

Cervical Cancer is preventable, that is the important part we want to focus on. Chemo is torture, most people prefer to die in peace than to go through Chemo. Early dectection is treatable, and vaccines can repress the HPV causative agent of cervical cancer. We have to advocate for these vaccines to be approved in Nigeria and be made affordable and available

Vaccines are still in the experimental phases and unavailable 4 now.Chemo,radio & surgery are the practicable gold standards.Regular checks will reveal an early stage.

@Karl Ken

Gardasil, the cervical cancer vaccine is not at the ex[erimental stage please.

http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html

No reseanable discussion about this cancer should be taking placing by people who are unaware of the latest findings in the field.

In fact the TX governor ordered every 12-13 year old girl going into public school to be vaccinated. By the time you are chasing chemo, Rt, or surgery, you have dropped the ball.

Karl, Vaccines Cervix by GSK and Gardisal by Merck are approved and used in three countries. We are waiting NAFDAC approvalin Nigeria. Chemo, Radiotheraphy are too expensive and too painful. Chemo is used at the third stage of cancer development and there are low survival rates. why would we allow a disease to get to the last stage which is associated with so much pain and suffering when we can actually prevent the disease. Infact There is now a simple one single visit procedure, Visual Inspection with Acetic acid (Vinegar). It is simple, easy and affordable. It does not require the involvement of trained personal. It is being done in Shagamu, and we want to partner and expand its use. Pre-Cancerous infections can be traeted using a Crytheraphy.

Cervical cancer vaccines are now std medical practice that one could be sued if you don't offer it to an age appropriate patient.

The importance of prevention cannot be over-emphasized in this forum.

@Naijaking & aisha!Thanks men 4 educating me.Remember as we post here innovations are taking place in other medical faculties.Note that prevention isn't absolute.Despite d vaccines,there's bound to be 'escape' cases that will require intervention!

very interesting topic, it's really ironic that such a detectable cancer is still the number one cause of mortality in women with cancers of the genital tract here in nigeria, in developed countries the incidence is greatly reduced due to early detection, but in naija how practical is dis going to be? even when the vaccines are introduced how many parents will take their daughters to be immunized against a disease that has a [/i]sexual[i] link? wouldnt that be encouraging promiscuity before i get attacked i dont support this view but i've heard parents say this.even with the vaccines available on the NPI(national program on immunization) schedule, how many children have completed initial courses by their first birthdays?
back to cervical cancer, how many female [/i]doctors[i] in the reproductive age go for pap smears?

@aisha if you know of any group interested in increasing the awareness of cervical cancer pls inform me,

Doctor B,
I will. We plan to start a project on that soon

REPORT ON TWO DAY INTERNATIONAL CONFERENCE ON STOP CERVICAL CANCER IN AFRICA:  “ACCELERATING ACCESS TO VACCINES”

VENUE: ABUJA SHERATON HOTEL
DATE: 24TH -25TH JULY, 2007.

EPIDOMOLOGY OF CERVICAL CANCER
Facilitators: Prof. Isaac Adewale, Dr. Emmanuel Hammond, Prof. Ime-Obong Ekanem and Dr Yewande Thorpe.
Papers were presented on the following topics: The Epidemiology, cause and incidence of cervical cancer.
 Cervical cancer and precancerous lesions are not only health concerns but Social, Economic, and Psychological burdens.
 Cervical cancer results in an estimated 270,000 deaths every year
 Globally, a woman dies every two minutes from cervical cancer. in Africa, a woman dies every ten minutes. ( This means that 86,400 women around the world and 17,280 women in Africa would have died from the start of the conference to the time this report would have been concluded)
 Cervical cancer is the second most prevalent cancer  in women under 45 years
 Cervical cancer is now the leading cause of cancer deaths among women worldwide
 Eighty- five percent of deaths from cervical cancers occur in the developing world due to lack of screening programmes for women in these countries.
 It is estimated that without a significant improvement in prevention, there will be a million new cases of by the year 2049.
 It is a disease of inequity, Inequity between rich women and poor women, due to disparities in access to health care, It also a gender based disease, cervical cancers is a female disease and in many countries particularly, African countries, most women do not receive equal information about or access to healthcare as their Male counterparts.
 ALL WOMEN ARE AT RISK
 CERVICAL CANCER IS PREVENTABLE, AND TREATABLE IF DETECTED EARLY.

CAUSE OF CERVICAL CANCER: HPV
According to the speakers Humun Pappillomavirus HPV is a ‘necessary cause’ of cervical cancer. Global prevalence of HPV in cervical carcinoma is 99.7%.
HPV is an extremely common virus; it is DNA- based and genetically stable. This means it can be prevented by long term vaccination unlike RNA- based virus which changes and requires regular vaccination.
100 types of HPV have been identified, 15 HPV can cause cancer or precancerous lesions on the cervical surface. The other low risk HPV types can cause genital warts or low grade lesions on the cervical surface.
HPV 16 and 18 account for more than 70% of all cervical cancers in the world. HPV 45 and 31 cause about 4%, collectively, HPV 16, 18, 45, and 31 account for 80% of all cervical cancers.




HPV TRANSMISSION
Every woman is at risk oncogenic HPV infection which may cause cervical cancer. HPV is transmitted through sexual intercourse, however transmission can occur without penetrative sex, as HPV is transmitted through skin to skin contact in the genital area. Therefore every sexually active woman is at risk.
50-80% of women will acquire an HPV infection in their lifetime and up to 50% of those infections will be oncogenic HPV type.

Progression from HPV Infection to Cervical Cancer.
Cervical Cancer begins with HPV infections; most infections are asymptomatic and resolve without any medical intervention but persistent infection with high risks types, i.e. HPV16 and HPV 18 can lead to precancerous cervix abnormalities. It develops through these stages.                                                                         
Initial infection     → HPV infected cervix → mild Cytological abnormalities                                                   
(Transient Infection)                     ← (Retrogress)    ↓ (Progress)
                                                                                         
                                                                                    Pre-cancerous Lesions
                                                                                        (Persistent Infection)
                                                                                      ↓
                                                                                      Invasion               
                                                                                      ↓
                                                                                      Cancer
Progression from HPV infection to Cervical Cancer is slow and usually takes years, hence the Infection is usually more prevalent among women from ages 35-50.
Risk Factors:
 Sexual activity: All sexually active women are at risk of HPV infection. HPV however differs from other Sexually Transmitted Infections as it could be transmitted through non- penetrative sexual intercourse.
 Prior STI infections
 Early sexual debut: Early age at first sexual debut is a risk factor because, an underdeveloped cervix has an immature Epithelium which is easily penetrated by the virus.
 Having same sex or multiple sexual partners and being uncircumcised.
 Long use of birth control pills
 Women who smoke.
 Women with HIV.

Other factors that contribute to high prevalence of cervical cancer in developing countires include:
 Poverty and Illiteracy
 Inaccessibility of screening and treatment centers
 Cost of screening, treatment and vaccines
 Behavioral and cultural practices
 Stigma associated with cervical cancer
 The Mystification of cancer
 Lack cancer policies in most developing countries
 Emphasis on other public health issues such as HIV/AIDS, TB and Malaria.
 Poor Media Enlightenment

Prevention and Treatment: Screening and Vaccines
Facilitators: Dr Emmanuel Hammond, Dr Issa Mukumbi, Dr Olufemi Akinsanya, Prof. Emmanuel Olotorin, Dr Frank Taulo, Dr Alan Smith  (GSK) and Dr Elizabeth Mckren, (Merck Pharmaceuticals)
Preventing cervical cancer can be done in three stages:
Primary
Secondary, and
Tertiary Interventions.
Primary Intervention:
This can be done by either preventing initial infection or detecting the precursors to cervical cancers and providing treatment.

Vaccines
GSK Pharmaceuticals and Merck have both developed vaccines that have been tested and approved in some countries to arrest the development of HPV infections which leads to cervical cancer. GSK produces Cervarix vaccine, while Merck produces Gardasil these vaccines work by increasing the human immune response to HPV infection. Merck’s Gardasil is also designed and tested to prevent other Cancers, and Genital Warts.
However both Vaccines are not yet approved for distribution in Nigeria.

Secondary Intervention:
Screening, Diagnosis and Treatment
Secondary prevention is done through screening and treatment of identified Pre-cancerous lesions. There are several screening methods to detect cervical cancer. These are listed below:
 Cytological Screening, (Pap Smear)
 Visual Inspection with Acetic Acid
 Visual Inspection with Lugol’s Iodine
 HPV DNA Testing
 Hybird Capture 2 Test
 The Fast HPV test
Two of these methods were broadly discussed in the Conference. Cytological testing (Pap Smear) and Visual Inspection with Acetic Acid.

Pap Smear: This has been used world wide to identify pre-cancerous lesions for treatment or follow up.
Pap smear screening in developed countries have contributed to an 80% reduction of the incidence of cervical cancer. However, in developing countries similar success is lacking due to limited resources (i.e. supplies, trained personnel, equipment, quantity control, health care infrastructure, and effective follow up procedure), cost of Pap smear tests and lack of information among women and even health care workers.

Limitations of cytological screening include:
 Lack of sensitivity which often results in false negative hence repeated screening.
 The need for follow up medical appointments.

Visual Inspection with Acetic Acid (VIA)
This involves applying 3.5% to 5% of acetic acid (vinegar) to the cervix using spray or cotton swab and observing the cervix with the naked eye after one minute. If well defined aceto-white areas are seen adjacent to the transformation zone, the test is positive. VIA does not require laboratory or intensive staff training., it is a single visit approach, safe, cost effective, does not require electricity, outpatient treatment, easy to perform and ideal for large scale screening.
VIA also involves a screen and treat program by using VIA and Cryotheraphy.

Tertiary Intervention
This unfortunately is the last stage and it is at this stage that most women get seek medical intervention. At this stage in not much can be done, survival rates are low and treatment is usually a palliative measure. 
Early invasive cancers can be treated successfully. Hysterectomy and Radiotherapy are mostly used. Radiotherapy aims at destroying cancer cells while preserving normal cells.
Chemotherapy could also be used with hysterectomy and radiotherapy.


Palliative Care and Support

Dr A. M Nyakabau and Dr Tajudeen Olasinde

Dr Nyakabau stated that mortality figures of cancer do not describe the pain and suffering of patients before death. The pain and suffering she described as unimaginable.
The palliative care involves:
 Multi- Disciplinary Approach( Physicians, Nurses, Pharmacists, Volunteers, Chaplains/Imams, and Social Workers)
 Multi-Modality
 Cultural And Religious Sensitivity
 Principal Ethical Guidance
 Communication between care provider and care receiver.
There are four Hospices in Africa and one in Nigeria located in Zaria, Kaduna State.
Some challenges faced by pc centers include:
 Poor funding
 Unavailability and inaccessibility of oral Morphine

Mobilizing NGOs
Facilitators:
Mary Onyango (Kenya), Shirley Sirbah- Sackey (Ghana), Dr Adamu (Nigeria)
The facilitators in their different presentations highlighted the role NGOs have played in their respective countries.
 Advocacy and lobbying: lobby for favorable polices, and for Government attention to cancer and related issues.
 Communication and Information: Provide information in simple and clear language with the aim of de-mystifying cancers.
 Funding:
 Research
 Partnership And Networking
 Building screening and testing centers

Mobilizing FBOs
Facilitator: Idris Abdulahi
FBOs are the greatest avenue for mobilization, present in all communities and present an effective channel for communication. Christian Association of Nigeria (CAN) and Supreme Council for Islamic Affairs are credible organizations, well structured and run existing health programs. Their involvements or non-involvement in previous health programs have contributed the success or failure of these programs. It is therefore important to enlist the support of religious bodies in the fight against cancer.

Thanks aisha2 for the post. Besides the vaccine aspect which I first read about some weeks ago, I believe everything else still tallies with what we were taught back in med school. Regular Pap smears still remains d gold standard for early detection in sexually active women if u ask me.
Pls how available is this vaccine? At what cost? Who bears the cost?/is there any form of subsidy? Why is it yet to be approved for distribution in Nigeria? Thanks all.

We are working towards starting an Intervention program as soon as possible. I have lost four People close to my heart cancer. One cannot explain the feeling of helplessness of watching your loved one waste away in so much pain and you cannot do anything to ease their pain.
I am ready to commit my time, energy and resources to prevent people's Mothers , Wives and Sisters from dying from cervical cancer. At least this cancer, we know its origin and it is treatble, it will be unreasonable for any of us to turn our face from this because it has not affected you.
Information is power, we also need to work on providing access to screening centres, which by the grace of God we will lobby Stakeholders to do.
Please tell your friends, sisters, your mothers to go for a pap smear test if they can afford to, it is N500.
Please do not wait till you loose someone to Cancer before you take action.
Better  health starts with me and you. please let us act now

@Bolarge,
The vaccines are not approved in Nigeria, The are waiting NAFDAC approval. Like all new vaccines they are expensive but we are working to lobby for its speedy approval and to get Government and even private individuals to subsisdies it.
About pap smear being the gold standard, i think that is quite outdated. VIA has been tested and discovered to have the same senitivity as pap smear and because of shortage of man power and screening centers and equipment, we cannot realistically say we expect all women in Nigeria to get a pap smear. Please have it in mind that this is a public health emergency and public health is not  only about using the best method but using the best method to treat the largest number of people.
I am not a doctor I am looking at this from a humaistic approach. If you have lost someone to cancer, your only concern will be to prevent other people from dying from cancer because it is a horrible feeling.
It is not a time to debate about the best method, we have to look at this from the side of the patient.
75% of Nigerian households survive on less than $2 a day. a pap smear cost between 500 and 750, They cannot afford a pap smear not to talk of shortage of testing centres, multiple visits and shortage of Man power.

My reference to Pap smears was meant in the Nigerian context. Are there cheaper ways of early detection? I'm not aware of any.

Hey aisha2,nice topic. At the seminar or is it workshop did they mention that women who started having sex early in life are more prone to the disease? I ask cos we were taught about this in school and that was mentioned.

@Bolarge
Yes there are. I included it in my report, You can read it above. We are particularly interested in Visual inspection with Acetic Acid(Vinegar). It is simple, cost effective and involves a single visit.Visual Inspection with Acetic Acid (VIA)
This involves applying 3.5% to 5% of acetic acid (vinegar) to the cervix using spray or cotton swab and observing the cervix with the naked eye after one minute. If well defined aceto-white areas are seen adjacent to the transformation zone, the test is positive. VIA does not require laboratory or intensive staff training., it is a single visit approach, safe, cost effective, does not require electricity, outpatient treatment, easy to perform and ideal for large scale screening.
VIA also involves a screen and treat program by using VIA and Cryotheraphy.


@tng,
Yes Early sexual debut: Early age at first sexual debut is a risk factor because, an underdeveloped cervix has an immature Epithelium which is easily penetrated by the virus. However, Cervical cancer can be contracted through non sexual intercouse from skin to skin contact. Read the full report, it is posted above i think almost all the questions are answered there.
I will not rest until we start a campaign agaisnt Cervical cancer and we have acessible screening centres

@ TOPIC

When I was a Kid, I was told if you slept around
you get breast cancer or Cervical Cancer or if you kiss, you get Throat cancer.
I guess my parents were trying to scare me off sex.

@ topic

very explainatory. i lost a childhood friend years ago to cervical cancer. she was just 19years old and her mother said that she was a virgin. the cancer was detected while she was in USA and she died there.

how soon will the vaccines be available in nigerian hospitals?

Just a quick question, is HPV the only main cause of cervical cancer, and apart from sexual intercourse, are there any other means of getting it?

terrible disease, lord help the world,

wow, i have heard of such cancer but never really took time to learn about it. so is it only people who have had intercourse that can get cervical cancer or is it likely for a non sexually active person to contract it? i beg i wanna know

Aisha thanks a lot for that conference report.I actually heard of it but was not opportuned to participate.As a Cytologist I understand the danger posed by cervical cancer and its epidemiology in African women.
I sincerely hope that somrthing tangible would be done soon to curb this impending pandemic.

Galadriel:

Just a quick question, is HPV the only main cause of cervical cancer, and apart from sexual intercourse, are there any other means of getting it?

@ Metoyou
HPV the cause of cervical cancer can be transmitted from skin to skin contact around the genital area, but sexually active women are more at risk and women who have repaeted child birth. So basically, every woman is at risk.

funkybaby:

@ topic

very explainatory. i lost a childhood friend years ago to cervical cancer. she was just 19years old and her mother said that she was a virgin. the cancer was detected while she was in USA and she died there.

how soon will the vaccines be available in nigerian hospitals?

We are trying to looby for speedy testing in Nigeria by NAFDAC, as much as we want to get treatment we have to take prcautions

aisha thanks a million for th is thread

concerning speedy testing i think as you said we also have to be cautious cos of the nigerian factor (u know)

though it's called cervical cancer, can it not affect men too?

Carlosein:

though it's called cervical cancer, can it not affect men too?

men don't have a cervix so they can't have cervical cancer. however men have their own wahala in the prostate which can get enlarged and problematic as in BPH or even get cancerous. women have no prostrate so they can't get prostrate cancer or enlargement.

@topic
good one aisha. the best health approach to cervical cancer or any other cancer or indeed any disease whatsoever is preventive medicine . a sound health system which incorperates public awareness will do a lot.

early detection and prompt management is invaluable

MEN: THE SILENT CAUSES OF CERVICAL CANVER!!!

What are the signs and symptoms of HPV in men?

Most men who get genital HPV do not have any symptoms. However, some types of HPV can cause genital warts. Genital warts are single or multiple growths that appear in the genital area. They may be raised, flat, or cauliflower shaped.

In men, genital warts may appear around the anus or on the penis, scrotum (testicles), groin or thighs. Even men who have never had anal sex can get warts around the anus. Warts may appear within weeks or months after sexual contact with an infected person, or not at all. A person can have the type of HPV that causes genital warts, but never develop any warts.

How do men get Genital HPV?

Genital HPV is passed on through genital contact –such as vaginal and anal sex.
Both men and women can get HPV – and pass it on - without even realizing it.
Genital warts can also be passed on by a person who has HPV but no visible warts. Since the virus can be “silent” for a long time, people can have genital HPV even if years have passed since they have had sex.

What is the connection between HPV and penile and anal cancers?

Certain types of HPV have been linked to cancer of the anus and penis in men. These cancers are rare –especially in men with healthy immune systems. The types of HPV that can cause genital warts are not the same as the types that can cause penile or anal cancer.

How common is HPV and associated conditions in men?

Over half of sexually active men in the United States (U.S.) will have HPV at some time in their lives.

About 1% of sexually active men in the U.S. have genital warts at any one time.

The American Cancer Society (ACS) estimates that about 1,530 men will be diagnosed with penile cancer in the U.S. in 2006. In this country, penile cancer accounts for about 0.2% of all cancers in men. It is especially rare in circumcised men.

ACS estimates that about 1,910 men will be diagnosed with anal cancer in 2006. The risk for anal cancer is 17 times higher among gay and bisexual men than among heterosexual men. The risk is also higher among men with compromised immune systems, including those with HIV.

*** In Nigeria, there are never any statistics, at least not yet ***

Is there a test for HPV in men?

At the moment, there is no test approved to detect HPV in men. However, there are ways to detect the most common problem caused by HPV in men, genital warts. Genital warts are usually diagnosed by visual inspection. Some health care providers may use a vinegar solution to help identify flat warts, although this test is not specific for warts. That means the test may falsely identify normal skin as a wart.

Is there a test to screen for HPV-related cancers in men?
There are currently no tests approved to detect early evidence of HPV-associated cancers in men, as there are for women (Pap tests). Nonetheless, since anal cancer is more common in gay, bisexual, and HIV-positive men, some experts recommend routine anal Pap tests for those populations. The anal Pap test is used to find abnormal cells in the anus (caused by HPV) that could turn into cancer over time. However, it is not yet clear that finding and removing abnormal cells from the anus will effectively prevent anal cancer from developing in the future. CDC does not recommend anal cancer screening.

Is there a treatment or cure for HPV?

There is no treatment or cure for HPV. But there are ways to treat the health conditions associated with HPV in men, including genital warts, penile cancer and anal cancer.

Visible genital warts can be treated with medication, surgically removed, or frozen off. Some of these treatments can be applied by the patient, while others must be performed by a health care provider. No one treatment is best. Warts might return, especially in the first 3 months after treatment.

It is not known whether treatment of genital warts will reduce the chance of passing the virus on to a sex partner. If left untreated, genital warts may go away, remain unchanged, or increase in size or number. They will not turn into cancer. For these reasons, some individuals may choose not to get treated, but to see if the warts will disappear on their own.

Should I be worried that I cannot be tested or treated for HPV?

No. HPV is not like other sexually transmitted infections (STIs), which need to be detected and treated. HPV is a virus that lives in the skin, rather than in your body. There is no clear health benefit to knowing you have this virus—since HPV is unlikely to affect your health and cannot be treated. For most men, there would be no need to treat HPV, even if treatment were available— since it usually goes away on its own.

So why should I care about HPV?

While most men will not develop health problems from HPV, some men are at higher risk of disease from HPV. HIV-positive men are more likely to get severe and prolonged cases of genital warts, which may be more resistant to treatment. They are also more likely to develop anal cancer.

It is also important for men to realize that they can unknowingly transmit HPV to their female sex partners. Compared to heterosexual men, women are at higher risk of developing disease from HPV—most notably, cervical cancer. Cervical cancer in women is much more common than anal or penile cancer in men. According to ACS, more than 9,700 women will be diagnosed with cervical cancer in the U.S. in 2006.

Are there ways to reduce my chances of getting HPV?

Because HPV is so common but usually invisible, the only sure ways to prevent it are not to have sex, or to have sex with only one uninfected person, who is only having sex with you. You can lower your risk by limiting your number of sex partners and choosing partners who have had few or no sex partners. Condoms may also lower your risk of HPV-associated conditions. Condoms may provide some but not complete protection against HPV, since HPV can infect skin that is not covered by a condom. Condoms have been shown to reduce the risk of genital warts and cervical cancer. Condoms can also reduce the risk of HIV and some other sexually transmitted infections, when used all the time and the right way.

Common questions for men and their female partners about HPV

I hear there's a HPV test for women, but not for men. Why not?

There is now an HPV test for women, which can be used as part of cervical cancer screening and management. This test is not a general check for HPV, and it is not designed to find HPV in men.

There is no general test for HPV that can tell a man or woman his or her “HPV status”. There is no clear health benefit to knowing if one has the virus—since it usually causes no health problems and goes away on its own.

My partner just found out she has HPV,

* What does it mean for me?

Partners usually share HPV. If you have been partners for a long time, it is likely that you already have HPV. The types of HPV that put a woman at risk for cervical cancer very rarely cause any health problems for heterosexual men.
* What does that mean for her?

This probably means she has a type of HPV on her cervix that could put her at risk for cervical cancer. She should follow up with her doctor or nurse as advised, so that she does not develop cervical cancer in the future. Also, she should know that most of the time, HPV goes away on its own without causing any health problems.
* What does it mean for us?

HPV is not a sign that you or your partner has been unfaithful in the relationship. HPV can be silent in the body for many years before it is found on a test. She may have had HPV for many years, and there is no way to know when or from whom she got HPV.