Zahra* is a 23-year-old Tuks student. Last year she got a phone call from her gynaecologist. “They phoned me and said my pap smear showed it was cervical cancer and they had to operate immediately,” she says. Zahra’s cancer developed under exceptional circumstances attributed to stress, but she is just one of the countless women who have developed cervical cancer.
The South African Society of Obstetricians and Gynaecologists (SASOG) state on their website that cervical cancer causes more than 3 000 deaths a year in South Africa. According to SASOG, in 80% of the cases, cervical cancer is caused by the world’s most common sexually transmitted infection: the human papilloma virus (HPV).
There are 200 new cases of cervical cancer per 100 000 reported cancer cases annually in South Africa. So, ladies, do you remember the first man you slept with? Was it a matric dance date, or were you drunk out of your clothes after a night in Hatfield? Maybe it was the sweet romance story with candles and rose petals (if so, well done: your life is like a movie). Maybe you were high school sweethearts or maybe he was a crazy axe murderer. Either way, during one of your wild trysts, you may have met one of over 120 identified HPV types.
Prof. Lindeque, head of the obstetrics and gynaecology department at Tuks, says that 94% of sexually active people will have been exposed to one of the HPV types in their lifetime. While most immune systems eliminate the infection, some of the types are more sinister. HPVs are identified by numbers and several can be high-risk types and cause cancer. Of these, the highest risk types are 16, 18, 31 and 45. Depending on the type, the viruses can be asymptomatic or they can cause warts. “Genital warts, not warts on your nose or like Liewe Heksie had on her forehead,” Prof. Lindeque says.
According to Prof. Lindeque, the dormancy period of these HPVs can be years, even decades. So, that special night with Piet or Jabu may still come back to haunt you.
HPVs work by penetrating the cervix which is paper-thin. The virus settles into the growth layer and there it becomes part of the nucleus of healthy cells and starts regenerating and it is these abnormal cells that may become cancerous cells.
Prof. Lindeque explains that condoms don’t always help because HPVs do not grow in isolated areas, meaning it can live on the skin surrounding your genitals. In fact, research shows that HPVs can be transmitted via skin-to-skin contact, including oral sex and genital stimulation with your hands.
Prevention is always better than cure. Obviously, abstinence is best, but Prof. Lindeque suggests that to lessen the risk of contracting an HPV and developing cervical cancer, one should engage in monogamous sex, always use “a suit of armour” and avoid smoking (post-coital or otherwise).
The other preventative method is the HPV vaccines. There are two kinds of vaccines that have been on the South African market since 2008: Gardasil and Cervarix. Gardasil will protect against infection with high-risk types HPV 16 and 18, as well as against HPV 6 and 11 (which cause anogenital warts). Cervarix will protect against infection with high-risk types HPV 16 and 18 (which cause cervical cancer).
Medical professionals suggest that these vaccines be given to prepubescent girls, but it is effective in all women that have not yet contracted the high-risk types. It is also effective in boys, but Prof. Lindeque says that it is a matter of economics. “The virus dies if the girls are immune, so vaccinating boys is a moot point.” HPVs can cause penile cancer if the virus is not eliminated by the male’s immune system, but the risk of penile cancer is one that is drastically lower than that of cervical cancer, says Prof. Lindeque.
The vaccine is given in three shots over six months. The shots may be covered by your medical aid, depending on your plan. There are rumoured plans of a government subsidised programme, but no formal announcement has been made yet.
Now, you may be sitting reading this and have an HPV type. In fact, there is a 94% chance that you do. It is unlikely that you will know about it until your 40s. Cervical cancer is particularly threatening because it is rarely caught in the early stages.
However, there are screening processes that you should consider when you’re about 30 years old. HPV testing isn’t really worth it before you turn 30 because of the high incidence of HPVs, but by the time you hit the big 3-OH, most of these HPVs will be gone. If you have been tested positive for HPV, a pap smear will determine the kind of abnormal cells. If caught in the early stages, like Zahra’s, cervical cancer isn’t the death sentence she and many other women initially think it is.
Cervical cancer caught early is infinitely treatable. But very few women are aware of the HPVs. “Fear for the disease is not there, so the desire for protection isn’t there either. But we shouldn’t fear the disease, we should respect it,” Prof. Lindeque says.
*Name has been changed