Health awareness: Don’t fear the smear

HPV quietly wrecks cervix cells, may take around 10 years before you will find it has progressed to cervical cancer.

We fear the diseases that creep up on us with no symptoms. For women, one in particular is caused by Human Papillomavirus (HPV). You can catch the bug during sexual intercourse. The virus can quietly begin wrecking the cells of your cervix. If you are lucky, your immune system will overcome the infection on its own in a few months. But if a particularly fatal type of the virus manages to stay put for longer than that, it may take as long as 10 years before you will find it has progressed to cervical cancer — the second leading type of cancer among Pakistani women.

In Pakistan, chances are that a woman will find out about the HPV infection through “opportunistic screening”, says gynaecologist Dr Sadiah Ahsan Pal, because few actively get tested. “There is no awareness campaign like in other developed countries where governments provide vaccines free,” she says. “Here, women happen to come to a doctor and are told to get a pap smear. But not all gynaecologists will do it.”

The Papanicolaou or Pap smear is recommended when a woman becomes sexually active. It is used by doctors to detect abnormal changes in the cells of the cervix, even when the patient does not feel any symptoms. A spatula is used to collect cells in the painless test. If the results are fine, you should ideally repeat the test every three to five years up till the age of 60. However, if the test detects an abnormality, further tests are ordered to take a closer look. If they reveal the presence of pre-cancerous lesions, invasive procedures are used to remove the infected area to prevent deterioration.

“The disease at this stage is curable through minor surgeries and these women can go on to have babies,” says Dr Pal. “But if the disease progresses to cancer [stages 1 and 2], major surgery has to be done to remove the uterus.”

In the advanced stages, cervical cancer is too malignant for just the uterus to be removed, warns Dr Razia Korejo. By that time the cancer has usually spread throughout the body.

Prevention from cancerous strains of the HPV is a little heavy on the wallet. The simple test comes costs Rs800 to Rs2,000 at private hospitals, unless you get a free one at some of the government-run hospitals. The recommended three-dose preventive vaccine costs between Rs4,700 to Rs9,000.

Treatment for cervical cancer is radical and expensive. The 2008 statistics from GLOBOCAN, a global project, state that 11,688 women out of every 100,000 develop cervical cancer annually in Pakistan and 12.9 per cent of them die.



Though anyone can contract HPV, poor women are more at risk. “They are less likely to get pap smears done, they practice poor hygiene, and usually have early marriages,” says Dr Pal. “The cervix of a teen is susceptible to oncologic changes. Starting in the 20s, the cervix matures and can fight back cancers better.”

Published in The Express Tribune, Sunday Magazine, June 23^rd, 2013.

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