Dr. Shivani Samlall, MBBS is a specialist in Obstetrics and Gynecology with a sub-specialty in Gynecology Oncology, with over 10 years of practice. Dr Samlall can be contacted at drshivanisamlall26@gmail.com

PREVENTING CERVICAL CANCER- PART 1
In my upcoming series of articles, I hope to bring awareness to Cervical Cancer, its impact on women’s health, and how we can prevent this disease.

My first question: Knowing how deadly Coronavirus is, would you vaccinate your kids?
My second question: If you have the option to prevent your daughter from developing Cervical Cancer, would you do it?

When COVID-19 was declared a pandemic, there was high expectation of a vaccine that can prevent the disease. However, while the novel coronavirus is recent, Cervical Cancer has been around for centuries. While vaccines are now being tested for the novel coronavirus, the vaccines against Cervical Cancer have been around for years, extensively studied in many clinical trials, and have been established to be safe and highly effective against Cervical Cancer.

Cervical Cancer is caused by the Human Papillomavirus (HPV), the most frequent sexually transmitted infection, and although it is not a pandemic, it is the most common cause of cancer mortality in women in Guyana (based on statistics from World Health Organisation (WHO) Mortality and Morbidity report of Guyana 2002-2012), the fourth most common type of cancer in the world and Guyana’s second most frequently occurring cancer in women after Breast Cancer.

What is unfortunate is that despite these numbers, the level of awareness of Cervical Cancer remains low. It is therefore no surprise that prevention of this disease is considered a public health failure. In comparison, because of the increased awareness of COVID-19, we can expect a significant decline in the numbers of coronavirus disease once the vaccines are proven to be safe and effective. Similarly, if a higher level of awareness is afforded to Cervical Cancer, we can eliminate this disease, or at worst reduce both the morbidity and mortality.

Given that Cervical Cancer is 100 per cent preventable through vaccination, and recognising the burden of this deadly disease, the WHO has launched a global strategy with the goal of eliminating Cervical Cancer in the next 100 years, termed the 90/70/90 Target. They have identified three pillars to achieve this, which includes:
1. Prevention through vaccination – 90 per cent of girls should be fully vaccinated by age 15
2. Screening and treatment of precancerous lesions – 70 per cent of women should be screened by the age of 35, and again by the age of 45
3. Treatment and palliative care – 90 per cent of women with Cervical Cancer should receive treatment.

ACHIEVING THE WHO 90-70-90 TARGET
Projections from the WHO have shown that we will be able to reduce the median Cervical Cancer incidence rate by 10 per cent by 2030, and by 2120, 70 million cases could be averted. This is a drastic reduction! Additionally, an estimated 62 million Cervical Cancer deaths could be averted by 2120. In the meantime, implementing the strategy will start saving lives today.

THE AUSTRALIAN SUCCESS STORY
Australia, now in her 14th year of the HPV vaccination programme, has implemented one of the earliest and most successful programmes. They have already been able to demonstrate, through research, to show evidence of significant decline of HPV infections and precancerous lesions in young women following vaccination.

THE GUYANA SITUATION
HPV vaccination was piloted in 2012, for girls aged 13, using Gardasil vaccine which targets the prevention of HPV types 6, 11, 16 and 18; which together, are responsible for at least 70 per cent of cancers. In October 2017, the Ministry of Health relaunched the vaccination programme, this time to include girls aged 9-13. In 2019, the vaccines were also made available to boys and were extended to age 16. You may ask why boys? And the simple answer is because the virus that cause Cervical Cancer is sexually transmitted.

OVERALL BENEFIT
Cervical Cancer prevention will not only substantially reduce the number of cancer cases; it will also improve the lives of people affected by the disease. According to the WHO, eliminating this disease would result in both positive economic and societal outcomes. This means that women will be healthier; will still be able to work and thus contribute to the economy and still be part of their families.

Achieving this target, will require participation from all stakeholders, mainly the Government through policies and funding, the private sector and civil society through advocacy. There will be a need for a robust monitoring system, including a functional population-based cancer registry which is essential to keep track of the progress and to make course corrections.

Eliminating Cervical Cancer is possible within the lifetime of today’s youngest girls, but the clock is already ticking, and all activities should start now, with each one of us. Remember every intervention counts!