Combating cervical cancer


Farouq Manji examines the lack of cervical cancer services in Ireland, and looks at how this is about to change.


The lack of cervical cancer screening in Ireland has been a source of concern for many years, however, in the face of Health Service cutbacks and general strife in Irish hospitals, these concerns have largely been put on the back burner. However, in recent months, this is beginning to change.

Cervical cancer mostly affects women aged 30 to 45. It is a significant cause of cancer mortality – in 2001, there were 185 new cases, and 70 deaths. Many more women suffer from its lasting consequences. Sadly, these statistics are for a wholly preventable disease.

Almost 100 per cent of cervical cancer is caused by the Human Papilloma Virus (HPV). It is sexually transmitted and therefore does not affect young females who are sexually inactive. HPV is so common that many sexually active adults will become infected at some point in their lives – in the US alone, approximately 20 million people have HPV.

Of the many females who become infected with HPV, the majority do not actually develop cancer. For the significant amount of women that are affected by the disease, the development of the disease is a gradual process, and often takes years to become apparent.

This slow ‘development period’ carries both advantages and disadvantages. Cervical cancer only becomes physically apparent to a woman in the late stages of development. Therefore when she finally visits her GP with symptoms, the cancer has likely been developing for many years. And the chance of a cure at this point will have decreased dramatically.

The advantage however, is that with an adequate national screening programme, the cancer can be detected at an early stage and be removed before it grows and spreads – effectively curing the patient.

Many countries have implemented such screening programmes, precisely for this reason. The UK cervical cancer screening programme began in the late 1960s while the US has had a national programme for more than 15 years.

A 2007 study illustrated that deaths related to cervical cancer have been dropping in the UK for the last 30 years – but have been rising and average of 1.5 per cent each year in Ireland. This comparison presents striking evidence that the UK screening programme is worthwhile – simply because it saves lives. A compelling argument.

Now more than ever, it is worth examining the issue of cervical screening. The estimated average age of sexual experimentation in Ireland is six years lower now that it was four decades ago. A recent survey suggests more than half the Irish population will have had a sexual encounter before the age of 17. It is against this backdrop of higher sexual activity that appropriate public policy must be formed.

For several decades the only measure against cervical cancer has been screening. This however, has changed. The recent advent of a HPV vaccine has added a new means to prevent the development of cervical cancer entirely.

Ireland had not even implemented a cervical cancer screening programme – the likes of which have been in place in the UK for over 30 years, and in the US since 1991.

The aim of the HPV vaccine is the same as others – to immunise the host against future infection. Administration of the vaccine virtually eliminates the chance of infection from high-risk strains of HPV, which in turn reduces the risk of cervical cancer by up to 70 per cent. The catch however, is that the vaccine must be administered before a woman comes in contact with the virus, because it can only block infection – it cannot cure infection already present.

The HPV shot must therefore be administered to girls before they become sexually active. Used correctly it could prevent a large percentage of cervical cancer cases. And coupled with a screening programme, it could become part of a very effective one-two punch. Recognising this, several countries have made moves to immediately introduce it into their health care systems.

In 2008, the UK National Department of Health began routine vaccinations for girls aged 13, in addition to their screening programme. Several provinces in Canada have made similar implementations. In the United States, the national recommended guidelines for vaccination include a 3-shot HPV vaccination for girls of eleven and/or twelve years-of-age.

Yet, at the time of these announcements, Ireland had not even implemented a cervical cancer screening programme – the likes of which have been in place in the UK for over 30 years, and in the US since 1991.

In September of this year, the Department of Health finally announced its intention to follow suit. In 2009, Ireland too will begin a national HPV vaccination programme for girls aged 13. This programme does not include a ‘catch-up’ component, meaning those older than 13 will not be eligible for free vaccination.

Director of Student Health Services in UCD, Dr Sandra Tighe believes that all women should, and will be vaccinated eventually. “You’d eventually like to get all of the population done, and the way to do this is a catch-up programme.”

“The follow-up programme may follow later,” Dr Tighe adds – the same was done with other vaccinations, such as those for meningitis.

With the lack of retroactive vaccination, a large section of the existing population clearly will not benefit from the new policy.

The University Observer has learned however, that in addition to the HPV project, the implementation of a national cervical screening programme is underway in Ireland.

“It makes sense that they are introducing the two together,” says Dr Tighe, “to be effective they need to link together.”

This is a remarkable step forward in the fight against cervical cancer. Just one year ago, there was a complete absence of national services available for screening and prevention. Soon, vaccinations and screenings will be available at thousands of GPs across the country – a massive change in direction.

The co-implementation of these programmes comes as great news. For unvaccinated women already at risk for cervical cancer, a screening programme will be in place for early detection. Furthermore, screening will allow scientists to monitor the effectiveness and long-term consequences of the vaccine.

There are concerns however, surrounding the introduction of a general HPV vaccination. Some believe that receiving an HPV shot will dissuade women from their routine cervical screening – a dangerous decision, says Dr Tighe.

“People may be less inclined to go for screening tests because they think ‘well I’ve had the vaccine so I’m okay’ but in fact the vaccine only protects you against 70 per cent of… the HPV viruses. So the cervical screening is a must for all sexually active women.”

The implementation of a national screening programme may address this concern. One aim of such a project should emphasise and educate the importance of routine screening – thus reducing misinformation within the public.

Furthermore, the ease of accessing services through a nationally coordinated programme could eliminate the socio-economic barriers that may have prevented women from pursuing checkups in the past.

Opponents of the vaccine have also suggested that the common use of a vaccine for sexually transmitted infections may change the sexual behaviour of teenagers. Many scientists are quick to point out however, that Hepatitis B is also a sexually transmitted disease. And there is little controversy surrounding its vaccine.

Astutely, Dr Tighe points out that many young teenagers hardly recognise the link between sex, HPV and cervical cancer in the first place – therefore behavioural changes are highly unlikely.

It appears that vaccination programmes in other countries are moving ahead successfully. Against the viral strains to which it is targeted, the vaccine has a reported 100 per cent effectiveness rate – and there are almost no side effects. Clearly, the data speaks for itself.

Albeit on the heels of other nations, Ireland is implementing sound, informed policies to combat cervical cancer. Though the cervical screening and HPV programmes are young, the concerns which plagued the Health Service are subsiding.