Easily preventable if detected and treated in the early stages but deadly when caught too late
With an increase in awareness programs on cervical cancer and increase in the number of Pap smear screenings in the country, 77 cervical cancer cases were detected in 2018.
The record with the JDWNRH shows that, in 2018 they received 77 cases of cervical cancer and women aged between 30-44 years of age contributed the highest case load with 28 cases. There was an increase of 18 cases from 2017.
In 2017, they received 59 cases with the age group (45-59) reporting the highest with 30 cases.
In 2016, JDWNRH received 74 cases of which again women aged between 45-59 years of age contributed the highest with 30 cases.
In Bhutan, cervical cancer is the most common cancer diagnosed in women and the peak incidence is between 40-49 years in the country. Most are diagnosed in later stages, leading to high mortality.
Medical Superintendent (MS) of JDWNRH Dr. Gosar Pemba said that cervical cancer is the fourth most common type of cancer for women worldwide, but because it develops over time, it is also one of the most preventable types of cancer.
He said, “If we increase the screening program of the Pap smear in and around the country than they are liable to detect more numbers of cervical cancers.”
Pap smear will help in detecting the cervical cancer at an early stage whereby women can get cured at the earliest. He said, “Women at any age can get cervical cancer and if not cured on time than the severity will increase over time.”
In 2018 they received 6, 223 clients (women) for Pap smear screening of which the highest were in the age range between 25-34 years of age (52 %) followed by 35-44 years of age with 26 %. There is an increase of clients who came to avail the services of Pap smear. In 2016 they have received 5,242 clients while in 2017 there was an increase by 430 clients.
In Bhutan, the target population for Pap smear is all women between 25 to 65 years of age regardless of HPV vaccination status. All women who are or were sexually exposed should participate in screening or do Pap smear.
He said that operable cervical cancer patients who receive treatment will remain cancer free for some years but there are chances that it may reoccur in a few cases. The treatment for those patients who are not operable is radiation therapy.
The radiation kills the cell and the patient will be okay for sometime, depending on how well the cancer has responded to the radiation therapy. Cervical cancer women live for quite long after the treatment, even if it’s at a late stage, he added.
He said, “If cervical cancer is detected at the early stage than it can be cured by doing operable treatment. When the cancer is detected at a late stage then the women will need treatment now and then. However, it can recur two to three years later.”
He said that marriage at an early age is one of the most important risk factors for cervical cancer. Human Papilloma Virus (HPV) is found in about 99 percent of cervical cancers. “More than 70 percent of cervical cancer cases can be attributed to two types of virus, HPV-16 and HPV-18, often referred to as high-risk HPV types”, he added.
In addition, he also said that multiple sexual partners also increase the risk of exposure to HPV virus infection and the presence of other Sexually Transmitted Infections also acts as co-factors in the development of cancer.
Multiple deliveries can also cause cervical cancer as every time a woman delivers, her cervix undergoes repair and during repair there are immature dividing cells that are susceptible to HPV infection.
Smokers and HIV positive women with Immuno-suppression are at higher risk of developing cervical cancer. He said, “We have started HPV vaccination in all children above the age of 13 years and it has been 7 years.”
He said that those who can be treated here are operated here while those who are in the late stage are sent outside for Brachy therapy. However, they have the plan to have Brachy therapy in the country soon.
Meanwhile, some of the symptoms of cervical cancer are abnormal vaginal bleeding, excessive or foul smelling vaginal discharge and high urinary frequency and backache. And in advanced cases, there may be pain in the pelvic region or lower limbs, swelling of lower limbs, renal failure in last stages and passage of urine and feces from vagina.
Cervical cancer is a type of cancer that affects the cervix (the lower part of uterus that connects to the vagina) in the female reproductive system.