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  1. #1
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    Cervical cancer = preventable infection

    A 19 years old British girl recently died from cervical cancer which had been diagnosed too late ( last November ). There’s now an online “ e-petition “ to lower the age of “ smear test “ to 16. ( http://www.mirror.co.uk/news/uk-news...cancer-3257839
    ).


    A “ Pap smear test “ might have helped the clinical diagnosis of cancer here, although its purpose is to prevent cancer from developing by recognising early changes in surface cells by microscopic examination. The problem is that about a third of women under the age of 25 may have abnormal results ( but not cancer ) and be referred for unnecessary treatment. This is the usual age at which screening is recommended to start, because far fewer have “ false positives “ after 25, and screening at a younger age doesn’t reduce the rate of later developing cancer.



    Cervical cancer IS important, and while it’s very rare under the age of 25, it does mainly affect sexually active women between the ages of 30 – 45. UK screening is usually recommended to the age of 64. Cancer is not confined to old people !



    Screening by examining cells from the surface of the cervix is effective and saves lives. Diagnosis at an early stage offers the best chance of cure. Prevention would be even more effective, but there are problems of awareness, cost, and availability.


    While it’s relatively uncommon in the UK, it’s the second most common female cancer ( after breast ) worldwide – and in the Philippines. It’s also caused in almost all cases by a virus ( Human Papilloma Virus, or HPV ). HPV screening might be even better than examining cells, in the future.



    In the UK, girls have been offered free vaccination against HPV infection for several years now. The vaccines are also available ( at a price ) in the Philippines. “ Cervarix “ protects against HPV 16 and 18 ( P 5000 for course of three ) ; “ Gardasil “ against 6, 11, 16 and 18 but is more expensive ( P 15,000 ). Of all the 100 ( + ) HPV types, these are the ones most likely to cause cancer – others may cause genital warts or be harmless.



    A fifth of “ eligible “ women in the UK – and far fewer in the Philippines - don’t go for their “ smear test “. Even if / when young women have their course of vaccinations, smear testing is still recommended for the foreseeable future. A cheaper “ compromise “ screening is VIA ( visual inspection with acetic acid … yes, dilute “ vinegar “ ), following which abnormal areas can be destroyed by freezing ( cryotherapy ).



    If nothing else, the publicity over this tragic 19 year old’s death from a preventable cancer draws attention to it. In the Philippines a year-long awareness programme started last September ( “ X Means Love Campaign “ ) - supported not just by the vaccine manufacturer ( GSK ) but also celebrities, like Andi Manzano. But the natural emotions aroused by this cancer need to be balanced by realistic expectations. Screening – by whatever method – has limitations, and is not always taken up by those most at risk ( through ignorance and cost ). Similarly universal vaccination against HPV is unlikely any time soon, especially if the vaccine is not free.


    I have every sympathy for the family and friends of the young English girl who died from this cancer, because it wasn’t diagnosed clinically ( symptoms and signs ). But in my opinion their e-petition is misguided. Far better to attempt prevention by vaccination and - as second best - to start screening at an age ( 25 ) when any changes are more likely to be significant and require treatment.



  2. #2
    Trusted Member Rosie1958's Avatar
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    How tragic that such a young girl died from cervical cancer at the age of only 19. Thank you for taking the time to provide a wealth of information on this subject, Doc Alan.

    We are very lucky to have the availability of a vaccination and also screening here in the UK to prevent this terrible disease and I can't for the life of me understand why so many women don't take advantage of this ...........

    Indeed, following the televised illness of Jade Goody (the English reality TV personality and mother of 2 young sons) who contracted cervical cancer and subsequently died in 2009 at only 28 years old, there was a lot of publicity. This has undoubtedly helped to raise awareness but it would appear that more education is needed.


  3. #3
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    There WAS an increase in cervical screening attendances – especially for women younger than 50 - during the time Jade Goody was diagnosed and after her death in early 2009. The pattern of increased attendance mirrored the media coverage. It’s likely that the increased screening saved lives – the point of the screening programme – but, as with other “ celebrity “-based publicity, the effect was short-lived, uptake falling to a 10 year low recently.



    Whether or not the e – petition succeeds in its aim of “ lowering the smear test to 16 “, the publicity may help. There’s also a new “ app “, created by Jo’s Cervical Cancer Trust ( “ Put Yourself in the Picture “ ) encouraging women to take up cervical screening.



    The point of cervical screening is to pick up early, pre-cancerous changes, BEFORE symptoms appear. This is the usual situation.


    In the minority where there ARE symptoms - such as abnormal bleeding “ down below “, or painful intercourse - diagnosis should be suspected by the personal doctor / GP, and/or specialist / gynaecologist ). Following examination, small samples / biopsies would be taken for microscopy and confirmation by ANOTHER medical specialist ( pathologist ).



    I am no celebrity, and I’ve no way of knowing - after one response - who else might have found this thread helpful.


    It's reassuring that everyone ( including me ) taking part in the UK screening programme MUST take a test of their diagnostic skills twice a year. If they don’t pass, they have to attend an educational course and may be banned from continued screening.



    http://www.nhs.uk/Conditions/Cancer-...roduction.aspx



    http://www.cancerresearchuk.org/canc.../types/cervix/




    http://www.jostrust.org.uk/?gclid=CO...FQoYwwodBZUAOg



    http://www.businessmirror.com.ph/ind...nd-worst-enemy



    http://lifestyle.inquirer.net/136235...cancer-and-sex


  4. #4
    Admin's Assistant ^_^ raynaputi's Avatar
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    I've read this story the other day. Poor girl. Denied of having the right treatment for her illness at the very early stage. But shouldn't they, the young girls, be given the choice to avail/get the tests when they think they're experiencing such symptoms?
    -=rayna.keith=-
    ...When you realize you want to spend the rest of your life with somebody, you want the rest of your life to start as soon as possible...



  5. #5
    Trusted Member jake's Avatar
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    Very interesting article.
    I am sure many members and none members found the article interesting, even though not many replied

    My daughter was offered the vaccination last year by her doctor even though she is classed as low risk. According to the Doctor Gardasil is better than Cervarix as it targets more strains.
    She ended up having three jabs of Gardasil spread over a 6 month period. The total cost was 12,000php.


  6. #6
    Trusted Member jake's Avatar
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    Quote Originally Posted by Rosie1958 View Post
    We are very lucky to have the availability of a vaccination and also screening here in the UK to prevent this terrible disease and I can't for the life of me understand why so many women don't take advantage of this ...........
    Does seem strange that people who have 'free' access to good medical care choose not to go for check ups.
    Maybe they have a fear of discussing something so intimate


  7. #7
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    EVERYONE should be able to have the tests they need when they’re feeling ill. It's up to the doctor to take a patient’s history ( listen carefully to what they have to say ) and examine them, then refer them for the tests they judge to be appropriate.


    A “ Pap smear test “ MIGHT show cells which are cancerous. But a sample of cells from the surface of the cervix can’t prove invasion ( a hallmark of cancer ). It could show abnormal looking cells associated with blood and inflammatory cells = suspicious of cancer. Cervical screening is to find PRE-cancerous changes ( three grades of severity ) BEFORE symptoms are present.


    Tests where symptoms suggest cervical cancer - at any age - START with clinical examination by the doctor, with a chaperone. The patient could be referred to a gynaecologist. Tiny ( mm ) biopsies ( NOT a smear ) would be taken from abnormal looking areas for microscopic diagnosis by a pathologist. Depending on the diagnosis, the abnormal area(s) could be treated ( destroyed by laser / method ), or larger samples could be taken. These would be curative, OR indicate the need for surgery. Blood / urine tests and scans might also be judged useful.



    We’re lucky in the UK that such testing and treatment is freely available. In other parts of the world, VIA ( visual inspection with acetic acid ), followed by immediate cryotherapy ( destruction of abnormal looking areas ) may be ALL that is possible – for those women who actually get to a clinic.


    A fifth of “ eligible “ women don’t have screening in the UK. We don’t know if women younger than 25 would be any more keen to have it. FAR more women in the younger age groups have “ abnormalities “ which would disappear - even with NO treatment. That’s why the best age for starting screening is 25 in the UK ( Scotland will change back to 25 next year ).



    The tragedy of Sophie Jones’s death was that the diagnosis of cervical cancer was missed, partly because it’s so rare at her age. It was too late, and inappropriate, for a smear test. Routine screening of everyone under the age of 25 is impossible . It would cost too much ( money and skilled personnel ) ; not everyone would comply ; and possibly a third of those who did might have unnecessary treatment and worry.


    The title of the thread includes “ preventable infection “. About 1/6 cancers worldwide are caused by infections. Cervical cancer accounts for half of infection-related cancers in women.


    An HPV vaccination programme - freely offered to young girls in the UK - is too expensive for everyone who would benefit. Jake is correct - Gardasil is best ( and recommended in UK ). 12,000 php is less than the price I've seen quoted ( pero masyadong mahal ).


    Screening – for abnormal cells and HPV ( on the same smear sample ) - is still going to be needed for the foreseeable future.


    HPV is a sexually transmitted virus. There could be a case for vaccinating boys. Michael Douglas claimed that oral sex caused his throat cancer, but smoking and alcohol are also risk factors. That's another topic ( #12 ; http://filipinaroses.com/showthread....ht=HPV+vaccine
    ).



    Thanks Rosie, Rayna and Jake for responding .!


  8. #8
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    Cervical cancer is preventable, detectable, and treatable at early stages.


    In the UK it’s relatively rare, ~3,000 cases / 1/50 cancers diagnosed in women, causing ~900 deaths each year.


    The HPV ( human papilloma virus ) vaccine has been available to girls aged 11 - 13, for almost 10 years - at least 4/5 are thought to have been immunised, and thus protected against this cancer.


    Cervical screening, by examining smears, has been running for over 50 years. It’s not the only reason for a decline in numbers of deaths from this cancer. Better hygiene and nutrition, smaller family sizes, delayed childbearing, and fewer sexually transmitted diseases may all have contributed.


    It’s still going to be recommended for women aged 25 - 64, but fewer tests could be needed for those who have been vaccinated, perhaps only 3 ( instead of 12 ). For unvaccinated women, it’s likely that testing will be for HPV first - and only if positive will the smears be examined for abnormal cells.


    Clearly the ~6% of smears which are " abnormal " leads to anxiety. Examination by a gynaecologist with removal of the abnormal area may well " cure " something which might never have progressed to cancer. The government says a smear test is " a good idea " - if that corresponds to the woman’s own wishes. She should certainly discuss the matter first with her doctor.

    ….……………………………………………………………………………………………………………


    How different is the situation in the Philippines, and other " low- and middle-income countries ". Here, cervical cancer is second only to breast cancer in frequency - there are ~6,700 new cases and ~2,800 deaths each year.



    Far fewer Filipinas have ever been screened for this cancer ( perhaps 5%, compared to ~73% in the UK ).


    Public clinics offering screening may lack the ability or resources to treat abnormalities if they are found. It’s not only difficult for patients to travel to such clinics in the first place, but also hard to return for multiple appointments, or visit separate referral centres. If abnormalities can’t be treated, that raises ethical issues, not least the anxiety caused to the patients.



    The HPV vaccine is available in the Philippines - but its high cost prevents wide enough coverage and use, not to mention resistance to vaccination efforts through fears of promoting promiscuity with a vaccine preventing a sexually transmitted disease.



    Unfortunately, this cancer still too often remains " out of sight " when considering women’s health in countries like the Philippines.


  9. #9
    Moderator Steve.r's Avatar
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    Sad facts Alan
    If you want your dreams to come true ...... first you have to wake up


  10. #10
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    *N.B. - ALL FEMALE MEMBERS OF THE FORUM

    , ladies ... do read and take note of the contents of Doc Alan's highly informative advice. It could SAVE your life!


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