CERVICAL CANCER

Cervical Cancer.

Cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases in 2012. A large majority (around 85%) of the global burden occurs in the less developed regions, where it accounts for almost 12%of all female cancers. High risk regions, with estimated Age standardized incidence rate (ASRs) of over 30 per 100,000, include Eastern Africa (42.7), Melanesia (33.3), southern (31.5) and middle (30.6) Africa. Rates are lowest in Australia/New Zealand (5.5) and western Asia (4.4). Cervical cancer remains the most common cancer in women in eastern and middle Africa.
There were an estimated 266,000 deaths from cervical cancer worldwide in 2012. Mortality varies 18-fold between the different regions of the world, with rates ranging from less than 2 per 100,000 in western Asia, western Europe and Australia/New Zealand to more 20 per 100,000 in Melanesia (20.6), middle (22.2) and eastern (27.6) Africa.
Cervical cancer is a common cancer in women in sub-Saharan Africa, both in terms of incidence and mortality. More than 75 000 new cases are diagnosed annually, 27,326 of these occurring in West Africa. In sub-Saharan Africa it causes over 50 000 deaths, each year of which 16,546 occur in West Africa. The overall age-standardized incidence rate of cervical cancer in sub-Saharan Africa was 31.7/ 100 000 in 2008. This is one of the highest incidence rates in the world.
About 14,089 new cervical cancer cases are diagnosed annually in Nigeria, where it causes about 8,240 deaths annually. An estimated 96% of women in developing countries have never been screened of cervical cancer and over 80% of women newly diagnosed with cervical cancer live in developing countries; mostly diagnosed when advanced disease 1.
Formulation of a cervical screening program and ensuring compliance with national program guidelines is an essential step toward significantly reducing the burden of cervical cancer 2. It has been observed that these services does not reach women most at risk that is older women aged 35-60 years, especially those who live in rural areas

TYPES OF CERVICAL CANCER SCREENING
There are two types of tests used for cervical cancer screening:
The Pap test can find early cell changes and treat them before they become cancer. The Pap test can also find cervical cancer early, when it’s easier to treat.
The HPV (human Papilloma virus) test finds certain infections that can lead to cell changes and cancer. HPV infections are very common, and most go away by themselves and don’t cause these problems.

RISK FACTORS FOR CERVICAL       CANCER
Several factors influencing cervical cancer screening have been reported. They include;

Poverty: Women who are poor may not have access to medical services that detect and treat precancerous cervical conditions. When such women develop cervical cancer, the disease usually remains undiagnosed and untreated until it has spread to other parts of the body. Women who are poor are often undernourished, and poor nutrition is thought to increase cervical cancer risk 3.

Tobacco use:  Women who smoke are about twice as likely to develop cervical cancer as women who do not. The more a woman smokes - and the longer she has been smoking - the greater the risk 4
Multiple sexual partners: The more the number of sexual partners the higher the risk of infection with HPV. 

Being overweight: overweight women are more likely to develop adenocarcinoma of the cervix.
First full-term pregnancy at a young age: (being younger than 17 at your first-full term pregnancy). Women who were younger than 17 years when they had their first-full term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.

Having multiple full-term pregnancies: women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. no one really knows why this is true. One theory is that these women had to have had unprotected sex intercourse to get pregnant, so they may have had more exposure to HPV.
Past or current Chlamydia infection: Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Chlamydia infection can cause pelvic inflammation, leading to infertility.
Smoking is associated with an increased risk for squamous cell carcinoma but not for adenocarcinoma.

HIV (Human Immune-deficiency Virus): HIV increases the risk of progression of cervical cancer. This is because HIV appears to alter the natural history of HPV (Human Papilloma virus) infection, causing much more rapid progression to high grade and invasive lesions that are refractory to treatment, or which regress more slowly.

DES (Diethylstilbestrol) EXPOSED: in 1971, the new England journal of Medicine published a report showing that seven of eight girls and young women (ages 14-22) who had been diagnosed with vaginal clear cell adenocarcinoma had been exposed prenatally toDiethylstilbestrol (DES).

PERSONAL HISTORY OR CIN3, OR CERVICAL CANCER: women who have been treated for high-grade cervical intraepithelial neoplasia or cervical cancer (CIN2 or higher)

PREVENTION OF CERVICAL CANCER.

Screening: screening includes; cervical cytology (also called the Pap test or pap test or pap smear) and, for some women, testing for human Papilloma virus (HPV). Screening is done by checking the cervix by the Papanicolaou test, or Pap smear, for cervical cancer has dramatically reduced the number of cases of and mortality from cervical cancer in developed countries. Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer.

  Barrier protection: barrier protection and/or spermicidal gel use during sexual intercourse decreases cancer risk.

  Vaccination: two HPV vaccines (Gardasil and Carvarix) reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93% and 62% respectively. The vaccines are between 92% and 100% effective against HPV 16 and 18 up to at least 8 years.

  Nutrition: Vitamin A is associated with a lower risk as are Vitamin B12, Vitamin C, Vitamin E, and Beta-carotene.