Cervical cancer is the second most frequent cancer in women in the world and the third greatest cause of death from cancer in women. Cervical cancer is caused by the human papillomavirus, which is the most common viral infection of the reproductive tract.
Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected. The peak time for acquiring infection for both women and men is shortly after becoming sexually active.
HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognised mode of transmission. Cervical cancer is caused by sexually acquired infection with certain types of HPV. Two HPV types (16 and 18) cause 70 percent of cervical cancers and precancerous cervical lesions. Vaccines against HPV 16 and 18 have been approved for use in many countries.
Many more women die of cervical cancer in the developing world than in wealthier countries.
According to the World Health Organisation, of the estimated more than 270 000 deaths from cervical cancer every year, more than 85 percent occur in developing countries.
It is now being projected that if nothing is done to deal with cancer, the disease has potential to take over from HIV and AIDS in terms of mortality.
Its against this background that the Ministry of Health and Child Care with support from Global Alliance for Vaccines and Immunisation is set to lay a solid foundation to the fight against cervical cancer by introducing Human Papiloma Virus vaccines to 10-year-old girls in Marondera and Beitridge on a two-year pilot project.
The project is later expected to be rolled out at national level targeting girls aged 9-13 years old.
“Under this programme, Zimbabwe will deliver vaccines to girls aged 10 years in the two districts of Marondera and Beitbridge starting on the May 19, 2014.
“The vaccination programme, scheduled to run simultaneously in the two districts will reach a total of 4 441 ten-year-old girls residing in Marondera and Beitbridge, both in school and out of school ensuring that they complete a course of three vaccines over a six month period. A further 4 490 girls in the second year will be reached out,” said Dr Paul Chimedza, Deputy Minister for Health and Child Care.
Dr Chimedza further indicated that thereafter a full national programme of vaccination will start in 2016, vaccinating girls aged 9-13 years.
“Learning derived from the 2014 and 2015 rounds of vaccination in the two districts, and from observed any province-wide effects will be used to inform the national roll out of the vaccination program scheduled for 2016,” he said.
The two districts, according to the ministry, were selected based on previous assessments of vaccination coverage which showed high PENTA 3 coverage, good oversight of the Expanded Programme on Immunisation (EPI), therefore their readiness to add another vaccine and achieve the required coverage.
Whilst the pilot project is covering an arguably small area considering the impact of cervical cancer on women, the ministry is exercising caution by not rushing to roll out the programme at national level.
“In addition, for a vaccine targeting pre-adolescent girls, and perhaps boys in the future, it was deemed prudent to derive in-depth learning of services available for the targeted groups and in comparison with what is desired or required in line with culture. In this respect, study of the major socio-cultural groups will be undertaken during the course of the two year demo project, looking at cultural diversity, earthnic dynamics, urbanity and traditional practices,” indicated the ministry.
However, this is not the first time that the vaccine is being introduced in Africa.
WHO indicates that by the end of 2012, 45 countries had introduced HPV vaccination.
Most of these are developed countries, but given that the global burden of cervical cancer falls heaviest on developing countries, there is still a great need for more countries to introduce the HPV vaccine as part of a national public health strategy that includes a comprehensive approach to prevention and control of cervical cancer.
Although the national programme will eventually target the 9-13 age group, figures from the National Cancer Registry point out that many women 15 and above are at risk of cervical cancer.
“In Zimbabwe, the whole population of 3,96 million women aged 15 years and older are at risk of developing cervical cancer as this is the commonest cancer in women, (National Cancer Registry, 2011).
It is therefore against this background that the ministry is intensifying on prevention of cervical cancer in this project.
“The HPV vaccine targets girls before they are sexually active in order to prevent acquisition of a sexually transmitted infection. The goal is to reduce deaths and improve lives,” indicated Dr Chimedza.
Apart from HPV vaccines, WHO recommends that countries should strengthen early screening and treatment programmes.
WHO says the majority of HPV infections do not cause symptoms or disease and resolve spontaneously.
However, persistent infection with specific types of HPV (most frequently types 16 and 18) may lead to precancerous lesions. If untreated, these lesions may progress to cervical cancer, but this progression usually takes many years.
Symptoms of cervical cancer tend to appear only after the cancer has reached an aanced stage and may include:
Irregular, inter-menstrual (between periods) or abnormal vaginal bleeding after sexual intercourse
Back, leg or pelvic pain
Fatigue, weight loss and loss of appetite
Vaginal discomfort or odorous discharge and
A single swollen leg.
WHO notes that although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer.
It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Risk factors for HPV persistence and development of cervical cancer
Early first sexual intercourse
Multiple sexual partners
Immune suppression (for example, HIV-infected individuals are at higher risk of HPV infection and are infected by a broader range of HPV types).
If signs of cervical cancer are present, treatment options for invasive cancer include surgery, radiotherapy and chemotherapy.
Source : The Herald