Preventing cervical cancer through your sexual habits

In the Philippines, the Young Adult Fertility Study (YAFS) research in 2002 reveals that 1.2 percent of our youth will have had their first sexual contact before 13 years old. The youngest reported was at eight years old. Twelve percent of the females while 28 percent of the males would have started sexual contact before 18. In fact, 38 percent of our youth are already in a live-in arrangement. These statistics are disturbing because the youth are engaging in practices that increase their exposure to acquiring the virus that causes cervical cancer.

Cervical cancer is the most common cancer in the female reproductive tract and is the second most common cancer in women, next to breast cancer. In 2005 alone, National Cancer Institute statistics reveal that there are 7,225 new cases of cervical cancer in the Philippines. Sadly, two-thirds of these cases are diagnosed when they are beyond the operative stage, such that 32.3 percent of them die in one year, and 73 percent die in five years. The irony is that it is completely preventable, or at least diagnosable before it becomes life-threatening.

What Do We Know About This Virus?

Over a century ago, it was observed that women who developed cervical cancer were among those with husbands who traveled frequently, or who had penile cancer, or those who fleeted from one sexual partner to another. It was not until the past two decades that research showed that one of the main causes of cervical cancer was a virus called the human papillomavirus.

World experts on the human papillomavirus from 18 countries gathered recently to organize the Asia Oceania Genital Infection & Neoplasia (AOGIN), a research organization on genital infection, to share their latest research on the virus and to discuss global intitiatives on cervical cancer prevention. It was revealed that there are 70 distinct site-specific types of this virus (meaning they will grow on one part of the body but not on another). Of these, about 35 types are found in the anus and the genital areas, causing warts and cervical cancer, the most notorious being types 16 and 18. It is a virus acquired through sexual contact and infects the lining cells of the genitalia and can be detected in 5 to 40 percent of women of reproductive age. It has been found that infections are relatively short-lived lasting usually eight to 10 months. This indicates that our bodies are, indeed, capable of clearing the virus which is why in women over 30 years old, the prevalence drops by 5 to 10 percent. It is in this group of women with persistent infections and who are not able to clear the virus from their bodies that cancer in the cervix now has a chance to progress. The virus is apparently able to thrive in the cells without killing their hosts and inducing any immunologic reaction from the patient. The body, therefore, "ignores" the virus, allowing it to eventually alter the genetic code of the cells. This results in uncontrolled cell growth, which becomes cancerous after many years.

Is there a way to test if you are positive for the human papillomavirus?

Because of advances in our knowledge linking the human papillomavirus to the causation of cervical cancer, it became necessary to develop HPV tests that would indicate if the woman is positive for the high-risk strains of the virus that would increase her risk for cervical cancer. The HPV DNA test using the Hybrid Capture II System, developed by a company called Digene, recently came out with a commercially available test which has a sensitivity of 90 percent and a negative predictive value of over 90 percent. Available in major hospitals, the test entails taking cervical swabs, much like a Pap smear, using the brush from the Digene cervical sampler. Pap smear collected with a broom collection device and rinsed in the ThinPrep System PreservCyt solution may also be used to provide the same specimen for HPV testing. (You see, Pap smears are done in two ways: The conventional way is to smear the cervical swab on a glass slide; the latest is to use the broom collection device with the ThinPrep System.)

Many recent studies have shown that the combination of HPV DNA test and Pap smear improves the detection rate of pre-cancerous lesions of the cervix compared to Pap smear alone.

Factors That Increase One’s Risk For Cervical Cancer

It is important to understand the risk factors that increase your chances of acquiring the virus as well as the co-existing factors that mediate progression to cancer. In a case-control study of women with invasive cervical cancer in four Latin American countries where they evaluated cervical cancer risk in relation to sexual behavior, histories of specific venereal diseases, and hygiene practices, it was noted that early age at first sexual intercourse and increasing number of sexual partners were associated with significantly increased risk for cervical cancer. Risk increased over twofold among women reporting first intercourse at 14 to 15 years old, compared with those who started after 20 years old. An initial pregnancy before 18 years old and multiple pregnancies (over five) as well as a history of having acquired a sexually transmitted disease (STD) also increase your risk. Having an uncircumcised male partner, cigarette smoking, an impaired immune system (such as AIDS patients), and poor nutrition (diet low in fruits and vegetables, and deficient in vitamin A, C, and folic acid) all increase ones’s risk for cervical cancer.

What To Do

It is vital for us to educate our youth that it is prudent for men as well as women to delay having sex as late as possible. This is because the earlier you engage in sexual intercourse, the higher the chances for having multiple sexual partners which will increase the chances of acquiring the carcinogenic human papillomavirus. Men should realize that although the virus does not cause much harm to them in general, other than occasionally causing unsightly penile warts, through their sexual practices, they can transmit the virus to their unsuspecting, innocent monogamous sexual partners. Engaging in sex early has also been linked to increased number of early, unwanted pregnancies, which can also increase the chance for the virus to mutate the genetic code (because of the immunocompromised state during pregnancy) of the cell to promote cervical cancer. The youth must know that promiscuity can be potentially lethal if one acquires the HPV virus or, worse, AIDS so sex should be limited to a significant other or to one destined to be a lifetime partner. It was also found that choosing a circumcised male partner can also decrease one’s risk for cervical cancer. One word of caution: Using condoms cannot protect one from acquiring or transmitting the virus since the warts may be in the testicular area which is not covered by the condom.

The human papillomavirus test may be recommended to all women over 30 years and above together with a Pap smear. If both tests run up negative, and the last three Pap smears were normal, you can even defer your next Pap smear test for three years because in the absence of the virus, it is unlikely that you will develop cervical cancer in three years. If your test turns up positive, you may either opt for a repeat testing in one year or go for colposcopy of the cervix to check for possible precancerous changes.

Future Promises

Two major pharmaceutical companies, GSK and Merck, are already doing human trials on an HPV vaccine in the hope of reducing the risk for cervical cancer. Hopefully, in two years, at least one of them will receive FDA approval from the US and be commercially available. It is hoped that such vaccines would boost an immune response against the development of cancer or even existing tumors. Preliminary trials of the vaccine have shown some promising success. Hopefully, mass vaccinations in females around 10 years old, before women become sexually active, can one day free all women from this deadly cancer. Remember that promiscuous sexual practices can play a tremendous role on you or your partner’s health.

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Dr. Rebecca B. Singson is a fellow of both Obstetrics and Gynecologic Society and Philippine Society of Cervical Pathology and Colposcopy. She is holding clinics at Rm. 381, Makati Medical Center with tel. no. 892-7879 and Rms. 202-203, Asian Hospital & Medical Center with tel. nos.771-9204 and 771-9206; or e-mail at obmd@surfshop.net.ph.