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How does Thailand combat cervical cancer?
It is rather unthinkable that cervical cancer was the most common cancer for women in Thailand just twenty years ago. The country’s 30 years of the test-and-refer approach had failed to make a dent in the country’s death toll from the disease. Luckily, this has all changed in 2000 with the Safety, Acceptability, Feasibility and program implementation Effort (SAFE) study.
This June, the Provincial Health Office of Roi Et, one of the parties involved in implementing the SAFE study, has received the 2018 UN Public Service Award for its cervical cancer prevention programme. After the introduction of the programme, the number of cervical cancer cases has seen the largest decline over the past decade among Thailand’s five leading causes of cancer death for women. This week, Pacific Prime Thailand will take a look at how the programme made a difference, and the symptoms, stages, and treatment of cervical cancer.
How does the new cervical cancer prevention work?
In 2000, Jhpiego, the government of Thailand, the Provincial Health Office of Roi Et, and the Royal Thai College of Obstetricians and Gynecologists have implemented the SAFE study, which has taken on a screen-and-treat approach for cervical cancer prevention.
Unlike conventional cytology screening, this non-cytology-based approach is low-cost, does not require sophisticated equipment, and can be made available in under-resourced areas. Furthermore, this method allows women to attend a single visit with a health care provider and services can be provided by a nurse, allowing for task-sharing within the health system. Shifting the task from doctors to nurses to perform cryotherapy is largely attributed to the success of the programme since there were only 3 doctors in every 10,000 citizens in Thailand two decades ago, according to the statistics from The World Bank.
Over the next seven months, 5,999 women were screened for precancerous lesions. After one year of follow-up, 94·3% of the women who received treatment after screening tested negative. Since then, 32 provinces have implemented the approach, providing free visual inspection of the cervix with acetic acid screenings (VIA) and cryotherapy services to women. Based on results from this study, the WHO has adopted the screen-and-treat strategy as part of their comprehensive cervical cancer guidelines.
So what exactly is cervical cancer and what are its symptoms?
Cervical cancer is a form of cancer that affects the entrance to the uterus, which develops when cells in the cervix become abnormal and multiply rapidly. If left untreated or undetected, it may cause the patient to bleed to death eventually.
Almost all cases of cervical cancer are caused by a specific type of virus called human papillomavirus (HPV), the most common sexually transmitted infection. There are over 100 different strains of HPV, of which at least 13 can cause cervical cancer.
In the early stages of cervical cancer, the patient may not exhibit any symptoms at all. Therefore, it is crucial for women to undertake regular Pap tests, which involves swabbing your cervix with a device that’s similar to a cotton swab for examination of precancerous or cancerous cells.
When cancer progresses into advanced stages, women may notice the following symptoms including:
- Abnormal bleeding, such as bleeding between periods, after sexual intercourse, after a pelvic exam, or after menopause;
- Discomfort during sexual intercourse;
- Smelly vaginal discharge;
- Vaginal discharge tinged with blood;
- Painful urination.
What are the stages of cervical cancer?
Stages of cancers show how far cancer has developed and help doctors determine the most effective treatment method. Cervical cancer usually includes four stages:
Stage 0: Precancerous cells are found in the innermost lining of the cervix.
Stage 1: Cancer cells have grown from the surface into deeper tissues of the cervix, and possibly into the uterus and to nearby lymph nodes. It may or may not be visible without a microscope.
Stage 2: The cancer has spread beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes.
Stage 3: Cancer cells are present in the lower part of the vagina or the walls of the pelvis, and it may be blocking the ureters, the tubes that carry urine from the bladder. It may or may not affect nearby lymph nodes.
Stage 4: The cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. Later in stage 4, it will spread to distant organs, including the liver, bones, lungs, and lymph nodes.
How do you treat cervical cancer?
Early stage cervical cancer
When the cancer cells are limited to the cervix only, surgery is commonly used. Radiotherapy may also be used since the doctor believe that some cells may still exist in the body so as to reduce the risk of recurrence. Chemotherapy may also be used before the surgery to shrink the size of the tumor so that it will be easier for the surgeon to operate.
Advanced stage cervical cancer
If the cancer has spread beyond the cervix, surgery would not be a viable option. Radiotherapy, or a combination of radiotherapy and chemotherapy, is administered to destroy cancer cells.
How do you prevent cervical cancer?
To lower your cervical cancer risk, you should reduce your likelihood of contracting HPV since it is the major cause of cervical cancer cells. There are a number of measures you can take to prevent HPV.
- Engage in safe sex
Using a condom during sex properly can prevent you from HPV infection. However, bear in mind that body areas unprotected by a condom may still be infected.
- Get HPV vaccine
All HPV vaccinations provide immunity against types 16 and 18 of HPV, the two most cancer-causing strains, while some vaccines can protect you from even more HPV types.
- Take cervical screening
It is crucial for women to undergo regular Pap smear tests to identify abnormal changes in the cervix.
For more information on how to effectively prevent cervical cancer, you can click HERE to download our HPV guide.
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