In the 21st century, the question that still scares experts who care for women’s health is why, even though it is a preventable disease, the mortality rate of cervical cancer remains high, reaching approximately 311 thousand deaths per year in Worldwide. In Brazil, more than 6 thousand women die every year because of the pathology. Lives lost to misinformation, inequality and prejudice, in a country that has around 16,700 new cases annually, most of them in the North region. According to statistics from the National Cancer Institute (INCA), the South and Southeast regions occupy, respectively, the fourth and fifth position in the Brazilian ranking of deaths.
Rare in women up to 30 years of age, the disease has a higher incidence in the age group from 45 to 50 years, from which the mortality rate increases progressively. Research indicates that HPV (Human Papillomavirus) infection is the most frequent sexually transmitted disease on the planet, and the risk of a woman having contact with the virus throughout her life reaches 80% chance. However, less than 5% will have a viral manifestation and only about 1% will result in a lesion leading to malignancy. Enough to generate irreparable losses. Very common, the infection is slow and usually leads to local diseases that are benign, but if left untreated, cause cancer.
A disease that, according to experts, in addition to being preventable, also has a great chance of cure when detected in its early stages. “The main cause of cervical cancer is the persistent infection by the HPV virus. If we somehow prevent this infection from happening, we prevent the appearance of cancer from happening”, explains physician Leandro Ramos, oncologist at Oncomed, a clinic specialized in cancer prevention and treatment. In the month of March, when International Women’s Day is also celebrated, the Cervical Cancer prevention campaigns are reinforced, remembering the importance of raising awareness to combat the third most frequent cancer in Brazilian women, behind only the breast cancer and bowel (colorectal) cancer.
Considered by the World Health Organization (WHO) as one of the most serious public health problems to be faced in 2022, two years ago the entity launched a global strategy for the elimination of the disease, supported by the World Health Assembly. Since then, the recommendation is that 70% of women worldwide be evaluated regularly, through high performance testing, and that 90% of them receive appropriate treatment. Combining human papillomavirus (HPV) awareness and vaccination, the strategy aims to prevent more than 62 million deaths over the next 100 years. “It is also necessary to invest in tertiary prevention, offering treatment of invasive cancer at any age, ensuring access to ablative surgery, radiotherapy and chemotherapy, according to the staging of the disease”, warns gynecologist Maria de Fátima Dias de Sousa Brito, from Instituto Orizonti .
To prevent, the orientation is always to use condoms and invest in the vaccination of the younger population. Girls from 9 to 14 years old have a vaccination schedule well established by the Ministry of Health, as do boys from 11 to 14 years old. However, in 2020, only 55% of Brazilian girls took both doses of the HPV vaccine. It is worth mentioning that even vaccinated women, aged between 25 and 64 years, and sexually active, should undergo a preventive examination (Pap smear) to assess the existence of any change related to the infection. The first two exams must be performed annually and the others repeated every 3 years. The importance of the exam is to make the rapid detection of lesions that are amenable to treatment and cure.
A year ago, relationship manager Marina Ramos Dolabela, 39, received unexpected news. Because of the pandemic, she had stopped taking the preventive exam for cervical cancer. When she returned to the doctor, the result showed a slight change, but it was the biopsy that confirmed the diagnosis. “It was scary. You never imagine you’re going to go through this,” she says. After a few months facing a heavy treatment routine, with chemotherapy once a week, radiotherapy 37 consecutive days and some brachytherapy sessions, Marina celebrates life and makes a point of warning about the disease. “Cancer has brought many changes to my life. It is necessary to talk about it and provide information so that other women do not go through what I went through”. Mother of a nine-year-old girl, she is already preparing to vaccinate her against HPV.
Cervical cancer is a public health problem that not only affects women, but also all those close to them, such as friends and family. Often, fearing abandonment, rejection by the partner and the judgment of society, they prefer not to talk about the disease, forgetting that they are the main victims. “The more people informed and informed about cervical cancer, the less suffering we will have and the more lives will be saved”, says Meire Rose Cassini, a psychologist at the hospital service at Hospital Felício Rocho. The WHO warns that if there is no global effort to control the disease, a 30% increase in cases is expected by 2030.
Risk factors for cervical cancer:
- Early onset of sexual activity and multiple sexual partners
- Smoking and immune factors
- Long-term use of oral contraceptives and irregular condom use
- Low socioeconomic status, multiparity (non-surgical births), nutritional deficiencies, and other genital infections caused by sexually transmitted agents
- Pain and/or bleeding during intercourse
- fetid vaginal discharge
- Appearance of small warts in the genital area