We need to inform women about cervical cancer, so they will be alert to changes in their bodies
14 May 2007
"When I see a spade, I call it a spade," said Little Cecily in The Importance of Being Ernest. "I am glad to say I have never seen a spade," retorted Gwendoline. When talking about cervical cancer, we need to call a spade, a spade. This government has given a commitment that it will extend the screening programme for cervical cancer to the whole country. The all-Ireland Cancer Foundation is encouraging this. We are aware how useful it has been in Northern Ireland, the rest of the United Kingdom and in other European Countries, too. We need now to start calling "spades", "spades".
It is one of my great regrets that ten years after the "pilot scheme" for cervical screening in the Limerick area was established that it has not been extended country wide since it proved to be successful. Hundreds of Irish women have died of cervical cancer since then. About seventy women die each year and it is reckoned, with a well run scheme, 80 per cent of these deaths could be avoided.
When we debated setting up the Limerick scheme and brought in the legislation to make it possible, I pressed for the establishment of a population register. Such a register makes it possible for us to know who the people are that should be screened, in this case women of a certain age and where they live. This register is still not in place. While this is not a help, it should not be used to deter us.
Much progress has been made on the etiology of cancer of the cervix. We now know that it is caused by a group of human papilloma viruses (HPV). Some of these viruses in some women cause cancer. For some peculiar reason there appears to be a reticence in saying that the viruses are transmitted by sexual intercourse and I have had women ask me if they could get the infection from tampons, or from using towels which others had used.
Now, no one wants to have women blaming a partner for "giving" them cancer of the cervix but, at the same time, people are entitled to be given accurate information. We tell people that viruses are transmitted in the air, droplet infection or water, so let us be honest here too, about this mode of transmission,
Infection with the HPV does not appear to cause cancer in many women, but those who are unlucky enough to be affected need the benefit of screening. The earlier the condition is diagnosed the easier it is to treat. Late treatment is not a jolly process and even worse, the patient is frequently a woman in her late thirties or forties with many social responsibilities.
We must also speak more plainly about cervical cancer signs, which should not be ignored. Bleeding from the vagina, and we need to say the vagina because I have been asked "bleeding from where", outside the menses (or periods) should be seen as a call for action and a visit to the GP.
What is really alarming is the long delay patients may experience before the GP can get an appointment for them with a gynaecologist. And then there can be another long delay before the result of any smear or other tests taken are given to the patient. These delays to patients are really intolerable. There is no use asking patients to be alert to abnormal changes in their bodies and when they do report to the doctor to find they will not be dealt with urgently.
It is wrong, also, that so many cervical tests are being sent abroad for processing. Technologists in the field cannot gain the necessary experience if this continues, and laboratory resources must be produced at once.
Vaccines against some of the HPVs which cause cervical cancer have been produced and are licensed, or in the process of being licensed, here. These are effective against about 70-80 per cent of the infective viruses and this situation may improve. They need to be given, however, before a girl is sexually active because after exposure to HPV we are not clear how effective they will be.
The last year of primary school is probably the best time to give girls the required shots. In some parts of the United States of America campaigns have been initiated urging parents not to have their daughters vaccinated because this will encourage them to be promiscuous. Someone even took the trouble to write to me from Texas with this warning.
President George W. Bush has for some years been running a campaign for teenagers on the topic of sexual abstinence before marriage. While this is a very good idea, and would avoid all sexually transmitted diseases as well as teenage pregnancies, the results have been very disappointing. According to Peter Bearman of Columbia and Hannah Bruckner of Yale, those who took pledges of abstinence had about the same number of sexual partners and made, as it is so nicely put, their sexual debut at about the same age as those who did not. So the idea that any girl who has been vaccinated against cervical cancer will think this is a passport to sex with all without any problems is a bit bizarre.
It will take quite some time before a vaccination programme is up and running. It has yet to be evaluated by the Childhood and Adult Immunisation Section of the Department of Health and Children, and then if recommended, the costs are considerable. At present each dose costs about €120, and three are required, but this cost will decrease if greater numbers of doses are required. It is essential that a vaccination register is set up so that in years to come we will be able to assess results.
All the talk of vaccination does not mean we must not press ahead immediately with the cervical screening programme. And after this must come immediate treatment of those affected. The lives of too many young Irish women are being lost. Indeed, on an international basis the numbers lost to cervical cancer, a curable condition, are horrific.
Senator Mary Henry, MD
