Ghanaian Epidemiologist, Yvonne Nartey on research and cervical cancer
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According to the World Health Organization (WHO), “in almost all countries of the African Region, the population and care providers lack information on cervical cancer prevention and management methods. Health professionals sometimes adopt inappropriate medical protocols, thus using already limited resources ineffectively. In addition, women are not aware of the available services even when such resources exist. In some communities, ignorance and lack of information regarding the disease pose further obstacles to prevention.”
Yvonne is currently pursuing her PhD at the University of Otago, where she studies Epidemiology with a major focus on Cancer Epidemiology. She attended Hohoe E.P Senior High School and the University of Ghana where she obtained her high school and undergraduate education respectively. She went on to pursue her Masters at the University of Oxford.
“In simple terms, Epidemiology is the study of the distribution and causes of health-related states or events (including diseases) in a specific population, and the application of this study to control health problems. The disease of interest in my study is cervical cancer. It is worth pointing out that epidemiology differs from clinical medicine on the basis that it is concerned with events that occur in a defined population and not individuals.”
- What prompted your interest in Epidemiology?
"I became interested in cancer when I realized that cancer kills more people than HIV and other communicable diseases in Ghana. However, in Africa, we are so much focused on communicable diseases."
- What have been your challenges? And how have you dealt with them?
"There have been a lot of challenges along the way. One major challenge is being able to succeed in a field, which is highly dominated by medical doctors…and men."
- According to the Government of Ghana Official Portal, over 1,000 women die from Cervical Cancer each year in the country. With respect to your specialty in this area, what exactly causes Cervical Cancer, what are its symptoms, and how can it be prevented?
"Cervical cancer is cancer of the cervix. The cervix is the lower part of the uterus (womb). The cells embodying the cervix do not suddenly change into cancerous cells. Instead, the normal cells of the cervix first slowly change into pre-cancerous cells before evolving into fully-fledged cancer. These changes may be called dysplasia. The change can take many years, but sometimes it happens faster. Fortunately, early diagnosis of precancerous cells makes it possible to implement treatment protocols that prevent evolution of these cells into the cancer stage.
The most important risk factor for cervical cancer is infection with a virus known as HPV (human papilloma virus). HPV is really a group of more than 150 related viruses that can infect cells on the surface of the skin, the cells lining the genitals, anus, mouth, and throat. It is known that very few of the women who contract HPV ever develop cervical cancer. In most cases the body fights off the virus and gets completely cured of the infection without any treatment. But in some women, the infection lasts and may cause certain cancers, including cervical cancer.
There are other risk factors that can increase one’s chance of developing cervical cancer. Women who smoke are about twice as likely to get cervical cancer as those who don’t. Previous work has led to the observation of tobacco by-products in the cervical mucus of women who smoke thus lending credence to the theory that the weakening of the immune system by the tobacco smoke makes the body more vulnerable to HPV infection. Women who have had 3 or more full-term pregnancies are also noted to have an increased risk of cervical cancer. HIV (human immunodeficiency virus) is the virus that causes AIDS − it is not the same as HPV. Women infected with HIV are more likely to get cancer of the cervix. Having HIV tends to make a woman’s immune system less able to fight both HPV and early cancers. Cervical cancer may run in some families. For instance if your mother or sister had cervical cancer, your chances of getting the disease are two to three times higher than if no one in the family had it. Among other risk factors of cervical cancer is the long-term use of birth control pills. Research suggests that the risk increases with increasing time of use of the pill but the risk reduces after the individual stops. It is therefore advisable for women to seek advice from their doctors with regards to the pros and cons of birth control pills before taking them. Overweight women are also observed to be more likely to develop a type of cervical cancer known as adenocarcinoma. Other sexually transmitted diseases may also increase a woman’s risk of developing cervical cancer.
Early cervical pre-cancers or cancers often have no signs or symptoms. That’s why it’s important for women to have regular screening with a Pap test. Symptoms often do not start until the cancer is further along and has spread to nearby areas. You should report any of the following to your doctor right away:
- Abnormal vaginal bleeding, such as bleeding after sex, bleeding after menopause, bleeding and spotting between periods, or having periods that are longer or heavier than usual. Bleeding after douching or after a pelvic exam.
- An unusual discharge from the vagina (not your normal period).
- Pain during sex.
Of course, these symptoms do not mean that you have cervical cancer. They may be due to something else. However, one must check with a doctor to find out. It is best not to wait for symptoms to appear. Regular cervical cancer screening is most recommended for all women within the reproductive age group.
Most cervical cancer cases are preventable. One way is to find and treat pre-cancers before they become cancer, and the second way out is to prevent the pre-cancers. A well-proven method to prevent cancer of the cervix is to have testing (screening) to find pre-cancers before they can turn into cancer. If a pre-cancer is found and treated, it can stop cervical cancer before it really starts. Most cervical cancers are found in women who have not had Pap tests when they should.
Since HPV is the main cause of cervical cancer and pre-cancer, avoiding exposure to HPV, which could be accomplished by avoiding early sex until one is older is observed to be cardinal in preventing cervical cancer. Condoms may help protect against HPV when they are rightly used but it should be noted that HPV can still be passed from one person to another by skin-to skin contact with an HPV-infected area of the body that is not covered by a condom. However, this does not eliminate the necessity of wearing condoms as it protects against AIDS and other sexually transmitted diseases, which are also linked to HPV. It does help for women to limit the number of sexual partners they have.
Finally, avoiding smoking is another important way to reduce the risk of cervical pre-cancer and cancer. There are now vaccines (Gardasil® and Cervarix®) that can protect people against certain types of HPV. These vaccines are only used to prevent – not to treat an HPV infection."
- From your research, are there any new leads on treatments for Cervical Cancer aside the common ones (Hysterectomy, Chemotherapy and Radiation therapy)?
"There are other surgical procedures that can be performed; typical of them are hysterectomy, trachelectomy and pelvic exenteration. As scientists have learned more about the gene changes in cells that cause cancer, they have been able to develop new drugs that are aimed right at these changes. These targeted drugs have a mechanism of action that diametrically vary from standard chemo drugs in that they often have less severe side effects. Standard treatment of cervical pre-cancer includes cryotherapy, laser treatment, and conization. Hyperthermia is also used as a treatment modality to raise the temperature around the tumor. Some research suggests that adding hyperthermia to radiation may help keep the cancer from coming back and help patients live longer. Recent studies aimed at using drugs for treatment instead of radiation have had some promising results. Many clinical trials are testing new chemo drugs, new ways of giving radiation treatment, and new ways to combine treatments."
- What are your thoughts on African Spirituality, Ethics and Traditional Healing in relation to Cervical Cancer? Is it wrong, in your opinion, for women with this disease to consult “traditional healers and spiritualists”? And also, why do you think they do this?
"This is a very complicated issue. I will advice individuals to go to the hospital first. They have to continue seeing their doctors for review. They may consult spiritualists if they think that is helpful for their spiritual protection, but discussions with their doctors in reference to concoctions recommended by spiritualists is strongly recommended."
- What would you advise women, living with this disease, to do?
"I advise women living with cancer to always have hope. With continued follow-ups and treatment, they can live longer and fight it."
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