There’s nothing shameful about suffering from cancer down there.
Caused by sexually transmitted infection, cervical cancer has the second highest incidence among Filipino women, next to breast cancer. It claims the lives of thousands of Filipinos each year. The increasing rate is partly due to the taboo surrounding the disease.
The truth is, every woman, regardless of age, race, sexual orientation and lifestyle, is susceptible. One doesn’t need sexual penetration to get infected.
But cervical cancer is highly preventable. There’s a vaccine against certain types of human papillomavirus (HPV), the DNA virus that causes cervical cancer in women.
“Since 2006, only a little over 500 Filipino women had themselves vaccinated out of the estimated five million who can afford to pay,” said Kristel V. Guce, product manager of GlaxoSmithKline (GSK).
This year, GSK, with Healthway Philippines, launched “X Means Love,” an aggressive campaign for cervical cancer awareness among Filipinos.
Its latest ambassador is radio DJ, TV host and former MTV VJ Andi Manzano, whose 49-year-old mom, Rose, was diagnosed with Stage 1 cervical cancer last June.
Manzano was in the middle of planning her wedding to top nightlife mover, GP Reyes, when her mom was undergoing treatment. She had no idea what to expect—she didn’t even know what chemotherapy or radiation was. (She thought chemotherapy was a big machine.)
Thus it was horrifying for her when her mom started to lose hair and weight rapidly. Death seemed inevitable, she said.
“And just to see her go through [that] was the most difficult thing, especially when you’re planning a wedding… I always have my mom for [everything], to pick out a wedding dress… My mom is my best friend… It was the lowest of lows, the loneliest time of my life. For six months, I didn’t feel like planning anything for the wedding,” the 26-year-old Manzano said.
After chemotherapy and radiation cycles, her mom is now cancer-free. Andi and her three siblings had themselves vaccinated.
“Oftentimes women discover cancer when it’s already in Stage 3 and 4, because that’s when symptoms appear. There are almost always no symptoms during the early stages,” said gynecologic oncologist Esther Ganzon. Ganzon is a doctor at the Asian Hospital and Medical Center.
A healthy cervix is smooth and shiny and pink all over, a lot like Krispy Kreme’s glazed donut, Ganzon said.
Women with cervical cancer have dark red cervixes, almost black, with cauliflower-like lesions.
“But even if you look at your vagina, and put a mirror between your legs, you won’t be able to see your cervix. You need an OB/GYN to check it for you,” she said.
HPV is very easily transmitted. Even worse, it remains infective for a very long time.
Ganzon said anyone can be a carrier—male or female—and there’s no telling when it becomes active.
The risk begins once you become sexually active. Any form of sexual intimacy will make you vulnerable to infection—kissing, necking, oral sex, genital skin-to-skin contact, anal sex. Penetration is no prerequisite.
“When you engage in physical intimacy you use your whole body. Condoms do not guarantee protection because it will just cover the penile shaft. The anal skin, scrotum and other parts are still exposed. Skin cells with HPV can remain infective for days,” Ganzon said.
Monogamous relationships are not spared either. The risk of infection in a monogamous relationship rises to 46 percent after three years.
There’s also the risk of fomite infection, where inanimate objects transfer the virus. Sometimes HPV doesn’t die from the heat, but there’s less than 5 percent chance of one getting infected from the towels, dildos or underwear used.
There are rare cases of men developing cancer in the anus, penis and oropharynx, Ganzon said. It’s the women who are much more vulnerable.
“The penis is outside. Skin is shed off regularly. The skin of the penis is the same as the skin elsewhere—it’s keratinized. The cervix’s skin is not keratinized so there’s less protection. When you have sex there are micro abrasions. Repository ang babae,” she said.
There’s a 75-80 percent chance of women acquiring HPV in their lifetime, although not all will be fatal. There are over 100 different types of HPV. About 15 are considered risk factors for cancer.
Certain types of HPV, such as No. 16 and 18, contribute to 70 percent of cervical cancer cases.
It takes 10-15 years for the infection to develop into full-blown cancer.
Ganzon cited the case of a 24-year-old patient who was diagnosed with Stage 3B cervical cancer. The young woman had her first sexual experience at 15. She married at 20, had three children, and died at 24, six months after her diagnosis.
A widow of 10 years also developed cervical cancer, even without having any sexual contact after her husband’s death. She caught the HPV when her husband was still alive.
A 90-year-old woman was diagnosed with cervical cancer, refused treatment and died from other causes.
Foul smell
Cervical cancer is marked by a strong, foul smell that can be detected even from several meters away. This, said Ganzon, is also one of the reasons some women refuse to get treatment.
“We don’t talk about it. We think we will never get cervical cancer. But that is far from the truth,” Ganzon said.
Something as simple as getting an annual pap smear can save your life. Pap smear will reveal precancerous lesions in the cervix, lesions that can be easily treated by doctors.
If those lesions remain untreated, the risk of developing cancer increases significantly.
Not genetic
Cervical cancer is not caused by genetic factors; 99 percent of the time it is caused by HPV.
It affects not only women with multiple sexual partners; anybody with a cervix can be infected.
It cannot be detected early, so annual screening is a must.
Established cofactors include: women who have given birth to three or more children; smoking; long-term use of oral contraceptive pills; and those with HIV.
“If I didn’t go with my mom throughout her entire chemo and radiation sessions, I wouldn’t have really known what we were dealing with. If anything, it made our family stronger and closer,” Manzano said.
As early as 10
Ganzon said one must vaccinate children as early as 10 years old, when the antibodies produced are twice higher than somebody who is already 15 or 20.
Older women who have been exposed to HPV longer can still get vaccinated.
There is no age limit.
Guce said a vaccination from GSK follows the 0-1-6 step: first shot in the deltoid area is 0; the second shot after one month; and the last after six months.
The vaccine will protect women for 20 years from HPV types 16 and 18. Since there are 15 types of HPV that can cause cancer (including 16 and 18), annual pap smear and screening are still required.