There’s never a bad time to think about your health, but since February is Reproductive Health Awareness Month, it’s an especially good time to put the spotlight on the wellbeing of your lady parts. And since cervical cancer is one of the biggest killers of women in South Africa, we talked to Dr Trudy Smith, an obstetrician and gynaecologist based in Jo’burg, to find out what you need to know now – and what you can do to protect yourself.
What causes cervical cancer?
‘Human papillomavirus (HPV) – specifically HPV 16 and 18 – causes 70% of cervical cancers,’ explains Smith. ‘Some strains, such as HPV 6 and 11, are responsible for genital warts.’
Okay, so what’s HPV then?
‘It’s one of the most common viruses,’ says Smith. ‘Your chances of getting HPV by the age of 25 are about 70%. It’s passed on by skin-on-skin contact as well as sexual activity. Most of the time it’s harmless; it’s only when dangerous strains of HPV get into your cells that you could be at risk of cancer. Anyone can carry HPV – men and women – and it can lie dormant for years, so you won’t necessarily know that you have it.’
How do you test for HPV?
‘There are two main test options: a woman’s Pap smear, which can pick up abnormalities in the cervix perhaps caused by HPV; and an HPV-specific test,’ says Smith. ‘HPV-specific tests do not necessarily indicate you have a problem – most of us will have HPV at some point in our life, and having it isn’t by default dangerous. You rather want to check for abnormalities, such as lesions caused by HPV. These should show up in a Pap smear, making this your best testing option. It’s important to note that having HPV doesn’t mean you’ll get cervical cancer, but can increase your risk.
‘When you become sexually active, you should go for a Pap smear. This should be done at least every three years, but more often if you change partners or have other problems such as abnormal bleeding.’ If you’re HIV-positive, you should also get a Pap smear more frequently, since your risk profile is higher.
Sadly, the government only provides three Pap smears free in your lifetime – one at age 30, 40 and 50. Health-wise, this isn’t enough to adequately protect you from risks such as cervical cancer. If you can afford it, book extra appointments privately (and before the age of 30 if you’re sexually active then).
Are there any obvious ways to tell you have HPV?
‘In a word, no. It’s internal,’ says Smith. ‘The only thing you might pick up is external genital warts, caused by HPV 6 and 11.’
How can I prevent getting HPV in the first place?
‘Because HPV can be transmitted through as little as skin-on-skin contact, it’s pretty hard to protect yourself 100%,’ says Smith. ‘Using a condom during sex will help lower the risk, but your best bet is to be vaccinated (more about that in a bit!) and go for regular Pap smears, so a doctor can pick up if you have a strain of HPV that may need further monitoring. You can also make some lifestyle changes – smoking increases the risk of the HPV getting into your cells and causing cervical abnormalities.’
But – stop press! – you can get vaccinated against key strains of HPV
‘There are two vaccines available. Currently, one that targets strains that cause cervical cancer is being given to all girls in government schools during their last year of primary education,’ says Smith. ‘Another, Gardasil, can be administered privately – it protects against cervical cancer and genital warts, so it’s also licensed to give to men.’ Why men too, we hear you ask? ‘Men are also affected by HPV – the Gardasil vaccine will protect them against genital warts, penile cancer and anal cancer,’ explains Smith. ‘Anyone can have the vaccine – it doesn’t matter if you’ve had HPV before or if you’re already sexually active. You just need to be under the age of 55. Privately, you can get a prescription from your doctor or gynae, then buy it at a pharmacy. Nurses at pharmacies such as Clicks can administer the vaccination for you. Typically, there are three treatments to complete the vaccination: an initial injection, then one three months later and another six months later. The vaccine doesn’t prevent you from getting HPV, but it does prevent the most dangerous strains from penetrating your cells, which is what eventually causes things like cervical cancer.’
Is the vaccine dangerous?
‘Not at all!’ says Smith. ‘In many countries, such as Australia, HPV vaccinations are mandatory for boys and girls, and it’s made a marked impact on reducing cases of genital warts and Pap smear abnormalities in women that, if left, could turn into cancer. There’s no proof of any dangerous side effects, and the very real risk of getting cervical cancer without the vaccination – one of the biggest killers of women right now – far outweighs any reasons not to get the jab.’
So if I get the vaccine, I’m 100% safe?
‘Not quite – the vaccine protects against 70% of cervical cancers. But the biggest cause of cervical cancer is HPV, so it definitely makes sense to get vaccinated.’