The national rollout of the cervical cancer vaccine last year is a giant leap towards safeguarding future generations of women from this disease. But until the effects of this vaccine start showing results several decades from now (the girls being vaccinated are between nine to 12-year old while cervix cancer usually only occur from the age of 40 onwards), many more South African women will die from the disease.
This is according to Prof Hannah Simonds, the head of the Division of Radiation Oncology of the Faculty of Medicine and Health Sciences at Stellenbosch University.
Simonds says there a variety of reasons why mortality rates will not immediately decrease. Firstly, despite the fact that the national screening programme offers three free Pap smears (at ages 30, 40 and 50) to scan for the precursors of cancer, not enough women utilise these services resulting in many cancer cases only being diagnosed in the later stages of the disease when it is harder to treat.
Secondly, around one in five South African women diagnosed with cervix cancer are also HIV positive.
Simonds explains that co-infection with HIV and the human Papillomavirus (HPV) – which is responsible for most cervix cancers – is a cruel combination. “HPV infection in women with HIV is at least five times more likely to develop into cancer, while cervix cancer in HIV-positive women indicates the progression from HIV to AIDS, and is a so-called AIDS-defining illness,” she says.
Even antiretroviral therapy (ART) does not appear to reduce the incidence of cervix cancer in women with HIV and data from oncology departments in the country shows that the large-scale rollout of ART has had no impact on the number of cervical cancer cases presenting to the six national oncology units in South Africa.
According to Simonds, the management of cervical cancer in patients with HIV is also challenging. Despite the considerable portion of co-infected patients, all clinical trials on the treatment of cervix cancer (both local and international) exclude HIV-positive patients, leaving oncologists with untested treatment regimens for women with this comorbidity.
“Finally, the importance of the social determinants of health cannot be overstated,” Simonds says. Poverty, health-seeking behaviour, public health education, domestic violence and social stigma are just a few factors which contribute to the sustained prevalence of this disease in South Africa. “Without resources to battle these issues we are unlikely to impact the numbers of patients presenting for care,” says Simonds.
