Silent virus can lay dormant for 15 years

ISLAMABAD: Jade Goody. Does the name ring a bell? She was paired up with Indian actress Shilpa Shetty on the UK reality TV show ‘Big Brother’ back in 2008. Most of us would recall the bit of news that Shetty had more or less walked out of the show after a spat with Goody.

Then came the bombshell in March 2009: Jade had succumbed to cervical cancer at the age of 27 years. Like so many others, she had simply not known of the cancer until it was in its advanced stage, and that was just too late.

Cervical cancer symptoms are usually benign and there are little to no initial symptoms and signs. It is a disease that can strike women of any age, ethnic background, or social and economic class.

The cancer is caused by the human papillomavirus (HPV) and is simply a silent killer that nests in the host’s body for up to 15 to 20 years, so the woman finds out when it is already too late.

Cervical cancer is the second most common cancer among women and the third leading cause of cancer deaths among women globally. The global burden of cervical cancer is 500,000 cases every year, with 270,000 women dying of it globally — that is one death every two minutes.

According to a report in the Times of India, cervical cancer is “the commonest cancer in India”.

“If detected at a pre-cancerous stage (when the cells are not normal, but are not yet cancerous), this cancer is 100 per cent curable,” says oncologist Dr Gauravi Mishra of the Tata Memorial Hospital, Mumbai.

Approximately 80 per cent of deaths related to cervical cancer occur in developing countries such as ours. Typically in Pakistan, a woman would be susceptible to this cancer from marriage onwards, with commencement of sexual relations.

But unfortunately studies have shown that a lack of awareness — of both the disease as well as availability of the preventive vaccine — is steadily increasing the incidence of cervical cancer in Pakistan.

A 2008 study by GLOBOCAN, a WHO project for cancer-related research, reveals Pakistan’s cervical cancer incidence is 19.5 per 100,000 in 2008 as compared to less than nine per 100,000 in 2002 — a clearly rising trend. The same study shows deaths from the cancer at 12.9 per 100,000.

Risk levels for young girls are much higher today than before. Pakistan has in fact moved from a low risk to a moderate risk country for cervical cancer and the increasing incidence is seen especially in younger women with the disease at an advanced stage when they go to the doctor for diagnosis.

The onset of cervical cancer would not only create deep trauma to both the woman and her family, but also be unbearable in terms of the cost of treatment. Young women should therefore be vaccinated before marriage, as this is the most effective option for prevention from the disease.

In fact, this should really be a part of the protection that parents provide to their daughters. An easy and practical action is simply a visit to the gynaecologist, who would advise the best course of action for the bride-to-be. Such a prior visit could be the parents’ most precious gift of all — timely vaccination would provide a future free from the trauma of this cancer. Among other things, the gynaecologist would clarify that cervical cancer is not a hereditary disease and that any woman can acquire it.

[Ed’s note: About a month or so ago, a new vaccine Cervarix became available in the Pakistani market. It costs Rs4,700 and a woman will need three doses.]

As cervical cancer is caused by a virus, it can be prevented if an effective vaccine is available. And such vaccines are indeed available, and all women, whether young or not, deserve such protection. I strongly suggest no delay in this matter; parents must do what’s best for their daughters and get that appointment sooner rather than later.

Dr. Hashmi is a healthcare services manager with the Health Awareness Society

Published in The Express Tribune, November 6th, 2010.

Forget chasing the no. 1 ranking. Phil Mickelson was moreworried about being able to get out of bed.

Mickelson revealed Tuesday he has psoriatic arthritis, whichcauses his immune system to attack his joints and tendons andproduced such intense pain he couldn’t walk. He noticed the firstsymptoms five days before the U.S. Open, and the pain eventuallygot so bad he made a visit to the Mayo Clinic.

Weekly shots have brought the disease under control, andMickelson said there shouldn’t be any negative impact on his long-or even short-term health.

“I’m surprised at how quickly it’s gone away, and how quicklyit’s been able to be managed and controlled,” he said. “I feel 100percent, like I say. but when I’m laying there on the couch and Ican’t move, you know, yeah, I had some concerns. but I feel a lotbetter now.”

As if that bombshell wasn’t enough for the day, Lefty droppedanother one: the burger connoisseur is now a vegetarian.

“I know, I know,” he said as reporters laughed. “As long as Ibelieve that there’s a possibility that it will help me overall,yeah, I’ll continue to do that. If it will somehow keep this inremission or stop it from coming back, yeah, I’ll be able to do it.but I haven’t been put it to the real test. The real test isdriving by a five Guys and not stopping.”

Mickelson has been threatening to replace Tiger Woods as worldNo. 1 since The Players Championship in early May, only to stumbleat each opportunity. That’s led many to wonder what’s ailing him,particularly after his lackluster round Sunday at Firestone, wherehe made seven bogeys and a double-bogey _ and just one birdie _ onhis way to a 78.

Turns out, the ranking was the least of his worries.

Mickelson, who turned 40 in June, said he woke up five daysbefore the U.S. Open with “intense pain” in his tendons and jointsthat left him unable to move and his joints feeling sprained.Stretching, walking and anti-inflammatories alleviated the pain,and he went ahead and played Pebble Beach, where he shot 66 onFriday to put himself in contention. He wound up tied forfourth.

But the condition got progressively worse during the U.S. Openand a family vacation to Hawaii afterward, spreading to his knees,hips and elbows.

“That’s when I got concerned,” he said. “I certainly had thegamut of thoughts. … I would just lay down and I couldn’t rollover. I was concerned about being able to swing a club and soforth.”

After the British Open, Mickelson made a trip to the Mayo Clinicin Rochester, Minn., where doctors confirmed the diagnosis ofpsoriatic arthritis. according to the Mayo Clinic website, thecondition causes joint pain, stiffness and swelling. while it canbe linked to psoriasis, the arthritis can appear without thepresence of skin lesions.

There is no cure for the condition, according to the Mayo Clinicwebsite, but the disease is treatable. Weekly shots of Enbrel lowerhis immune system, and Mickelson said the difference was noticeablealmost immediately.

“I feel great now and things have been much, much better,” hesaid. “I’ll probably take this drug for about a year, and feel 100percent. I’ll stop it and see if it goes into remission and it maynever come back. It may be gone forever.”

“It’s not that it’s cured, but it may never come back,” headded. “Or if it does come back, I’ll start the treatment again andshould be able to live a normal life without having any adverseeffects. So I’m not very concerned about it.”

The arthritis is the latest health scare for Mickelson’s family.his wife, Amy, and mother are both battling breast cancer; thelong-term prognosis for both is good.

While Mickelson said the arthritis didn’t affect his play atPebble Beach or St. Andrews, where he was never a factor, he onlyresumed his regular practice routine last week. Revealing hiscondition earlier might have lessened some of the criticism of hisgame these last few weeks.

But that’s not Lefty’s style.

“First of all, I don’t want excuses. And second, I don’t want todiscuss something when I don’t know what the outcome is going tobe,” Mickelson said. “For five or six weeks, I was a little unsureof how this was going to affect me long term, career, what haveyou. now that I feel confident it’s not going to affect not onlythe rest of my career or the rest of my life, but even in the shortterm it shouldn’t have an effect, I feel a lot better about it andI’m a lot more at ease to discuss it.”

Mickelson certainly looked at ease Tuesday during his practiceround at Whistling Straits. He joked and laughed often with playingpartners Dustin Johnson, Jeff Overton and Steve Marino, and it wasclear there was more riding on the round than simple practice.

When Mickelson drained a 10-footer on 18, he gave a hearty fistpump.

“I’m probably not as sharp as I would like to be,” the four-timemajor champion said. “I didn’t play well at the British, obviously.I didn’t play well last week, on the weekend, but I’m able to workon it. I had a good session with Butch and I believe that thegame’s coming around. I’m not sure where I’ll be on Thursday, buthopefully I’ll be ready.”