Cervical cancer is the commonest cancer among women in their mid-30s. Symptoms of this type of cancer vary according to their stage, with no symptoms in the first stage. Recent data from the Uganda Cancer Registry indicates that the cervical cancer incidence rate (new infections) has risen from 38.1 per 100, 000 women annually in 1991-1995 to 52.4 per 100, 000 annually.

This increase is attributed to the fact that more ladies are undergoing screening, there is increased public awareness and health workers are efficiently detecting the virus that causes cervical cancer.

Oncologists say the main cause of this cancer is sub-type 16 and 18 of the human papillomavirus (HPV), which account for 70 per cent of all cervical cancer cases in the world. however, not all the women who have this virus develop the cancer. Dr Fred Okuku, a medical oncologist at Mulago Hospital, says young ladies are the most vulnerable group. this is because the epithelial lining in the cervices of these girls is not fully developed.

Therefore, if they engage in sex at this age, the friction would damage the epithelium. If it were with a man who has cancer of the penis (a chronic and persistent ulceration of the penis), the lady would in the process get HPV.Dr. Okuku explains, “Since the lining is delicate (immature), if the young women engages in sexual intercourse, it damages their cervices, and thus, exposes them to infection.

No symptoms in the early stagesduring the first 10 to 15 years after infection, there are no symptoms. In this phase, the lady might not even suspect that she has cervical cancer. So the viral infection gnaws their cervix. it is because there are no symptoms in this stage that medical oncologists urge all ladies to go for pap-smears.

Pap smears are free of charge in government hospitals. But in private health facilities, the charge ranges between Sh20,000 to Sh50,000. During a pap smear, an oncologist or medical attendant inserts a small brush in the cervix and lightly rubs it against the walls of the cervix to get some cells that will be tested for cancerous cells using a microscope. If the oncologist detects cancerous cells, they could use cryotherapy, that is, put a very cold swab in the cervix to incapacitate the cells that could be turning cancerous. the oncologist surgeon could also remove a section of the cervix to prevent spreading of the cancerous cell.

In extreme cases, they will remove the uterus, which would mean no more conceiving. such surgery is done free of charge in the government hospitals.“In the private health facilities, removal of the uterus costs Sh2m to Shs3m,” says Dr Okuku. But once cervical cancer matures, the infected lady will experience pain during intercourse. she will also bleed as a man tries to penetrate her. And in some cases, she could bleed even when not engaging in sex. “This bleeding sometimes confuses some women who are infected with the HPV virus into thinking that their period is taking unusually long to end,” says Dr Okuku.

Once it is in the advanced stages, cervical cancer could be treated through chemotherapy combined with radiation therapy or chemotherapy alone. Chemotherapy is usually free at the Uganda Cancer Institute “as stocks last”. If you go there when the stocks are out, you would have to buy the drug. Only one drug is used for chemotherapy. There is a user fee of Sh50,000 for radiation therapy.

Other symptoms are pelvic and lower abdominal pains, foul-smelling vaginal discharge, and anaemia due to over-bleeding. Dr Okuku says the other factors that put ladies at risk of HPV include HIV/Aids infection, sexually transmitted diseases and polygamy. Partly because of these, there is a lot of stigma.

A polygamous man could have a wife with the HPV, from whom he would acquire it and later transmit it to a woman who was not infected. Dr Okuku says cervical cancer is easier to control – as long as the group at risk goes for early testing and if diagnosed with the HPV, seeks early treatment.

Presently, efforts are being made to prevent the scourge. Vaccine trials are being piloted in Uganda targeting girls around primary five and who have neither engaged in sexual activity nor been infected with the HPV. the vaccines are meant to produce antibodies to that will be used to protect vulnerable women from HPV.