Lack of awareness leads to cervical cancer going unchecked

The prevalence of cervical cancer is going unchecked in Nepal.

In Nepal, around 10,000 patients with cervical cancer have been added every year, according to the Child Health Division, the Department of Health Services.

According to the World Health Organisation (WHO), in 2020, there were an estimated 604,000 new cases of cervical cancer around the world, and about 342,000 deaths occurred from it. Almost all cervical cancer cases (99 per cent) are caused by infection with high-risk human papillomaviruses (HPV), a common virus transmitted through sexual contact, and it is the fourth most common cancer in women. Around 90 per cent of the disease prevalence and deaths are based in developing countries like Nepal, it has been said.

The government of Nepal has taken measures to tackle the disease by administering a vaccine against HPV. The vaccination started in 2015 and 2016 in Kaski and Chitwan districts respectively. Now, it has been expanded to private hospitals across the country.

One of the health institutions administering the vaccine is Kanti Aarogya Hospital in Nepalgunj, Banke. So far, seven people have been administered the vaccine, according to paediatrician Dr Roma Bora. The number of beneficiaries is very low as the vaccine is costly, she said. It costs Rs 10,000 per person to complete the course of the vaccine. “The vaccine is expensive. People are reluctant to get administered due to its expensive price. People are found not to be interested due to lack of awareness that getting vaccinated against cervical cancer can save people’s lives from the disease.”

Kusum Dugad of Pasang Lhamu Marga of Nepalgunj Sub Metropolitan City-10 has recently received the complete course of the vaccine. “I got vaccinated against the disease having seen my sister-in-law in pain due to tuberculosis. Then I felt that I could go through such pain if I contract cancer,” she shared. Her two daughters have also been administered the vaccine. She also suggested other women get vaccinated against the disease. “A large amount of money is spent on the treatment of cancer. It is better off living a healthy life getting vaccinated against the disease,” she said.

Prastuti Sharma, a medical doctor, has also received the full course of the vaccine. It is not that all doctors get vaccinated against the disease. Many people do not have information about the vaccine while some others cannot afford it because it is much more expensive, she said.

Arrangements have been made at the hospital for administering the vaccine to the people who wish to get vaccinated, said Dr Bohara. The vaccinated people were between the ages of 10 and 49 years, she said.

To complete the vaccine course, people below 15 years of age should get vaccinated two times in a period of six months, and people above 15 need to be administered the vaccine thrice in a period of six months.

The disease can be treated when diagnosed at an early stage and treated properly, and by taking medicine timely as per the prescription of the doctor, she said. According to her, symptoms include irregular blood spotting or light bleeding between periods in women of reproductive age, bleeding after sexual intercourse, increased vaginal discharge, persistent back, leg and pelvic pain, weight loss, fatigue or loss of appetite, swelling of legs or both lower extremities as more severe symptoms.

Factors like getting married at an early age, unsafe sexual relations at an early age, giving birth to many children, and getting many pregnancies pose high risks, said oncologist Kritipal Subedi.

Women smokers have a high risk of developing cervical cancer in the cervix (the entrance to the uterus from the vagina), she said. Similarly, the women who have gone through temporary contraceptive methods with high amounts of hormone for more than five years are also at risk of cancer, she said. According to the WHO, it takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. But it can take only 5 to 10 years in women with weakened immune systems. The Bheri Hospital has received two to three patients with cervical cancer on a daily basis, she said.

Lately, the number of cervical cancer patients visiting the cancer hospital in Khajura, Banke, is increasing, said cancer surgeon Dr Indranil Ghosh, chief of the Department of Gynecology.

“Patients with all types of cancer in stages one, two and third visit the hospital for a test and treatment. Most of them are patients with stage third cancer. Such patients require surgery as the final alternative,” he said.

The Government of Nepal should manage the availability of the HPV vaccine at an affordable price although it cannot distribute it for free so women with cervical cancer can easily get access to it, he said.

The hospital received five to six patients with cervical cancer every five to six months, he said. “The patients are in the 24 and 65 age group. Cervical cancer is caused by HPV. This infection attacks the cervix.”

According to him, it turns into cancer after eight to 10 years of infection. A Pap smear test is carried out to diagnose the disease. This is a simple and accurate method in finding out if the uterus is in normal condition, he said. Cervical cancer is curable when treated in its stage first but lack of awareness leads to the stage third requiring surgery, he said.