Cervical cancer in the Caribbean

CERVICAL CANCER is considered a preventable disease. However, in the Caribbean, it is still one of the fourth most common causes of death in women. Efforts to overcome obstacles to the treatment and control of this preventable disease are being made by several countries within the Caribbean.

However, no health issue can be readily managed without first acquiring an understanding of the dynamics relating to its severity of impact reaching the target population, its clinical pathology, and the availability of treatment and/or preventative measures to control or halt its progression.

The cervix is the lower, narrow end of the uterus (womb) that connects the uterus to the vagina. Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.

Cervical cancers are named after the type of cell where the cancer started. The two main types are squamous cell carcinoma; most cervical cancers, up to 90 per cent, are squamous cell carcinomas. These cancers develop from cells in the ectocervix.

There is also adenocarcinoma, or cervical adenocarcinomas, that develop in the glandular cells of the endocervix. Clear cell adenocarcinoma, or mesonephroma, is a rare type of cervical adenocarcinoma. Sometimes, cervical cancer has features of both squamous cell carcinoma and adenocarcinoma. This is called mixed carcinoma, or adenosquamous carcinoma. Very rarely, cancer develops in other cells in the cervix.

According to Dr Tamu Davidson, director, NCDs and Injury Prevention Unit, Health Promotion and Protection Branch at the Ministry of Health and Wellness, the relationship between cervical cancer and the human papilloma virus (HPV) is widely revered as an important role in the prevalence and incidence.

“The advancements in treatment and prevention, for example, vaccination and management methods, have improved through the years. However, data for many Caribbean territories are lacking on incidence, mortality, patient demographics, clinicopathology, behavioural risks, genetics, and control and treatment,” Dr Davidson said.

Cervical cancer is considered preventable, and as such, the necessity of an early diagnosis is considered the main course of management. This has led to greater focus being applied to the identification of abnormal cervical cells (abnormal Pap smear results) during the process of screening.

Globally, in the early 2000s, the incidence of cervical cancer had noticeably decreased as improved methods of screening were being introduced and implemented. The dissemination of information regarding these methods and their perceived benefits became a priority, and the relevance of cervical cytology as an important tool of preventative care became more known.

“To this end, a combination approach of primary and secondary treatment was considered most effective. This involved informed consent for the administration of the prophylactic HPV vaccine and the introduction of screening using HPV assays and Pap smears, as part of a female’s routine check-up, respectively,” Dr Davidson said.

Data shows that at least 84 per cent of deaths due to cancer were caused by cervical cancer in lower-income nations; as such, greater efficiency in treatment and prevention is needed in these regions by providing equal access to uniform methods of vaccination and screening.

“The National Cervical Screening Programme was established in 1999, with main emphasis on public education on cervical cancer, HPV vaccination, STIs and tobacco use. In 2017, a vaccination programme was introduced for girls nine to 14 years old, that has since expanded to women up to 26 years old. As of April 1, 2023, the programme was introduced for boys nine to 14 years old,” Dr Davidson said.

The target, she said, is to have girls fully vaccinated with HPV vaccine by the age of 15. “The 90-70-90 targets must be met by 2030 for countries to be on the path towards cervical cancer elimination. That is 90 per cent of girls fully vaccinated with HPV vaccine by age 15 years; 70 per cent of women screened with a high-performance test by 35 years and again by 45 years; 90 percent of women identified with cervical disease receive treatment, with 90 per cent of women with precancer treated; and 90 per cent of women with invasive cancer managed,” Dr Davidson said.

The Ministry of Health and Wellness, she said, is finalising a national elimination 10-year plan for cervical cancer, and have ramped up promotion of HPV vaccination with a roll-out of a national education campaign. Promotion for screening has also increased, and an HPV screening, via pilot, will be unveiled in 2024-2025 in the public sector.

keisha.hill@gleanerjm.com

SOURCES: Jamaica Cancer Society, National Library of Medicine.