Kopano Matlwa Mabaso
Kopano Matlwa Mabaso

Cervical cancer: We can, must and should do more

The Reuters article on cancer in Africa that appeared in the Mail & Guardian on May 1 was an important reminder to all of us that while head-butting HIV and tackling TB, rushing food parcels to the malnourished thousands around the continent and battling our way through the diarrhoeas and pneumonias that plague our sickly continent, there lurks a gang of non-infectious diseases, dressed in leather jackets and animal print carvelas that work swiftly and slickly behind the scenes, robbing families of their most prized members and dumping those they leave crippled, on our already crumbling health care systems.

These so called diseases of “lifestyle”, diseases of the “affluent” that keep going forgotten, underfunded, never quite making it onto the global agendas, threaten to stall the progress in development we’ve worked so hard to make and are likely to turn back the achievements of our modern world if we don’t attend to them with a degree of force and as a matter of urgency.

Lest we forget, as we like to do, that Africa means us too, South African. Our cancer rates are alarmingly high too. Particularly so for cervical cancer, a disease that now is almost entirely preventable and for many developed nations has been reduced to nothing more than an inconvenient prick at age 12 and a couple of routine pap smears once womanhood ensues.

Cervical cancer is the leading cause of cancer death in South African women, killing some 3 000 women a year (1). Far too many women for a disease that is almost entirely preventable.

Diseases such as cancer and other non-communicable diseases i.e. diseases that are non-infectious and were traditionally considered diseases of the wealthy, such as heart disease, diabetes and cancers, are expensive to treat, not only for the family but for the country too. They require long-term care, they require expensive drugs, they require highly specialised medical practitioners, they require a health system that works well and they require a family that has alternative sources of income, all things we have in very short supply.

I’d just like to stop here and repeat, please, if you wouldn’t mind, just to say, once more, that cervical cancer is almost entirely preventable.

It shouldn’t be breaking news to us that there is a vaccine for cervical cancer. (Although that said a recent article (2) demonstrated that many of our country’s men don’t know what a pap smear is *hint: a test that screens for early signs of cervical cancer*, don’t know how a women gets cervical cancer *hint: its sexually transmitted* and tragedy of tragedies don’t know that they can be the heroes of the war against cervical cancer by simply *hint: being monogamous*. All of which is devastating when we live in a very patriarchal society where papa’s priorities are our priorities, so if papa doesn’t get it, no one else does. But, I digress. And even though this vaccine is not yet available in the public sector it certainly is available in the private sector and doesn’t even need a prescription.

Although it is extremely frustrating (and a debate for another day) that our health system is said to be unable to afford to make the vaccine available to those who need it most, there are many out there who can afford it but are not accessing it.

If there is a threat in our community we don’t wait for government to come round and put up electric fences and burglar bars on our behalf (we know better than that), we protect those we love out of our own pockets if we have to.

The Human Papilloma Virus that causes almost all cervical cancers can be prevented by the vaccines that are available. There are two vaccines, covering the subtypes of the virus that are most commonly associated with cervical cancer. The primary difference between the vaccines is that one, in addition to protecting against cervical cancer, protects against genital warts too. The vaccines have been shown to be safe and effective. (3) Countries that have made the vaccine available to their public immunise the girls before age 12, which is thought to be the age before most girls are sexually active (yet another debate for another day).

So dads, instead of getting her another BlackBerry or iPhone for her birthday get her the jab that might save her life. She’ll sulk for days about it but will thank you for it when she’s older, wiser and still alive!

(1) Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non-communicable diseases in South Africa. Lancet 2009; 374(9693):934-947.
(2) Maree J, Wright S, Makua, T. Men’s lack of knowledge adds to the cervical cancer burden in South Africa. European Journal of Cancer Care; 20(5):662-668.
(3) Sinanovic E, Moodley J, Barone MA, Mall S, Cleary S, Harries J, et al. The potential cost-effectiveness of adding a human papillomavirus vaccine to the cervical cancer screening programme in South Africa. Vaccine ; 27(44):6196-6202.

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    • MLH

      I do wish articles that maintain things are affordable would give (hint) an idea of the costs. Readers might well be able to save towards buying the product if they cannot immediately afford it. The writing rules of ‘what, when, where, how, etc.’ are so often ignored that such columns apprea incomplete.

    • Kopano Matlwa Mabaso

      Fair enough. The most recent figures I have are approximately R1500 (for the three required doses.)

    • Terry Higginson

      The vaccines are Cervarix (made by GlaxoSmithKline) and Gardasil (made by Merck).

      As well as protecting from human cervical cancer caused by human papillomavirus (HPV), only Gardasil protects both girls and boys from genital warts. The problem is that it has to be given to children before they become sexually active (10-12years)

      The actual cost in the private sector would be closer to R3000 for 3 injections and that would exclude an injection fee by a health professional.

      Kopano your article is sloppy. The reason it is not available through the public sector is that the NDoH already spends a fortune on vaccinations to prevent infectious diseases that kill millions of babies every year. We have one of the highest mother and infant mortality rates in the world

    • Geoff Smart

      A few months ago I was at a talk given by an oncologist where she said that Medical Aids have not approved the vaccination onto their lists of treatment.
      Plus, that HPV also causes oral and anal cancer. So parents you need to educate your children, boys and girls both, as the boy is the carrier and the girl suffers.

    • Leon

      @ Kopano

      I wish the cost of R 1 500 for the three doses you mention was true, but I am afraid it is not. I started the process of innoculation for my daughter (15 years old) last week. The product the doctor recommends is called Gardasil. This vaccine protects against cancer, precancerous or dysplastic lesions, genital warts, and human papillomavirus types targeted by the vaccine (i.e. HPV types 6, 11, 16 and 18) – this is a direct quotation from the package insert.

      I paid R 950 for this injection. In addition, the doctor charged R 300 for the consultation. So, this first step in the process had cost me R 1 250. This has to be repeated in two months’ time and then four months after the second dosage (six months after the first). Therefore, I expect the full course to cost me R 3 750. This is expensive by most people’s standards. My medical aid (Discovery Health) does not cover the cost of the vaccine. Given the improtant health and economic benefits this preventative healthcare intervention holds for South Africa, I am amazed that more is not done to drive down the cost.

      I cannot imagine how the average South African will ever have access to this benefit unless the Department of Health intervenes (and unfortunately, given their dismal record to date, this does not seem likely to happen soon).

    • Liana

      Dear Kopano,

      You’re so right! Please let me know if you’d be interested in writing something for me on South African women for Woman’s Day.
      We’re launching a new venture with South Africa’s finest writers, and have many famous names signed-up already. Let me know how I can get hold of you and I’ll tell you more. 0714805887, Liana

    • Sam Nkalashe

      Dear Kopano

      Just a correction and comment 1) the vaccine is schedule 4 meaning that it has to be prescibed by a doctor* hint, another hurdle in accessing the vaccine hence contributing to low vaccination rates 2) the government of Lesotho has vaccinated close to half a million girls between 9 and 13 years of age with little infrastructure but determination and ingenuity. As Merck (MSD) we are reaching out to governments in the region to discuss ways we can make the vaccine available in the public sector. Seeing that you are a doctor I am sure you would be interested in clinical study results, longterm efficacy and safety data and success stories from countries that have implemented national vaccination programs. My e-mail address is [email protected]