Cervical cancer is one of the major causes of cancer-related deaths among women, especially in developing countries. It is the fourth most common cancer in women and is mainly caused by an infection by a virus named human papillomavirus (HPV), which is a sexually-transmitted virus.
However, HPV infection does not necessarily lead to cervical cancer. Mostly, HPV goes away on its own. Only 1.5 percent instances of HPV cause the development of cervical cancer. Effective treatments are available for this cancer, especially in the case of early diagnosis and treatment. HPV vaccination can significantly reduce the risk of contracting cervical cancer.
Cervical cancer: Situation in Africa and the Caribbean.
The rate of cervical cancer in Sub-Saharan Africa is the highest in Eswatini, a landlocked country in Southern Africa followed by Malawi. In Africa, around 119,284 women develop cervical cancer every year while 81,687 die from it. The incidences of this cancer constitute 20 percent of the world’s cases. As for the Caribbean region, this cancer makes up 18 percent of deaths. According to the World Health Organization (WHO), deaths from cervical cancer will double to 440,000 by 2030 and 90 percent will be from sub-Saharan Africa.
Cervical cancer is more common among women aging above 40 with a higher death rate in women over 50. Despite being common in the African, Caribbean populations, people tend to avoid screening or getting HPV vaccination because of a lack of awareness and stigma associated with it. The fact that it is caused by a sexually transmitted infection (STI) discourages people from getting proper treatment of even being tested in the first place.
Why The Stigma?
Cervical cancer is associated with a sexually-transmitted virus, HPV. Evidence shows that individuals who start having sex before the age of 15 and those who have multiple sexual partners are risk factors for contracting an HPV infection. Oral sex is also linked to this infection and ultimately cervical cancer. Some studies show that the risk of cervical cancer increases with the increase in sexual partners.
The fact that this cancer traces back to a sexually-transmitted disease and its risk increases with an increase in the number of sexual partners leads to all the stigmatization of the disease. There is a perceived notion that if a woman has developed an HPV-related condition, she must have been promiscuous or careless. This perception increases in conservative societies (like some African-Caribbean communities) where monogamous relationships are expected or viewed as a duty. In such societies and communities , the stigma is more intense.
One study found that women in conservative societies fear their partners would blame them for contracting the HPV infection, regardless of their own sexual behavior. They also maintained that they would suspect infidelity on the part of their partners if they contract the infection. The same study observed that testing positive or even attending screening for HPV was feared as an implication of sexual activity and promiscuity by family and friends. Some participants also suggested that there is a denial in their communities about the need for HPV testing due to the belief that they are not at risk of STI (because of monogamy being a prevailing practice there).
The cervical cancer patients reported in a study that people jump to only one conclusion when they learn of the diagnosis. It is presumed that the patient must be promiscuous when she is diagnosed with this form of cancer. Similarly, when a person reports having this cancer, there is a perception that they have HPV. However, many people have cervical cancer, but they never contracted HPV, and many people have HPV, but they don’t develop cervical cancer.
Many patients reported getting isolated or alienated after telling their friends about their illness. Some of them got publicly humiliated by their close ones for developing cervical cancer.
This stigma for cervical cancer because of being related to an STI has limited its screening, which reduces the chances of survival due to late diagnosis and treatment. While it is a fact that multiple sexual partners are a risk factor, not all cervical cancer patients develop diseases due to that. HPV is quite common and most sexually active men and women contract the infection at some point in their lives.
People who have only one sexual partner are also susceptible to this virus.
Other factors that discourage women from coming forward and getting tested include certain misconceptions about the testing procedures and the disease’s causes. Some misconceptions are:
- There is lack of privacy during the screening and hence, one should not get screened.
- A part of the body is removed during screening.
- Screening is like getting vaccinated and a person who gets screened will not develop cervical cancer.
- Cervical cancer usually occurs in women who have poor hygiene practices.
All these misconceptions need to be dealt with to increase the screening rate and to lessen the stigma.
Stories of Survivors and Their Struggle
Dona Mop is a mother to four and a grandmother of many. Since she got married at 16, she remained with only one sexual partner—her husband. She took pride in the fact that she has never been like the women on the street with other men. She was shocked when she learned she had cervical cancer. After dwelling on this for long, she concluded that she might have been too enthusiastic sexually. According to her, this could be the only explanation for her illness. She was ashamed and feared her neighbors would call her ‘dirty’.
This is the story of many survivors who struggle not just with the disease but also with being treated as a pariah. The cancer survivors report many difficulties during their illness. Many of them do not even know about this condition.
“When I was bleeding, I did not know the kind of disease that was causing that to happen. I did not know what was wrong with me and what has caused this because I had stopped my period for about four years so when it started coming I was disturbed. I did not understand the reason why it had come to that until I got to the hospital and was told it was cancer,” says a participant in the study exploring the experience of cervical cancer survivors.
These cancer patients suffer from many physical disruptions during the course of their illness. Many women report severe body pain, loss of sleep and appetite, and immobility.
“I felt some pains in my vagina and the doctor instructed that I should be given an injection to reduce the pains. I was always in pain, my leg, everything, every part.” (Participant 11, 55 years).
“I bled from the vagina anytime I had sexual intercourse. So I decided not to get myself involved in any,” says another participant. Many patients are deserted by their partners or family members because of being a burden or being useless. “Because of the disease, my husband went to marry another woman and left me.” (Participant 4, 44 years).
Patients of cervical cancer go through a hard time and not just physically. The stigma surrounding the disease causes poor effects on mental health too.
How Do We Eliminate The Stigma Of Shame?
The misconceptions about cervical cancer should be rectified through advocacy and awareness programs. If the screening services are provided skillfully and respectfully, the women are more likely to come and also recommend the testing to their friends and family members. Moreover, HPV vaccination needs to be promoted. It can be destigmatized if the policymakers dub it as an anti-cancer vaccine instead of a vaccine for STI. While administering the vaccine, the health workers can clarify that it is an anti-STI vaccine that helps reduce the risk of cancer as well.
Raising public awareness about cervical cancer should also entail normalizing the infection. The awareness campaigns need to be inclusive of the fact that HPV is widespread and the majority of sexually active individuals are likely to contract this infection. Evidence shows that infections deemed as common are less likely to be judged for. A few studies show that knowledge of the high prevalence of a virus can reduce the feeling of shame and stigma. Hence, statistics about HPV’s prevalence should be a part of public health messages.
The awareness and health education campaigns about cervical cancers should include:
- Extensive information about the disease, its history, prevalence, and causes. The common myths about cancer should be addressed and the pertaining stigma be discussed.
- The speaker and message providers should create an open and comfortable environment for discussing sexual matters.
- Encourage screening for women.
- Men should also be included as the target audience in these campaigns. That will help reduce the stereotyping and prevent isolation of the cancer patients by their family members.
- The campaign sessions should be interactive and allow the audience to ask questions. The providers should be prepared to answer difficult questions pertaining to STIs.
- The narrative should be designed while keeping in view the local practices and beliefs. It should not directly challenge or chastise the religious or cultural norms.
But most importantly, each one of us – you, me, we – all need to be supportive towards people with cervical cancer.
The Bottom Line
It takes plenty of years for an HPV infection to cause precancer and many more years to cause cervical cancer. Women should go for screening at least once after the age of 35. It is better to get screened once every three years after the age of 25. Screening can identify precancer as well, whose treatment does not require hospitalization.
Women should seek medical care immediately if they experience vaginal bleeding, abnormal discharge, bleeding after sex, or bleeding after menopause.