Her Health, Her Future

What is Cervical Cancer?

Cervical cancer begins in the cells of the cervix. The cervix is the bottom, narrow end of the uterus (womb). The cervix connects the uterus to the vagina (birth canal).

Cervical cancer usually develops slowly over time. Before cancer evolves, the cells of the cervix undergo changes known as dysplasia, in which aberrant cells begin to emerge in the cervical tissue. If the abnormal cells are not destroyed or removed, they may develop into cancer cells that grow and spread more deeply into the cervix and surrounding tissues.

As it grows, cervical cancer may cause signs and symptoms, such as:

vaginal bleeding between periods or after menopause.
menstrual bleeding that is heavier and lasts longer than usual.
watery, bloody vaginal discharge that may be heavy and have a foul odor.
pelvic pain.

The Viral Cause of Cervical Cancer

Cervical cancer is closely linked to Human Papilloma Virus (HPV) infection, an extremely common family of viruses transmitted through sexual contact with an infected person. Almost all sexually active people will be infected at some point in their lives, usually without symptoms. In most cases the immune system clears HPV from the body.

There are more than 200 types of HPV (human papillomavirus). Many HPVs are skin types, meaning they invade and live in cells on the skin. They can cause warts on top of the skin in areas such as hands, feet, arms, and legs.

Mucosal HPV types invade and live in cells on mucosal surfaces. Mucous or mucosal membranes are moist surface layers that line organs and parts of the body that open to the outside, such as the vagina, anus, or cervix, but also parts of the penis. They are also called genital HPV types.

Mucosal or genital HPV types are further broken down into low-risk and high-risk types, depending on their ability to cause cancer. There are 12 high-risk HPV types: HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. Two of these, HPV 16 and HPV 18, are responsible for most HPV-related cancers.

Persistent infection with high-risk HPV types can cause abnormal cells to develop. If left untreated, these abnormal (pre-cancerous) cells may go on to become cancer. Typically, this process takes 15–20 years, but in women with weakened immune systems, such as untreated HIV, this process can be faster and take 5–10 years. Risk factors for cancer progression include the the HPV type, immune status, the presence of other sexually transmitted infections, number of births, young age at first pregnancy, hormonal contraceptive use, and smoking.

Cervical Cancer is Frequent!

Cervical cancer is the sixth most common cancer in women in the Eastern Mediterranean region, with 50% of reported cases in women living in the UAE aged between 35 and 55.

While cervical cancer cases have steadily declined in higher-income countries by 4% annually, a staggering nine out of ten deaths occur in developing countries, with the risk of death three times higher compared to more developed regions. The lower incidence and better outcomes in the developed world can be attributed to better screening programs and higher adoption of vaccination schedules.

Cervical Cancer Can Be Prevented!

Vaccinating girls at young age against HPV can prevent many cases of cervical cancer. There are three available HPV vaccinations:

- Cervarix (GlaxoSmithKline, available in UAE)

- Gardasil (Merck, available in UAE)

- Gardasil 9 (Merck, available abroad)

All three vaccinations protect against high-risk HPV 16 and 18 genotypes. The World Health Organization announced that 200 million doses of these vaccines had been given since 2006, and the outcome shows the vaccine’s safety record, with no adverse effects.

Despite the safety and availability of vaccination, the rate of cervical cancer is increasing rapidly. The major problems facing the vaccination drive among young women are cultural taboos and a lack of vaccine acceptance.

Do Women in the UAE Know How HPV Causes Cancer?

A recent study evaluated the awareness of HPV-induced cervical cancer and the preventive potential of vaccination and screening. A questionnaire was distributed to women aged 18 to 26 designed to assess their understanding and thoughts on cervical cancer, HPV, and vaccination. Of the 269 respondents, only 6% had attended awareness programs, and 11% reported having read any information leaﬂet. 78% of respondents did not know how HPV infection occurs, and less than 40% believed cervical cancer is preventable. 75% of respondents had not heard about the Papanicolaou smear test used for regular cervical cancer screening. 20% of respondents stated that they were uninterested in vaccinating, and only 5% had received the vaccination.

Compared to the awareness of HPV-associated cervical cancer globally, the UAE population has shown an increase in the understanding and prevention of diseases within the most affected age groups. However, there is still an urgent need for continuous education regarding HPV infection, its modalities, vaccinations, and screening programs to help making informed health decisions.

Be Aware About Your Chances to Prevent Cervical Cancer!

Knowledge is Prevention! Please inform yourself about your right and possibility to protect your health. The Abu Dhabi Public Health Center provides you with important information…

… in English: Cervical Cancer Infographic — English

… in Arabic: Cervical Cancer Infographic — Arabic

Your Health Matters!