September 29, 2020
Dr. John Jiao, M.D.
Cervical cancer is the second most common malignancy and is the most common cause of cancer-related mortality among Filipino women. According to the recent Department of Health (DOH) demographics (2017), the Philippines has a population of 35.11 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year, 6,670 women are diagnosed with cervical cancer and 2,832 die from the disease. About 2.9% of women in the general population are estimated to harbour cervical HPV 16 or 18 infections at a given time, and 58.6% of invasive cervical cancers are attributed to HPV 16 or 18.
Although considered as a vaccine-preventable disease, the burden of cervical cancer in the Philippines remains to be moderately high. In a country like ours, where the health system is not sufficiently developed to support advanced screening program, the use of alternative screening modalities is supported and is currently under evaluation.
The American College of Obstetricians and Gynecologists defines cervical cancer screening as a method that identifies changes in the cells of the cervix that could lead to cancer. The cervix is the opening to the uterus and is located at the top of the vagina. Screening includes cervical cytology (also called the Papanicolau smear/test or more commonly known as Pap smear) and, for some women, testing for Human Papilloma Virus (HPV). Cervical cancer occurs when cervical cells become abnormal and over time grow out of control. The cancer cells invade deeper into the cervical tissue. In advanced cases, cancer cells can spread to other organs of the body. Most cases of cervical cancer are caused by infection with HPV and are passed from person to person during sexual activity. It is very common in people who are sexually active.
Screening is started in women aged 21–29 years with the Pap smear and is recommended to be done every 3 years. HPV testing in this age group is not recommended. Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years. It is also acceptable for this age group to have a Pap test alone every 3 years. Usually, screening is stopped after 65 years if there is no history of moderate or severe abnormal cervical cells or cervical cancer. Moreover, there should be at least three negative Pap test results in a row or at least two consecutive negative co-test results within the past 10 years with the most recent test performed in the last 5 years.
The Department of Health (DOH) is currently advocating cervical cancer screening, however, less than half (approximately 42%) of the 389 Philippine hospitals surveyed offer screening and early detection services for cervical cancer. Furthermore, only 8% have dedicated screening clinics. In a study by the University of the Philippines-Department of Health (UP-DOH) Cervical Cancer Screening Study Group (2001), possible causes of failure of cervical screening methods were identified and these include: lack of knowledge about symptoms associated with cervical cancer; a fatalistic attitude towards cancer and lack of awareness that cervical cancer is curable; lack of cytologic screening facilities and expertise and of treatment facilities in rural areas; and lack of patient compliance with follow-up and treatment.
Despite current advancements in the diagnosis, treatment, and research on cervical cancer, implementation of these advancements is limited by the economic burden of the disease. The Department of Health has yet to implement programs on cervical cancer. Difficulties are encountered due to the high costs and the lack of manpower and infrastructures needed within the health system. Efforts should be integrated primarily in the prevention of the said disease. Though it may be a challenge for our current government, future endeavours should be directed towards the improvement of our health system delivery and the ability to prevent, detect, and cure cervical cancer. All these would be for the welfare of the general population and more importantly, the good of the modern Filipina.