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Cervical Cancer

Wednesday, 27 January 2010

Cervical cancer is one of the leading causes of early mortality among Irish women under 44, with over 90 lives lost to the disease every year.

Now that the vaccine has been brought back from the shelf, what does it mean for your daughter, and do the girls that were to get it last year miss out?

Why is it Relevant Today?

It's European Cervical Cancer Awareness Week! On Sunday The Irish Family Planning Association have launched a pearl of wisdom pin with the help of the lovely Maura Derrane!

Minister for health Mary Harney has announced a u turn in her decision to shelve the cervical cancer vaccine for secondary school students.

Cervical cancer strikes nearly half a million women each year worldwide, claiming a quarter of a million lives.

Who Is The Guest?

. Dr. Catriona Henchion - Medical Director of the Irish Family Planning Association
. Dr. Sharon Moss - Gynecologist UPMC Beacon Hospitel

. Jennifer O'Connell

Cervical cancer is the eight most frequently diagnosed cancer in women in Ireland. In 2004, 200 women were newly diagnosed with the disease, with more than 90 women dying from cervical cancer. (According to the Health Information and Quality Authority)

Along with screening, the vaccine will prevent 90% of cervical cancer cases.

Last year, after the tragic death of Jade Goody, a survey carried out by the Marie Keating foundation suggests that over 50% of women are more likely to go for a smear test following coverage of her battle with cervical cancer.

Cervical Cancer Vaccine:-

There is a plan to roll out a cervical cancer vaccine for secondary schools in first year. As yet the HSE are still in discussions as to when this will take place. There is no confirmation yet as to when the vaccine will begin (i.e if it starts before the end of the summer it means the girls that were promised it in 2009 won't miss out)
There is also no confirmation about whether it will be administered through a school programme or in a clinic.

The HSE will have an information campaign as soon as these issues are ironed out, and this will happen as soon as possible.

Dr. Catriona Henchion

The Department of Health have done a U-turn with the cervical cancer vaccine, can you explain what the update is?

There's no official explanation for the u-turn, apart from what the minister has said, whereby they have received a better deal with the pharmaceutical companies and now can fit the vaccine into the budget.

What about people who want to get the vaccine and will pay for it?
They can go to their GP, it will cost anything from 400 - 600 depending on the doctor.

Who is it for?
In Ireland it is licensed for women up to the age of 26 (however it is not unsafe to get it at any age). Ideally it is for women who are not yet sexually active, as they may have already picked up the virus.

What about girls in their young teens who may be sexually active but don't want to tell their parents?
The case can happen where a parent may want to pay for the vaccine for example their 15year old daughter. If she has already had sex, the IFPA still advise her to get the vaccine, because chances are her number of sexual partners is probably very low, and therefore a low chance of her having the virus.

What does this mean for the future of cervical cancer?
The vaccine is predicted to save up to 52 lives per year. With screening and the vaccination, 92% of cervical cancer deaths will be prevented.

Will someone who has had the vaccine need a smear?
Yes, the vaccine only protects against 70% of the virus.

Women between 25 - 60 are entitled to free smears, can they just show up at their GP clinic for one on the day?

Up to last year, women would show up on the day and ask their GP for a smear. However since September 09' women now need to register with cervical check, who will send them a letter telling them when they need to have their smear, which you bring to the doctor as proof that you are eligible.

How often?
This can depend on the results of their screening and their age. A woman between the ages of 25 - 44 and for women between 45 - 64 every five years.

Why are they so important?
Symptoms generally appear when it's at its latest stages, so screening is the way of preventing the disease. It is a preventable disease and we can treat pre cancerous cells.

Dr. Sharon Moss

Cervical Cancer - what causes it?

HPV virus
99 out of 100 cases of cervical cancer are caused by the HPV. (Human Papilloma Virus)

Most common of all STDs
80% of all sexually active adults will have at some stage. However most people clear it out of their system themselves.

Are there risk factors?
Sexual activity at a young age
Multiple sexual partners

Full prevention is to refrain from any genital contact with another person.
As with all STD's, use protection.
Monogamy will reduce risk factors

Abnormal bleeding
- in-between periods
- after intercourse)
- after menopause
Smelly discharge

What is an abnormal smear?
This is where the cells in the cervix look disordered. Often call pre cancerous cells.

Stages of abnormal Cells
There are different stages of pre cancerous cells

Stage 1 (CIN 1) -
1. Cells have mildly rearranged themselves (low grade changes)
2. Patient is referred to a gynecologist for a colscopic exam. (a better look) or possible a biopsy
3. These cells are then treated (NOTE can be treated at such an early stage)

Stage 2&3 (CIN 2&3):-
High Grade pre cancer cells
Treatment:- Shave the cells from the cervix and new tissue should grow back.

Stages of Cervical Cancer

What if cancer cells are found?
If cancer is found, you are diagnosed with cervical cancer.
Treatment depends on the grade

Stage 1a) This is the best possible way to find it because women may avoid full surgery (this is particularly important for women who haven't yet had kids)
Cone biopsy:- Cut away part of the cervix.
Further tests to ensure that it hasn't spread.

Grade 1b) - Stage 2:- Hysterectomy to debulk the disease, and chemo to reduce risk of recurrence.

Stage 3 - At this stage it would have spread from the to the top of the vagina, uterus and maybe the lymph nodes.
Surgery could be used to take out as much tissue as possible, but at this stage it may be impossible if it has spread, so the patient would undergo chemo and radio therapy.

Irish Family Planning Clinic - Pearl of Wisdom

The Pearl of Wisdom is the international emblem of cervical cancer prevention. During the awareness week the IFPA will distribute 20,000 Pearl of Wisdom badges to women around the country to encourage women to pass on the word to their peers about the importance of regular smear testing, which can save women's lives through early detection and prevention.

This year the IFPA is also teaming up with the Irish Hairdresser Federation and all 300 member salons will help distribute the Pearl of Wisdom badges across the country. The idea is to give a badge and an information leaflet about CervicalCheck to every woman during her hair appointment for the duration of the week.
Many women consider a visit to a hair salon as "me-time", a period when they have time to relax and reflect. This is an ideal opportunity to pass on some important messages about cervical cancer prevention and screening.

For more Information:

UPMC Beacon Hospital will hold a public seminar to mark Lung Cancer Awareness Month on Friday, 29th January at 1pm, sixth floor UPMC Beacon Hospital, Sandyford, Dublin 18.

The seminar will focus on early detection and treatment of the disease and will be delivered by Mr. Maher Shuhaibar, Consultant Cardiothoracic Surgeon and Dr. Deirdre O'Riordain, Respiratory Physician.

Those wishing to attend the evening should RSVP to / 01 293 56 86

For more info:

IFPA Head Office
60 Amiens Street, Dublin 1.
Tel 01 - 806 9444 / Fax 01 - 806 9445
E-mail - 1800 200 700

Fact File

Key Statistics on Cervical Cancer
. Cervical cancer is the second most common cancer in women under 44 worldwide. Each year, 500,000 new cases of invasive cervical cancer are diagnosed globally and more than 250,000 women die from the disease.
. Cervical cancer is the most common cancer in women under 44 in Ireland
. In Ireland 50% of all cases of cervical cancer are diagnosed in women aged 46 and under. Average age of death from cervical cancer in Ireland is 56
. Mortality rates from cervical cancer have increased 1.5% per year since 1978
. Women resident in the most deprived areas had an incidence 2.6 times higher than those in the least deprived area
. 99% of cervical cancer is caused by persistent infection of certain high risk types of the Human Papillomavirus (HPV).
. HPV is the most common sexually transmitted infection in the world and approximately 50% to 80% of sexually active women contract some form of HPV at least once in their life. Only a small proportion will develop cervical cancer.
. 2006 - In Ireland some 180 women are diagnosed with cervical cancer every year and over 73 women die (Women's Health Council, 2006).

Additional / Misc' Info:

15/01/2010 - 12:32:07
The Health Minister has today announced that she is reversing the decision not to roll out the cervical cancer vaccine for secondary school students.
Harney has announced the Government is now in a position to provide the vaccine for first-year students.
The decision came after the cost of the vaccine was negotiated down from €16m to just €3m.
The Health Minister had shelved her decision to immunise all 12-year-old girls against the human papilloma virus because the cost was too high.

It is hoped to start the programme this June, but Harney admitted there will not be a catch-up programme for girls who missed out on the jab last year.
The programme will be rolled out in two years time and target 60- to 69-year-olds.

Read more:

Date: 19 Jan 2010
National Immunisation Office urged to aim for 90% uptake of HPV (cervical cancer) vaccine by 12 year old girls in line with international experience Irish Cancer Society welcomes co-inventor of HPV vaccine from Australia to Dublin
(Tuesday, January 19th, 2010) In association with Professor Ian Frazer, HPV vaccine co-inventor and Director of Diamantina Institute of Cancer Immunology and Metabolic Medicine, Brisbane, Australia, the Irish Cancer Society reiterated its welcome for the rollout of the HPV vaccination programme for all 12 year old girls planned for June 2010. The Society also urged the National Immunisation Office to aim for the highest participation rate in the vaccination programme as possible.

Speaking in advance of the lecture, Professor Frazer said "I am delighted to arrive in Ireland and learn of the Minister for Health's recent decision to roll out the vaccination programme to 30,000 girls who are in their first year of secondary school. Experience shows that uptake rates are highest where the vaccination programmes are rolled out in schools as opposed to in GP practices. For example Scotland rolled out its schools based vaccination programme in September 2008 and by December 2009 the programme had achieved a 89% uptake level. Uptake rates are even higher when the programme is run on an 'opt-out' as opposed to 'opt-in' basis."

Also speaking in advance of the lecture, Dr Grainne Flannelly, Consultant Obstetrician and Gynaecologist and Chair, Irish Cancer Society, Medical Committee said "The National Immunisation Office will drive the implementation of this programme and we are confident that parents will support their daughters in availing of this vaccine. But we hope that the National Immunisation Committee will address any potential issues that parents might have relating to safety or the concern that vaccination may prompt sexual activity for example, in advance of the rollout. This will be important in achieving high uptake levels. High coverage is critical to the success of the programme".

"Once the vaccination programme is in place, we would also ask that the Minister looks for ways to deliver a catch up programme for 13 -15 year old girls as originally planned. These three generation of girls should not lose out on this important cervical cancer preventative measure" continued Dr Flannelly.

Cervical cancer is an entirely preventable disease. The biggest risk factor for developing cervical cancer is HPV infection. Cervical screening has the capacity to reduce the incidence of cervical cancer by up to 7% per year and reduce mortality by 50% in ten years. In clinical trials it has been demonstrated that HPV vaccines can prevent 95% of cases of cervical cancer related to HPV types 16 and 18, the HPV strains that are found in almost 70% of cervical cancers in women that did not have HPV at the time of vaccination. HPV vaccines should also provide lifelong protection.
Overall the evidence suggests that a combination of a vaccination programme which vaccinates all 12 year olds associated with an effective screening programme will reduce 90% of cervical cancers. A vaccination programme on its own will reduce probably only 51% of cervical cancers.

New and emerging evidence on the side effect profile of HPV vaccines confirms their safety. A major study published in JAMA in August 2009, which related to 2.5 years experience of administering 23 million doses of the vaccine, showed that for every 100,000 doses of the vaccine, only 53 adverse events were reported and these were largely minor and included fainting, local pain and dizziness. The overall death rate following administration of the HPV vaccine is 0.1 in every 100,000 cases (1 in a million).

Ireland has a serious cervical cancer problem. Latest data available from the NCRI shows that 286 women were diagnosed with cervical cancer in 2007. 59% of these women were under 39 years of age and 49% of these women presented with either stage III or stage IV of the disease, where the cancer has spread into the pelvic wall and other organs. 81 women died from cervical cancer in 2007.