The months of September, October and November on the Health Calendar are dedicated to raising awareness about various cancers that continue to plague human kind. Rwanda has not been spared of the cancer burden, and October 22 will see different activities undertaken to create awareness about breast cancer.
However, unknown to many is that one notorious virus – the human papilloma virus (HPV) – is among the top causes of various cancers. Other than cervical cancer, the HPV is implicated in causing many types of cancers, including virginal, anal, scotal, oropharyngeal as well as neck cancer.
US-based Centers for Disease Control and Prevention describes HPV as the most common sexually transmitted infection (STI). HPV is a group of more than 150 related viruses. Each HPV virus in this large group is given a number which is called its HPV type. There are more than 40 HPV types that can infect the genital areas of males and females. HPV is so common that nearly all sexually active men and women get it at some point in their lives.
Why the HPV is dangerous
According to Achilles Manirakiza, a training clinical oncologist at the Ocean Road Cancer Institute in Tanzania, HPV is transmitted normally through sexual intercourse, same as the human immuno deficiency virus (HIV) and Hepatitis B&C.
He explains that the virus is largely responsible for cervical, penile and anal cancers and is mainly transmitted through careless sexual behavior.
“It is now known that cervical cancer will take some time between exposure to the virus to when the condition becomes a visible disease. That accounts largely for the fact that it is found in older women,” he says.
Manirakiza notes that many more young people, mainly non-smokers, are being found with cancers of the head and neck. These cancers usually affect the lips up to the region of the vocal cords (larynx) and throat at large.
“Some of these now are caused by the same virus (HPV) which is also causing havoc in the genital and reproductive tracts. The same way skin-to-skin contact, oral-genital, genital-genital contact or anything else would cause cervical cancer, is the same way cancer is caused in the head and neck areas,” he adds.
Manirakiza says available statistics shows that at least 60 per cent of the cancers in the region between the lips and the back of the throat are caused by the human papilloma virus.
Joseph Muganda, a gynecologist in Kigali, says whether oral, anal or vaginal, the spread of cancers caused by HPV is through sexual contact.
“Even one sexual encounter can expose one to the virus through any abrasion. Sexual activity can cause abrasion of the soft inner lining of genital parts, rectum or oral cavity. After entry, it multiplies and changes its genome and causes abnormal multiplication of cells of that part, thus the cancer,” he explains.
Symptoms and treatment
Muganda says the signs of HPV depend on where the infection is, adding that generally they present as masses like any other solid cancers that tend to outgrow their primary area and spread.
“Depending on where they are, you’ll get a mass in the mouth, roof of the mouth, in the throat and a particular area of the vocal cords. The signs depend on the location as well, varying from food and air obstruction to voice changes,” he says.
Muganda further explains that although these types of cancer can be treated, there is high possibility of them recurring.
“Success of cure depends on the stage where they are found at, as well as on the availability of the treatment facilities, for instance, for surgery, radiotherapy and chemotherapy drugs. However, vaccination is still being looked into, and good results are being found with Ceravix (an HPV vaccine),”he adds.
Rachna Pande, a specialist in internal medicine, also says that HPV vaccines are now being given to adolescent girls for prevention of cervical cancer.
“This is because once it gains entry and causes a cancer there is no treatment for it. Treatment of the cancer depends on how big it is and how far it has spread. It can also be either surgery in early stages or chemotherapy/radiation therapy in advanced stages,” she says.
Pande says prevention measures such as condom use do not fully protect against HPV because the virus may gain entry from some small part not covered by the condom.
“Prevention lies in disciplined sex, such as having one partner, keeping good hygiene of perineal parts, particularly after sexual intercourse,” she notes.
Cancer burden in Rwanda
Francoise Uwinkindi, the director of Cancer Diseases Unit at Rwanda Biomedical Centre (RBC), says according to the most recent statistics from World Health Organisation which are captured every after four years, it is estimated that age standardised incidence and mortality rates for both sexes in Rwanda, cervix uteri cancer is the highest killer at 13 per cent, followed by liver at 11.2 percent, stomach at 7.4 per cent, prostate at 7.1 per cent and breast cancer at 4.6 per cent.
The report also shows that in men, the most common types of cancer include, liver, prostate, esophagus and kaposis sarcoma, at 15.3 per cent, 15.2 per cent, 7 per cent and 6.3 per cent respectively.
In females, the report shows that cervix uteri, breast, stomach and liver were the most common ones at 24.4 per cent, 8.7 per cent, 8.2 per cent and 7.6 per cent respectively.
He adds that in Rwanda cervical cancer is ranked as the top killer of all cancers, followed by breast cancer.
“In Rwanda alone, there were 1,540 new cases in 2015 and 903 deaths. These figures call for more efforts to reverse the trend in terms of early treatment and prevention,” Uwinkindi says.
MORE FACTS ABOUT HPV
If HPV infection is so common, is it really that bad?
Most people with HPV never develop symptoms or health problems. Most HPV infections (9 out of 10) go away by themselves within two years. But, sometimes, HPV infections will persist and can cause certain cancers and other diseases. HPV infections can cause: cancers of the cervix, vagina, and vulva in women; cancers of the penis in men; and cancers of the anus and back of the throat, including the base of the tongue and tonsils (oropharynx) in women and men.
HPV can also cause genital warts in men and women. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
How many people get cancer and/or genital warts from HPV?
Every year, about 17,600 women and 9,300 men are affected by cancers caused by HPV. About 180,000 women and 160,000 men are affected by genital warts caused by HPV every year. Also, about 1 in 100 sexually active adults in the United States have genital warts at any given time.
How do people get HPV?
People get HPV from another person during sexual activity. Most of the time people get HPV from having vaginal and/or anal sex. Men and women can also get HPV from having oral and other sex play. A person can get HPV even if their partner (straight or same-sex) doesn’t have any signs or symptoms of HPV infection. A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most people do not realize they are infected. They also don’t know that they may be passing HPV to their sex partner(s). It is also possible for someone to get more than one type of HPV.
In what other ways could someone get HPV?
It’s not very common, but sometimes a pregnant woman with HPV can pass it to her baby during delivery. In these cases, the child can develop recurrent respiratory papillomatosis (RRP), a rare condition where warts caused by HPV (similar to genital warts) grow in the throat.
Can you get HPV from the toilet seat?
There haven’t been any cases of people getting HPV from surfaces in the environment, such as toilet seats. However, someone could be exposed to HPV from objects (toys) shared during sexual activity if the object has been used by an infected person.
Who should get HPV vaccine?
All girls and boys who are 11 or 12 years old should get the recommended series of HPV vaccine. Teen boys and girls who did not get the vaccine when they were younger should get it now. Young women can get HPV vaccine through age 26, and young men can get vaccinated through age 21. The vaccine is also recommended for gay and bisexual young men (or any young man who has sex with men) through age 26 and young men with weakened immune systems (including HIV) through age 26, if they did not get HPV vaccine when they were younger.
Why is the vaccine recommended at such a young age?
For HPV vaccines to be effective, they should be given prior to exposure to HPV. There is no reason to wait until a teen is having sex to offer HPV vaccination to them. Preteens should receive all three doses of the HPV vaccine series long before they begin any type of sexual activity and are exposed to HPV. Also HPV vaccine produces a higher immune response in preteens than it does in older teens and young women.
EXPERTS SHARE TIPS
Francoise Uwinkindi, the Director of Cancer Diseases Unit at Rwanda Biomedical Centre
Avoid cancer risk factors such as smoking and alcohol abuse, eat healthy food (fruits and vegetables), avoid getting overweight, avoid exposure to infectious agents like the human papilloma virus to avoid contracting conditions like cervical cancer. Regular physical activity is also key in preventing many cancers.
Achille Manirakiza, oncologist
Exercising daily, at least 30 minutes per day, keeps colon cancer at bay. Also, including spices such as garlic in your diet helps in stimulating the immune system which is a natural defence against cancer. Some foods also help the body get rid of chemicals that are capable of causing cancer.
Prince Rwagasore, medical student
Eating healthy can help one reduce their risks of contracting non-communicable diseases including cancer. Try not to eat many processed and prepackaged foods which are high in sugar and salt as these play a big role in contributing to one developing different types of cancers.Check-ups are vital in knowing if one is safe or not.
Iba Mayale, gynecologist
Avoiding multiple sex partners is the key in preventing cancers of the cervixl, neck and others. On the other hand, avoiding being obese is essential since obesity puts one at the risk of contracting cancer as well as other complications such as hypertension, heart diseases and diabetes, among others.
Joseph Uwiragiye, nutritionist at University Teaching Hospital
Alcohol should be avoided at any cost, and if taken, should be in moderate amounts. Consumption of red meat should be limited as it is a major factor in causing most types of cancers such as that of the kidney, brain, stomach and ovarian, among others. Screening is essential for early management or even prevention.
Compiled by Lydia Atieno