Kathmandu:

The cancer of cervix has been recognised as the number one cause of death amongst women in Nepal. It is also invariably caused as a result of a sexually transmitted disease (STD) virus called Human Papilloma Virus (HPV). Only in recent years scientists discovered that HPV is definitively responsible for causing 70 per cent of all cancer of cervix. The cancer of cervix can be detected at precancerous stages through screening with Pap smear can be treated or prevented.

A company called Merck launched the vaccine called Gardasil in October 2005 followed by another company Glaxo whose vaccine is called Cervarix. Both vaccines have been 100 per cent effective in preventing HPV infection. US Food and Drug Administration (FDA) announced the approval of Gardasil. The UK Government has also announced that they would provide free vaccination. As the vaccination should be given before sexual activities these countries have decided to give vaccination to all girls at the age of 12.

For Nepal this vaccination could be ideal for prevention and death from cancer of cervix but the drawback is the cost of the vaccine. However last year Bill & Melinda Gates Foundation decided helping developing countries to buy vaccines and donated $27.8 million for vaccination in India, Vietnam, Uganda and Peru through a charitable organisation in US called PATH. This fact encouraged me to look for a Grant from Bill & Melinda Foundation to buy HPV vaccine for Nepal.

Nepalis living in UK established an organisation called UK Friends of Bhaktapur Cancer Hospital (UKFOBCH) in 2004 to help cancer care in Nepal. We registered it under UK Charity Commission and decided to apply for a Grant from Bill & Melinda Gates Foundation to initiate HPV vaccination in Nepal.

We hope that someday all the women in Nepal will be able to live a healthy life free from cervix cancer Dr. Bibek Pradhan, M.B.B.S; M.R.C.O.G (Chairman, UK Friends of Bhaktapur Cancer Society) b.pradhan@ntlworld.com

Pap test

Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer. Doctors generally recommend that:

• Women should begin having Pap tests three years after they begin having sexual intercourse, or when they reach age 21.

• Most women should have a Pap test at least once every three years.

• Women who have had a surgery to remove the uterus and cervix do not need to have cervical cancer screening. However, if the surgery was treatment for precancerous cells the woman should continue with screening.

Symptoms

Precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms. When the disease gets worse, women may notice one or more of these symptoms:

• Abnormal vaginal bleeding .

• Bleeding that occurs between regular menstrual periods.

• Bleeding after sexual intercourse or a pelvic exam.

• Menstrual periods that last longer and are heavier than before.

• Bleeding after menopause.

• Increased vaginal discharge

• Pelvic pain and pain during sexual intercourse

Risk factors and causes

• HPVs: These viruses can be passed through sexual contact.

• Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests.

• Weakened immune system: Women with HIV infection or who take drugs that suppress the immune system are at a higher risk.

• Age: Cervix cancer occurs most often in women over 40.

•Sexual history: Women who have had many sexual partners or who have sexual intercourse with a man who has had many sexual partners have higher risk.

•Having many children: Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection.