Cervical cancer still kills thousands of women in South Africa, mostly poor women in their 40s and 50s, many of whom are the breadwinners in their families.
Doctor Trudy Smith, a gynaecologist who works at the Johannesburg General Hospital and who also runs her own private practice, says she sees up to 850 women a year with cervical cancer. Most of them have spent their lives taking care of others and left their own health to last.
Because of financial constraints, most women seek medical advice or treatment in the late stages of cancer.
“Women come very late to seek help — often they might have a slight bleed or smelly discharge but they pay little notice. When they eventually notice the bleeding getting worse — or when the smell gets worse — they come to seek help. Unfortunately by then they are at stage three of the disease and need radiotherapy,” she says.
Cervical cancer is somewhat of a “Cinderella” disease compared with its more glamorous cousin, breast cancer, which enjoys a high-profile, pink ribbon campaign endorsed by A-list celebrities.
Smith says that even though cervical cancer is more common, women are less aware of it and it is not well covered by the media.
Of course, it is easier for women to examine their own breasts than their cervixes: “Women often do not realise how severe their condition is as it occurs where they cannot see it and they easily and often ignore the problem.”
Last week pharmaceutical company Merck Sharp & Dohme (MSD) launched a cervical cancer vaccine in South Africa, the quadrivalent human papillomavirus recombinant (HPV) vaccine.
The vaccine will help protect against diseases caused by the HPV types 6, 11, 16 and 18, namely cervical cancer, abnormal and precancerous cervical lesions, genital warts, vaginal and vulvar cancer and HPV infection.
The vaccine — called Gardisil — is available in South Africa at R770 a shot. Patients require three shots over a six-month period.
“As a schedule two drug it is available at pharmacies and can be administered by the pharmacist. You do not need a prescription for it,” said Doctor Sibongile Kubheka of MSD.
At R2 310 for a full course of treatment, the vaccine will be unaffordable for the women most severely affected by the diseases caused by HPV. The vaccine is available only in the private sector, but Kubheka says the focus in future would be on the public health sector.
She says that while MSD has not engaged with government to introduce the vaccine in hospitals and clinics, the company is open to such engagement.
Professor Lynette Denny of the University of Cape Town says that “because HPV-associated disease is so prevalent in HIV-positive women, it would be particularly useful to vaccinate women who might become HIV positive in the future, so that they are protected”.
She pointed out, however, that the relationship between HPV vaccination and HIV is still to be studied.
It is not clear if South Africa’s major medical aid companies will pay for the vaccine.
The department of health failed to respond to questions about whether the vaccine will be available in the public health sector.
Worldwide it is estimated that there are up to 40-million cases of HPV infection. More than 650 women die from cervical cancer around the world each day.