Cultural sensitivity can increase risk of cervical cancer

More awareness campaigns are needed in the UAE to break down the cultural barriers that prevent women from attending cervical cancer screenings and being vaccinated against it.

Two years ago, a friend's aunt died after a struggle with cervical cancer.

During her lifetime, this woman had never been vaccinated against this disease, nor had any screening. The cancer was not discovered until she felt physical symptoms, and by then it was too late: the cancer, already in stage IV, had spread to other parts of her body.

In the UAE, only one woman in four who has cervical cancer survives it. Cervical cancer is the second-most-commonly diagnosed form of cancer among women in the country. Compare that with the situation in England, where over two-thirds of cervical cancer patients survive for at least five years.

Most women in the UAE who have this disease learn about it, like my friend's aunt, only when it is in the advanced stages. A 2010 study conducted by doctors at Al Ain's Tawam Hospital showed that 70 per cent of cases in this country are diagnosed late, when the chances of being cured are much lower and treatment is very invasive and less effective.

Despite these horrific figures, women in the UAE have a lot of misconceptions and a general lack of awareness about the disease. Many women do not have regular check-ups and screenings.

Cervical cancer is the third most frequent cause of cancer-related deaths among women worldwide, after lung and breast cancer.

In recent years, the World Health Organisation's records show an increase in the number of new cases diagnosed in the UAE, from 48 in 2008 to 74 in 2010; the total number is expected to surpass 100 by 2020.

There is a cultural issue here. Aisha Al Zaabi, the head of health awareness at the Woman's General Union, told The National that many people here do not realise the importance of knowing about cervical cancer.

"When we talked to people, especially the young generations, we noticed that they didn't know anything about cervical cancer," she said.

"They feel shy when it comes to sensitive issues" like this disease, she added, and this is true even for those who have a female doctor.

A 2010 study by a group of students at Dubai Medical College for Girls, showed low levels of cervical-cancer awareness among young women.

Human papilloma virus (HPV), which causes 84 per cent of cervical cancers, is transmitted through sexual intercourse, which makes the whole subject taboo in a society like the UAE's. Frequently, women do not talk about the disease because they feel that they are at no risk of getting it.

Many women are not aware that in fact, chances of infection can be high. Dr Jalaa Taher, the head of cancer control and prevention at the Health Authority - Abu Dhabi (Haad) said about 80 per cent of all sexually active people have had HPV at some time in their lives. In some cases, HPV develops, over many years, to become a cancer. This occurs in 10 of every 100,000 women in the UAE.

However, HPV is very difficult to detect as it is often an asymptomatic infection, especially at its early stages. Doctors can detect it only by conducting a Pap smear test that shows changes in the cells of the cervix.

As with other forms of cancer, the earlier it is discovered by screening, the better chance doctors have to cure it. But wrong information from some doctors and media, associating it with other sexually transmitted diseases, creates unnecessary barriers for many women in the UAE.

Doctors say that such disease can be prevented by vaccination at age 15. A study by Dr Suhail Al Salam, an associate professor and consultant pathologist at UAE University, showed that 71 per cent of cases in the UAE are caused by HPV type 16, which can be prevented if the vaccine is used early enough.

Haad recommends one-time HPV vaccination for all sexually inactive young females, from the age of 15 years.

But some parents refuse their consent to this, out of fear of the implications the vaccine might suggest about their daughters' sexual behaviour, although there is no evidence to support the claim that vaccination changes behaviour. On the other hand, studies have shown that HPV vaccinated young females are at 70 per cent lower risk of cervical cancer.

The Health Authority will launch a programme in Abu Dhabi next month for free vaccination against cervical cancer for Emirati women between the ages of 18 and 26. The scheme will target those who have had HPV vaccination programmes in schools.

Regular screenings are also crucial for women between 25 and 65 to detect cervical cancer.

Starting last month, sexually active women between the ages of 25 and 65 can undergo regular Pap smear tests, in a programme organised by Haad, at primary health care centres around the emirate.

We need more awareness and to break down the cultural barriers that prevent women from attending screenings and being vaccinated against cervical cancer. Because when it comes to our health and well-being, we should not take any risks.

On Twitter: @AyeshaAlmazroui