MATTHEW HIRSCH
Sea Point resident Professor Lynette Denny recently won an international award for her work on cervical cancer prevention.
She will be awarded a “medal of honour” at the 50th anniversary of the International Agency for Research on Cancer in Lyon, France, next month.
She will also be speaking on the topic of early cancer detection in Africa.
She says she was happy – but surprised – to receive the award for work on a disease which has been overshadowed by other diseases such as malaria, tuberculosis, HIV/Aids and conditions related to maternal and neonatal morbidity and mortality.
“Cancer is considered rare in Africa, however, approximately 70% of cancers worldwide occur in low and middle income countries,” she said.
Professor Denny, who is based at Groote Schuur Hospital and the University of Cape Town, has been researching the prevention of cervical cancer for more than 15 years.
“I have always been interested in how to relieve suffering but particularly how to prevent preventable diseases. Cervical cancer is one such disease. When it was introduced into clinical practice in the Nordic countries in the 1960s there was a dramatic decline in the incidence and mortality from cervical cancer. This is because the pap smear is able to detect changes in the cervix prior to them becoming malignant – that means there is a long latent phase between the development of abnormalities and subsequently progressing to cancer.”
The reason cervical cancer is such a big problem in poor countries, according to Professor Denny, is because very few, if any, low to middle income areas have been able to set up mass population screening programmes, due to the cost and complexity of the infrastructure required.
“For instance, in the UK, over 80 percent of women are invited by the State for a pap smear every three years – if the smear is normal, then she is referred for appropriate treatment. This process requires strong health care systems, with built in quality control and the support of the community. No such programmes exist in any developing countries outside of specially designed research projects.”
She says the issue is all about political will and resources.
“Our government has introduced the (human papillomavirus) HPV vaccination to school girls and has a policy in the making. It must be said that the failure to push for cervical cancer screening was sabotaged by the demands of the HIV epidemic, and this continues to be the case.”
Her work has seen her scoop numerous accolades. Ms Denny was the first recipient of the Shoprite Checkers SABC 2 Woman of the Year award for Science and Technology in 2004. She was awarded the South African Medical Association Award for Extraordinary Service to Medicine in 2012 and was granted a fellowship to the Royal College of Obstetrics and Gynaecology, United Kingdom, in the same year.
Her latest work revolves around a test to detect the HPV which is the primary cause of cervical cancer.
“We are working on an algorithm where we can screen women and if positive, provide her with immediate treatment. This has not been possible to do with HPV testing until now. A new test known as GeneXpert allows testing for all the cancer causing HPV viruses and gives a result in one hour. We are currently comparing this test to more sophisticated tests and acceptability to both health care workers and patients. So far the test has proven to be extremely easy to use and highly acceptable to our patient population.”
According to the World Health Organisation (WHO), cervical cancer is particularly dangerous and “often grows very slowly over a period of years”.
“Before the cancer actually develops, there are early changes that occur in the cells of the cervix. While these abnormal cells (called cervical intra-epithelial neoplasia or CIN) are not in and of themselves cancerous, and many women with these cells do not develop cancer, these cells may lead to cancer.
“These cells are sometimes referred to as precancerous, meaning that they have the potential to develop into cancer if not treated,” the organisation said.
“CIN usually results from a viral infection by the human papillomavirus (HPV). HPV is a common virus that is generally sexually transmitted. While there are dozens of HPV type viruses, only a few have been linked to the development of cervical cancer. Even when women have the virus, their immune system generally eliminates it. For women whose immune system does not eliminate the virus, HPV may in time develop into cervical cancer.
“All women are potentially at risk of developing cervical cancer at some point in their lifetime. The most common risk factors for cervical cancer include an early age of first intercourse, having multiple sexual partners, and having experienced a weakened immune system. Cervical cancer is most often diagnosed in women in their late 30s. It can, however, be diagnosed in younger as well as older women.”
Some of the symptoms of cervical cancer of cervical cancer include complaints of abnormal bleeding, an “offensive” vaginal discharge and pain related to the pelvis.
“Cervical cancer can present in many ways but these are the most common,” Professor Denny pointed out. She said in poor countries cervical cancer often presents at an advanced stage, when it is incurable and causes a great deal of suffering.
“Yet it is a preventable disease and should be part of the struggle to provide women with equity of access to care.”
