 Welcome to another edition of Cancer with Dr. Denise Edgeo, CEO of Combo Cancer Foundation in partnership with Plus TV Africa. Happy New Year once again and thank you for joining us. This is very interesting. I actually think I really appreciate your time, your viewing because with you we can do a lot of things. So let us look at it. This month is cervical cancer awareness month. A lot is happening across Nigeria. So my notice, I encourage both men and women alike to please inquire and learn about this disease as knowledge is power. So in the house today, we've got a specialist who's going to be talking to us. My big sister, as I would always look up to her for anything. Our guest is Professor Ifoma Okoye, Professor of Radiology, College of Medicine, University of Nigeria Teaching Hospital. She's also a director at the University Center for Clinical Trials, U-N-N-C-E-C-T and co-founder of the African Clinical Trials Consortium. Prof is also a principal investigator on several research papers in Nigeria, Africa and globally. She is fondly referred to as Pinky Prof in the cancer space in Nigeria and across the world. So don't look at her sitting there smiling and she's the trustee of Project Pink Blue to list a few of her achievements. Prof, good afternoon. And thank you for joining us. Good afternoon. Good afternoon. Hope you are good and happy new year to you. Thank you. Nice to see you. You're looking really true. Yes, it's my pleasure. You're looking very true. She enjoyed the sunshine and now I'm freezing. Alright, let's go ahead so that I'm looking. We can get quite a few in. Well, I'm cause cervical cancer. It's very interesting. It's a very interesting conversation and I'd like you to educate us today on what we need to know about it to be honest with you. So let's start with it. What is cervical cancer and what is the burden of cervical cancer in Nigeria? Okay. In Nigeria, you have like 12,000 deaths from cervical cancer. Actually 12,000 new cases a year and 8,000 died from cervical cancer yearly. So almost this translates to the fact that almost every hour a woman dies from cervical cancer. It's a good way to put it. However, for many years now, the statistics has remained at 26 women die every day from cervical cancer. 26 women and that translates to a woman dying almost every hour in Nigeria. So that's the sad statistics for especially for a disease entity that is completely preventable. If we do the right things. Okay. So if we are we are bearing in mind the burden on looking at it from the perspective of the number statistically. What is cervical cancer? Okay, cervical cancer is like every other cancer. Some changes in the cell nature of the cell that enables it to begin to function abnormally. Those crop of cells that have their origins in any particular organ like in cervical cancer, it is at the neck of the womb. The cervix is the neck of the womb. The womb is the uterus where they have caused the baby for nine months. But the neck of the womb is this structure that is referred to as the cervix. And as the name indicates, it is actually the neck of the womb. The child has to pass through the uterus through the effaced cervix. The cervix effaces in order to permit itself to be flush with the uterus and the baby comes out doing birth. So that is the location of the cervix. So any cancer that originates at that point of the neck of the womb of the uterus is referred to as cervical cancer. So like any other cancer is just a malfunction of cells that have become autonomous and not behaving or obeying any rules of serving their function and dying and being removed for new cells to regenerate. No, cancer cells will continue to multiply. Okay, so based on what you are explaining to us about the cervix and the importance of at least giving us clarity of where the location of this cancer is in the body. Could you briefly explain to us or tell us the symptoms of cervical cancer? Because if we know what the symptoms are, we have a better chance of going forward and getting assessed. In terms of symptoms, I would always like to start with emphasizing that we don't like to have patients come when they have symptoms. We like people to come before they have symptoms so that we screen them and find it early when it can be managed and when the mortality and mobility that occurs from the disease will be at its most minimum. Now, if you do have symptoms, the symptoms will go like this, from early symptoms to late symptoms. The early one will be where you are having some kind of discharge. You're having some kind of discharge and that discharge may not be, may not be a bloody discharge, just discharge. And that's because there is an infection, the HPV infection, which is resulting in some more effluent flow of the normal fluid that comes from your vagina. A lot of men know that they tend to, and sometimes post your period three, four, five days after your period, you still tend to have to wear something to ensure you're not flowing too much. So if you have a continuous discharge from your vagina, it's something that you need to go and have a look at and have somebody look inside through your vagina to look at the service and see the state of the service. You see it undergoing some emotions, some changes, some people refer to it as dysplasia, and what kind of dysplasia is it? They can take some cells to path smear or they can do visual inspection with acetic acid to verify. But if you didn't go and it proceeds into what we call dysparunia, and that is when you start having pain after intercourse. It's called dysparunia. You should really, any woman that has pain after intercourse should come and present herself to be further investigated. Another thing is if you've already stopped having your period and suddenly that is you've achieved menopause and suddenly you start having your period, then that is something to worry about. That is another symptom that you can have, which is your period, as if your period has restarted bleeding after menopause, okay? Then the next one is actually bleeding whether you are having your period or not having your period. That's serious. Those are now on the listages. And after a while, you will find that the woman has a distasteful smell that accompanies her. And people are wriggling their noses when you are around because there is some manner of, you know, like a wound, a festering wound. But because it is inside, you don't know. The only thing is that you're feeling pain, but you are not wanting to pump up. Most women don't like to go and reveal that anything is happening in their private anatomy. So you find that a lot of women come late because they're hiding, they're hiding these symptoms. Yeah. So these are the symptoms that you, and then of course in the very list stages, you can have some fibrillations where you have, the cancer has eroded through the vaginal wall connected to the anal, to the anus or it has ascended and the bladder is anterior. So it can also have the cycle, vaginal fistula or the cycle rectal, sorry, yes, the cycle rectal fistula. Yeah. And that's the idea. If you're out there, if you need to have a check, you've got the idea of what the symptoms are. So let's look at, because last thing we're going to focus on is going to be the awareness. What are the things to prevent us before we even get to this point is a key conversation for us today. So I'm going to ask you one question and it goes, how long does it take for a woman to have, to have the treatment plan for cervical cancer, following or doing the treatment in the correct program. Does that make sense? Okay. So what usually determines the length of treatment is how long, what is the stage, the stage of this cancer. So if you come at the least stages, of course, it's going to be a lot of complications coming with it, a lot of interventions. And that if you come early, especially if you were detected during screening, a screening is when you do not have any symptoms, but because you are of the right age, you have made yourself available at the right hospital service or screening center to be screened for early detection. So if you're early detected, then you can, you could have been detected at the stage where it is not cancer yet. That's the pre-malignant. It's not cancer yet. And all that needs to be done is to virtually like ablate those areas of dysplasia, those areas where the HPV, that is the human papillomavirus has host changes, either by cryotherapy or by other methods which the gynecologists have an ability to use to clear up those changes. Now, those changes by the human papillomavirus is very interesting to know that you have to have sustained infection with human papillomavirus and untreated for close to 10 to 20 years before you have, you know, the changes that will convert to cancer, to become cervical cancer. Now, when it becomes cervical cancer, you can have what they call a micro, you know, the one that you can only detect through looking at the cells and the microscope. So that is the stage where there are still very, very interesting and curative procedures that can be done for that patient in that auction. And that patient can achieve, you know, you can achieve cure quite easily. You can achieve cure for such a patient. But then if you come in the post-microscopy stage where you now just by viewing, you are already seeing all the changes. And those changes when you take your pap smear, it reveals that definitely this patient has cervical cancer. Then you need to have other options like surgical treatment, other treatments like chemotherapy, using drugs, other treatments like radiotherapy, immunotherapy, and all other types of therapies that are utilized these days, the more high-ending, the higher the cost for such a patient. Thank you, Prof. Well, that's very detailed. Okay, so at what age should we start doing the cervical cancer screening? And how often? Okay, for screening, you know, earlier on, there was this idea that it's mostly post-menopausal women that will come up with it. But when, of course, the association with the HPV, the human papillomavirus was seen, and it's now gated into the age of first sexual activity. So the earlier the sexual activity, the earlier the exposure to the virus. And then, of course, if you're now putting like 15 to 20 years, you will almost be arriving because some studies have shown that it's as early as nine years, some have shown it's as early as 14 years, 16 years. So if you add up, you'll be getting yourself into, from after 20, one should, you know, could have cervical cancer, really, because the earlier the sexual exposure. And of course, you know, in some cultures, there are females that, you know, get married earlier. That is early marriages. So in such cultures, like in Nigeria now, breast cancer is supposed to be the number one female cancer in terms of prevalence. But some authorities will tell you that in the northern region where early marriages are prevalent, you find that there is a switch of cervical cancer being topping the list for cancers in women. In the entire of the African region, cervical cancer could be said also to top the list and second being breast cancer. So it just depends on, you know, some of the data that is available, which you can get against what the cultures are doing. So even in Britain, one of the British celebrity celebrities, she got her cervical cancer at the age of 24. And at that stage, nobody offers you cervical cancer screening in Britain at that time. It was with her case and the advocacy she led after her diagnosis that led to the reducing the age to 25. So from the age of 20 now, especially in the African setting with early marriages, one will say that it would be best for us to start screening from the age of 20. And you can do the kinds of screening you can do is either visual inspection with aesthetic as in which is more affordable and more accessible and more available. The reason being that we do not need to have the pathologist intervention in the process of completing the cycle of the screening. Whereas if you do the one that is called paparicula, a SNEH, the PAPS, most people call it the PAPS, you will need to have a pathologist that will interpret the outcome of the specimen that you have obtained. So for the other one, which is visual inspection with aesthetic passive or visual inspection with look-all side of the team, you see, you make the diagnosis right there that there are changes. You are not making a diagnosis that there is cervical cancer. That is only a pathological diagnosis. So you are making a diagnosis that there are changes that are attributable to the human papillomavirus. And you can treat at the same time. So we call it C and treat. And you can treat with what is called a thermal ablation facility that is called a cryotherapy. And then that is able to put a stop to the progression of the changes that have started. And once you are able to put a stop to the progression of those changes, you can actually stop the process of his progressing to cancer. Now, not all human papillomavirus have oncogenic ability. That is the thing that are able to translate it to cancer. There are certain species that will result only in watts. Those are called low risk. But the high risk one are about 14. But out of them 16 and 18, I think 16 and 18 are the most of the high, the most prevalent of the oncogenic type of the virus. You have a vaccine that you can use to actually prevent the acquisition of the human papillomavirus. So you have a vaccine that will be able to prevent it. And this vaccine is the mainstream gold standard that is being advocated worldwide, which is why the world is moving towards cervical cancer elimination. And the ongoing cervical cancer elimination campaign that started two years ago and has been heightened. Interestingly, Nigeria has adopted to put in the human papillomavirus vaccine in the National Immunization Program. And this is built to start in the third quarter of this year, 2023. And it will be available free to the ages of nine to 16 years. Thank you, Prof. You've answered the four questions I really had for you all in one. So based on what you're saying now, can I assume and can we say this is correct that Nigeria can afford to ensure that children between the age of nine and 16 years old with effect from the third quarter of the year, we will be able to start to push for schools and all to encourage their children to go and take this vaccine. Are you saying that that is the status at which we are? Because one of the key things is there's no point of doing this awareness program if we're not monitoring that what is being said is actually happening. So are you saying that it's good to publicize it because it will help us to hold the government accountable. What was said is that in the third quarter of this year, 2023, it will start being rolled out. But it has definitely been the policy is in place that it is going to be part of the National Immunization Program, which is very, very, I think it's the best news. You know, in India, they are actually producing the vaccine themselves. So this is where we should be heading to because we have a huge population and it should be best if we could ourselves get into production of the vaccine. That's a very good way for us to end this, actually, in my view, because at least you've been able to share the fact that there is hope for all of us. So based on what you're saying to us now is that this cervical cancer is usually caused by this HPV. That is the human terpuloma virus infection. That's correct, right? And it's a common virus that you get from having unprotected sex. I think we need to let people get clarity on what exactly it is. No, sorry, can I correct that? Whether you protect sex or you don't protect sex, I'm sorry. Even if you are protecting it with crowds, the human terpuloma virus will be transferred once there is sexual contact. But that's unprotected sex. It's not protected sex means that you're wearing a condom. Yes, even if your condom is a trouser. Oh my goodness, we learn every day. Of course, you know there is the oral pharyngeal. And then, unfortunately, also in people with HIV, you have a more florid infection. And the immunity, of course, is down. So anything that can bring down your immunity, people with chronic diseases or any form of immunotherapy that needs immunotherapy or something, like people with post-transplant patients, once your immunity is down, you'll have more propensity to have the HPV. But that doesn't mean that an able-bodied person will not have it. Alright, so a point of correction to the viewers and to all of us that have had this myth because now you see I've now learnt a new myth. And that's one of the reasons I love this programme because I get all these consultants and all these doctors and all these specialists come and tell us the myths from the facts. So thank you for that. You've clarified a new myth for us. But you will agree with us that there are no symptoms until the cancer starts to spread. So you don't really get symptoms except your normal discharge and you can have it and not even realise that you have cervical cancer because you just have any discharge, right? And you may not have any discharge. Is that a myth? I've been clarifying. Yes, because if you ask people, okay, if you have discharge, come, no. Don't have anything just by the virtue of your age. Go and get a check. Thank you very much. So when you do a check, you are more likely to find it at the stage where there are just minor changes that can be taken care of right there in that one single visit that you have made. Fantastic. Thank you, Bro. Yes. It is very important to note that cervical cancer, we have to get the doctors to do the work. So let us not just assume that we can just decide that we are the doctors on the job because we're not the doctors on the job. We need to go and get the help. And lastly, I want to point out that as they've said, and we need to clap for ourselves and clap for Nigeria and the fact that they signed it in that we will at least have access to the vaccine up until the age of 16, from nine-year-olds, starting third quarter of this year. The vaccine is affordable. Okay, but how much is it then? Okay, I think now for two doses should be around maybe 50,000. And this is the one effort. Nobody can do it for you. If you can afford it, make sure you go and get your tests. Go and do your checks regularly. If you have children, get them to do it and please understand, I have had my own children and they've all done it and they are all totally vaccinated to the last. I want to say to both and to the viewers, thank you all for joining us, especially on this conversation of cervical cancer. We appreciate the management of Lost TV Africa for sponsoring this awareness program. And to all our followers, we want to say thank you for sharing the cancer awareness episodes, clips, facts, and support us. Thank you all because together we will, together we fight, together we win. Follow us on our social media pages at comalcancerfoundation.org. You can find us there, share, subscribe, and click on the notification button. You will always find us on Instagram, Facebook, YouTube, LinkedIn, everything. We're there. Just try and ask the questions. Don't sit down and pretend you don't know. Thank you all for joining us today. It's been a very nice chat with you and above all, thank you, Professor. If a mouthful actually being with us, you really did a good job with us. Thank you and have a lovely week. God bless you all.