By Dr Helen Weber, 21 April 2022
The National Cancer Registry (NCR) reports an incidence rate of 22.56 per 100 000 for all South African women and 27.01 for black South African women. The high cost of cancer and the potential financial fall-out is immense, especially for women who don’t have the necessary policies in place to cover unexpected expenses such as a carer or an extended – and often unpaid – absence from work.
Human papillomavirus (HPV) causes over 90% of all cervical and anal cancers, plus over 70% of oropharyngeal cancers, along with many vaginal, vulvar, and penile cancers. Dr Helen Weber, Senior Medical Adviser at Sanlam, says South Africa’s high cervical cancer incidence rate can be attributed to multiple factors, to name but one – a high prevalence of HPV in South Africa.
“Right now, the government offers free HPV vaccinations to young girls across the country. Ideally, the vaccination roll-out should be gender-neutral in the future, given that HPV causes many other cancers that affect both genders, and approximately 91% of men (and 85% of women) with a sexual partner will be infected with HPV during their lifetime. We strongly urge all parents to vaccinate their children – girls and boys.” Importantly, the vaccination of boys will protect women from cervical cancer, later.
For girls especially, the cost of failing to vaccinate could be devastating. Most cervical cancer that is detected at an early stage is managed with fertility-sparing procedures; however, these can cause an increased risk of miscarriage and preterm labour as the cervix plays a critical role in ensuring that the pregnancy reaches term, by protecting the growing baby.
HPV includes over 100 very common viruses, which usually don’t manifest symptoms. HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity. More than 90% of them clear the infection eventually – some types, however, can cause genital warts. Two HPV types (16 and 18) are responsible for nearly 50% of high-grade cervical pre-cancers.
Because of how it’s spread, it’s often a taboo topic that’s not talked about. There’s also a bizarre and dangerous idea that giving girls the vaccine encourages promiscuous behaviour. Dr Weber adds, “We really need to address the stigma around HPV and the HPV vaccination. We have everything we need to eliminate HPV-associated cancers from our country and save countless lives. All it takes is a strong vaccination roll-out and willingness from families to participate. These injections can protect our girls from the psychological, physical, and financial toll of cancer. One decision early on could save a life later.”
Cervarix and Gardasil are the vaccinations, administered in two doses for optimal cover. They protect against the HPV-16 and HPV-18 strains, which cause over 70% of all cervical cancer incidents. The government provides the vaccination for free for girls aged 9-14. Medical aids also cover the vaccination – some up to the age of 25 years. Studies have shown efficacy decreases in mid-adult women (24-45 years). As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9-14 years was 75%, while 61% had completed the full recommended two-dose schedule. However, there’s a persistently downward trend in vaccine coverage and dose completion.
Dr Weber says South Africa’s high prevalence of cervical cancer is linked to the country’s high burden of HIV. “A study in the 2021 Lancet found women with HIV have a significantly increased risk of cervical cancer. So, it’s imperative to provide HPV vaccinations and cervical cancer screening to women living with HIV.”
Limited screening is another factor causing the high cancer incidence rate. A significant proportion of the population is dependent on state resources, which has negative implications for access to screening and detection. Screening hesitancy, stemming from lack of awareness, is a further issue. COVID-19 lockdown and the reprioritisation of health resources during the pandemic has been another compounding factor.
Dr Weber says, “We urge women to resume routine screening for breast and cervical cancers. During COVID-19, especially during the lockdowns, many women stopped their annual check-ups. We may see some serious ramifications from this. Screening is the best means of early detection. There are concerns from the medical fraternity that we may see cancer cases creep up considerably within the next couple of years due to the impact of lockdown.”
Cancer is extremely costly. Medical aid and gap cover have capped limits, so there may be a significant shortfall for some oncology treatments. Treatment side effects may also mean a person needs extended leave, meaning no income for several months. There are also various unforeseen expenses, to name a few; like childcare, scans, blood tests, a nurse or carer, petrol to get to appointments, and more. Policies like severe illness cover can make a major difference with fielding these additional costs.
Dr Weber concludes, “Sadly, it’s often only after a major health event happens that people seek first-time insurance cover. At that point, they may be uninsurable. It’s so important to work with a financial adviser to ensure the foundations are in place, to cover you and your loved ones against life’s curveballs, like cancer.”