Cervical Cancer Awareness Month is commemorated annually in September to encourage women to do screening and prevent cancer. The goal of screening for cervical cancer is to find cervix cell changes and early cervical cancers before they cause symptoms. Screening tests offer the best chance to detect cervical cancer at an early stage when successful treatment is likely. Screening can also actually prevent most cervical cancers by finding abnormal cell changes (pre-cancers) so that they can be treated before they have a chance to turn into cervical cancer.

Many thousands of South African women develop cervical cancer each year. Cervical cancer affects roughly one in 41 South African women, and Statistics South Africa estimates that 16.84-million women over the age of 15 are at risk of the disease in this country. At present, roughly eight South African women die from the disease every day, and the World Health Organisation (WHO) predicts that this figure could rise to 12 by 2025.

Cervical cancer is a treatable condition, and there is a good chance of a cure if it is found and treated in the early or pre-cancerous stages. However, many women with cervical cancer are in their reproductive years. Due to the advances in science there are fertility-sparing treatments available for women with early stage cervical cancer. You will need to speak to your oncologist about these options.

What is cervical cancer?

Cervical cancer is a type of cancer that affects the tissue of the cervix. Usually, it is a slow-progressing cancer that may not have obvious or immediate symptoms, but can be detected by a pap smear. A pap smear is a procedure in which a sample of cervical cells are examined under a microscope and checked for irregularities.

What causes cervical cancer?

As with any other form of cancer, there are many health and lifestyle factors that contribute to the growth of malignant cells in the cervix. However, the human papillomavirus (HPV), the most common of all sexually transmitted infections, is the cause of most cases of cervical cancer. HPV is spread through genital skin contact during sex when bodily fluids mix. There are many different types of HPV: some may lead to cancer and genital warts while others cause no problems at all and can go undetected for many years.

Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections. HIV, the virus that causes AIDS, damages the immune system and puts women at higher risk for HPV infections. This might explain why women with AIDS have a higher risk for cervical cancer.

Symptoms of cervical cancer

Abnormal vaginal bleeding is one of the most common symptoms of the disease, but in some cases, there may be no noticeable symptoms until the cancer has progressed to an advanced stage. Cervical cancer is preceded by a pre-cancerous condition called dysplasia, which is 100% treatable and can be detected by a pap smear. This is why it’s so crucial for all women to have regular pap smears as soon as they become sexually active, ideally once a year, throughout their lives. Today, most women diagnosed with cervical cancer have failed to have regular pap smears or have not followed up after an abnormal pap smear result. Whether or not treatment may be successful depends on various factors, including: the stage of the cancer; the shape and size of the tumour; the general health of the woman; her age and her desire to have children in future.

How can cervical cancer treatments affect your fertility?

• Infertility: There is an increased risk of difficulty in becoming pregnant if the cervix or lower uterus becomes scarred or narrowed as a result of surgery. This could potentially prevent sperm from entering the uterus. This can usually be overcome with an infertility treatment, such as intrauterine insemination (IUI). With IUI, a small catheter is used to deliver sperm directly into the uterus.
• Cervical insufficiency: Cervical insufficiency occurs when the cervix opens or thins earlier than normal during pregnancy. This can lead to miscarriage or preterm delivery (when delivery occurs before 37 weeks of pregnancy). Women who have had cervical surgery may be at an increased risk of cervical insufficiency. For these reasons, women who undergo treatment for cervical cancer need to be followed closely during pregnancy. This generally involves regular monitoring of the length and opening (dilation) of the cervix.
• Pregnancy options after radical hysterectomy or radiation: Advances in assisted reproductive technology now offer a way for women to have a biologically-related child after this type of treatment. Embryo, egg, and ovarian tissue cryopreservation are techniques available to assist women in having their own genetic children in the future. Since the uterus has been removed or damaged by cancer treatment, all of these techniques would require a gestational carrier to carry the pregnancy.

While most cancer patients face excellent prospects for survival, one of the very unfortunate side effects of treatment is permanent infertility. Fortunately, advances in both fertility preservation and infertility treatments are occurring at a rapid rate presenting viable options for cancer patients.

Having a Baby After Cancer

Having children may be the last thing on your mind following a devastating diagnosis of cancer. But with cancer, time is of the essence. Before you undergo chemotherapy, radiation or surgery, talk to a reproductive specialist about how to safeguard your fertility. If you can delay chemo or radiation for a few weeks, it may be possible to harvest eggs to freeze and store for possible future use.

Female Fertility Preservation

Cancer treatments on women pose a variety of reproductive risks including immediate infertility, premature menopause, and a compromised ability to carry a pregnancy to term due to cervical or uterine damage. Chemotherapy and radiation, both common cancer treatments, can cause permanent damage or destroy oocytes and follicles. This can lead to menopause for years after treatment. Other treatments such as surgery to remove the ovaries, fallopian tubes or uterus can drastically impair the ability to become pregnant or carry a baby.

The most proven and successful method of fertility preservation for women is embryo freezing. This involves undergoing IVF, retrieving as many viable eggs as possible, fertilising the eggs in a laboratory, followed by vitrification freezing.

Patients who are single or do not have a male partner to provide sperm for the creation of embryos can consider egg freezing.

Patients who do not have time for ovarian stimulation can consider experimental options such as ovarian tissue freezing which involves the removal, sectioning and freezing of ovarian tissue. These ovarian tissues can later be transplanted to restore hormonal function and for use with IVF.

What You Can Do

A diagnosis of cancer is devastating and making early parenthood decisions at such a time can be very difficult. It is, however, imperative to perform egg freezing prior to any chemotherapy or radiation treatment as potential damage can lead to infertility in both males and females. Cancer therapy can destroy a person’s fertility and their chances of having a family. Your risk of being infertile after cancer treatment depends on the type of treatment, your pre-treatment fertility status, and your age. Your oncologist can give you an estimate of the likelihood that your treatment will decrease your fertility.

Medfem Fertility Clinic is keeping hope alive by offering the opportunity to freeze eggs before treatment. If you are facing a medical treatment such as chemotherapy, radiation or surgery that may affect your fertility, we may be able to help you. In these circumstances, we often need to take action prior to the medical treatment. Therefore, we try to see all urgent cases within 24 hours of having received a referral from your physician.

If you or someone you know has been recently diagnosed with cancer that can impact their future fertility, call our offices immediately at +27 (11) 463 2244 to schedule a consultation.