Doctors call for cancer screens

DUBAI // Doctors have called for a national cervical cancer vaccination and screening programme to catch cases earlier and reduce the rate of the second most common cancer found in women, one that has seen progressively higher incidence in the UAE.

Cervical cancer affects 9.9 women in every 100,000, according to figures by Health Authority Abu Dhabi (HAAD), almost twice the incidence in the broader Middle East, which amounts to nearly five in every 100,000.

It afflicts women at a rate second only to breast cancer, but 70 per cent of cases are diagnosed in the late stages. At that point, only one in three women has a chance of survival. There is no co-ordinated screening programme for cervical cancer in the UAE, as there is in countries where most cases are detected in the early stages.

Dr Saad Aswad is a senior consultant gynaecologist and oncologist – the only specialist of his kind in the UAE – at Tawam Hospital in Al Ain. He compiled a detailed report on a proposed screening programme for cervical cancer drawing on the expertise of more than 40 health professionals and forwarded it to the Ministry of Health in 2004. There has still been no move to implement any of the plans. MoH officials were not available yesterday to comment.

“We need to do something to protect the women,” Dr Aswad said. “Cervical cancer is a cancer we can prevent. Why are we not doing this across the country? If the Ministry of Health introduced it, I think everyone would follow.”

While schoolgirls in Abu Dhabi are offered the Gardasil vaccination for up to Dh50 (US$13.60) for the required three doses, it can cost up to Dh1,900 in Dubai and is not as widely available in other emirates.

Dr Aswad said the preventive vaccine should be available across the whole country.

“We must push for this to be nationwide. It is much easier to implement prevention than cure.”

HAAD said in April it planned to build on a successful pilot vaccination programme in schools and make the vaccine available to all schools in the Emirates.

Last year it vaccinated around 6,000 girls aged 17 and has given another 4,000 the first dose this year. There was a 70 per cent uptake during the pilot scheme. Dr Mawahib al Biate, head of the gynaecology department at the GMC Hospital in Ajman, said a national vaccination programme was needed in the UAE.

“Prevention is always better than the cure,” she said. “A national programme would be a very good idea because of the rates here.” She also said it did not make sense for such an important vaccine to be offered cheaply to some but not others.

In 1998 the MoH reported only eight diagnosed cases of cervical cancer in the country. Last year Tawam Hospital alone saw at least 100 cases, Dr Aswad said.

Recent studies into the efficacy of Gardasil, which was approved by the US Food and Drug Administration in 2006, showed it was effective against the human papillomavirus (HPV) type 16 for an average of eight and a half years. The women in the study, by the University of Washington in the US, were vaccinated in 2001, so more follow-up tests are needed to establish the length of protection. HPV 16 and 18 cause 70 per cent of cervical cancer cases worldwide. Gardasil, made by Merck, is licensed in 109 countries, but some of them find it more difficult to implement a vaccination programme, Dr Aswad said.

Health officials estimate one in 10 women will get an HPV infection in their lifetime, but it is more common in women under 30. Some strains are sexually transmitted, and questions have been asked in some countries about the moral issue of vaccinating young girls.

“Here cervical cancer is increasing out of proportion with the population growth,” Dr Aswad said. “It is time to start protecting the women.”

Dr Ibrahim Abd Elrahman, a consultant gynaecologist and obstetrician at The City Hospital in Dubai, applauded any effort to introduce a national vaccination programme. He saw many women who had never had a Pap smear. “Often I get someone in their late 20s or early 30s who say they have never had one. I organise one with their consent.”

Mitya Underwood

* Last Updated: May 14. 2009 12:14AM UAE / May 13. 2009 8:14PM GMT