Cervical cancer is the fourth most common cancer among women, with over 600 new cases worldwide. In our country, on average every year 150 women get sick, and 20 women lose the battle with this disease. Only with a comprehensive approach to prevention, screening and treatment can end cervical cancer as a public health problem in just a few generations.

As the WHO special representative for North Macedonia and head of the WHO Office in Skopje, Dr. Anne Johansen, explains to MIA, the primary cause of cervical cancer is the human papilloma virus (HPV). It is, as he says, a highly contagious infection that is transmitted through sexual contact or skin-to-skin contact.

-HPV is an extremely common virus – 80 percent of sexually active women and men get it at some point in their lives. Persistent infection with a high-risk type of HPV can lead to abnormal changes in the cells of the cervix. These changes are called precancerous growths (or lesions). If they are not healed or removed, they can develop into cancer. It usually takes years for these growths to develop into cervical cancer, says Dr. Johansen.

As he emphasizes, risk factors include the age of the first pregnancy, three or more full-term pregnancies, cigarette smoking, a weakened immune system, HIV infection or the presence of other sexually transmitted infections.

Symptoms of early-stage cervical cancer include irregular bleeding between menstrual cycles or after menopause, increased vaginal discharge with a foul odor, vaginal bleeding after intercourse, pelvic pain, or pain during intercourse.

Symptoms of advanced cervical cancer include persistent pain in the back, legs or pelvis, weight loss, fatigue, loss of appetite, unpleasant discharge and vaginal discomfort, and swelling of the leg or both lower extremities.

Cervical carcinoma most often develops in women aged 20 to 45

The WHO Special Representative for North Macedonia says that cervical cancer is one of the most common types of cancer affecting women, with around 69.000 cases and 30.000 deaths registered annually in the WHO European Region.

She adds that the disease is more likely to develop in women aged 20 to 45, and the incidence is higher in countries that do not have effective organized cervical cancer screening programs.

During 2021, 179 new cases of cervical cancer were registered in the country, i.e. 5,5 percent of the total recorded cases of cancer in the country, while the incidence is 19,34/100.000 female population, according to the data of the Institute for public health of the Republic of North Macedonia.

According to the division of ten most common primary localizations of cancer in women in our country for 2021, cervical cancer is in sixth place, and breast cancer is in first place.

In 2020, there were approximately 604.000 cases of cervical cancer and 342.000 deaths due to it worldwide.

The Ministry of Health informs MIA that in our country, on average every year, 150 women get cervical cancer, and 20 women lose the battle with this disease.

Necessary information, education, vaccination, screening examination

As part of the cervical cancer awareness month, the main messages that were addressed are mandatory information and education of women about cervical cancer, screening examination and vaccination with two doses of the HPV vaccine.

- The messages are clear - inform yourself. Learn the facts about cervical cancer and the human papillomavirus (HPV) that causes it. Help educate the other women in your life as well. Do a screening exam. Cervical cancer screening usually begins at age 30 and is repeated periodically. Get vaccinated. The HPV vaccine is given in two doses that should start when the girl is between 9 and 14 years old. In North Macedonia, only girls over the age of 12 are vaccinated with the HPV vaccine, by giving two doses of the vaccine, six months apart, says Dr. Johansen for MIA.

The WHO special representative for North Macedonia assures that when diagnosed, cervical cancer is one of the most successfully curable forms of cancer, if it is detected early and effectively managed. Carcinoma diagnosed in late stages can also be treated with appropriate treatment and palliative care.

In addition to being prevented through HPV vaccination, precancerous lesions can be easily detected through screening before they develop into cancer.

The HPV vaccine is almost 100 percent effective in preventing most HPV infections that can result in precancerous conditions and cancer.

-When detected, precancerous lesions can be treated and cancer can be avoided. Screening programs can also detect cancer at an early stage when treatment has more potential for a cure. The introduction of the HPV vaccine more widely, combined with organized screening for cervical cancer, has the potential to save many lives, especially among younger women, adds Dr. Johansen.

As she explains, the main treatments for cervical cancer are surgery, radiotherapy and chemotherapy, which can lead to long-term health problems, including infertility.

Dr. Johansen emphasizes that organized screening programs enable the detection of precancerous lesions, which, if treated correctly, can prevent the development of invasive cancer.

The Ministry of Health organizes screening for early detection, awareness campaigns

The Ministry of Health informs about MIA that they are organizing a screening for early detection of cervical cancer. To schedule a preventive examination for early detection of cervical cancer, as they say, the web platform "https://skrining.zdravstvo.gov.mk/" is available.

From there, they emphasize that for the current 2023, the organized screening for women aged 21 to 59 years who have not had a Pap test in the last three years is continued. The examination as part of the screening for this age group is free for the woman.

- The Ministry of Health is focused on improving women's health and for this purpose a continuous campaign is being implemented to promote and raise awareness of this disease, with the aim of early detection, which can save life. For this purpose, screening for early detection of cervical cancer is carried out, with a free examination and a Pap test at the family gynecologist for women aged 21 to 59 years, who have not had such an examination in the last three years, the Ministry indicated.

They inform that with an organized screening, last year, women between the ages of 36 and 45, who had not had a Pap test in the last three years, were covered.

- The screening.mk web platform is directly connected to the MyTermin system and the family gynecologist immediately receives information about registered patients, after which he informs the patients in which appointment the examination is scheduled. According to the schedule provided in the plan for the Pap test, the family gynecologist calls the women informing about the exact date and time when the Pap test should be done. Likewise, obstetrician-gynecologists can register patients of this age and call them according to a plan and schedule, the Ministry told MIA.

As they explain, from April 2022 until the end of last year, a total of 17.204 patients used the web platform, of which 12.194 patients had a Pap test.

Otherwise, in the budget for 2023, 23.570.000 denars are provided for the Program for early detection of malignant diseases.