The cervical cancer vaccine and the costs

Cervical cancer is one of the most preventable forms of cancer. Moneybags speaks to experts and medical aids about the cervical cancer vaccine, the costs, the benefits and when you should receive it.

“Cervical cancer is a disease in which cells in the cervix become malignant (cancerous). The two main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). The place where these two cell types meet is called the transformation zone. Most cancers start in the transformation zone of the cervix,” explains the Cancer Association of South Africa (CANSA).

Dr Bridgette Goeieman, cervical cancer programme manager at Right to Care says: “Cervical cancer is the most prevalent cancer for women in South Africa. The stats are terrible – one in 26 women will get it. But it is also the most preventable cancer. If you are HIV positive, you are five times more at risk. Cervical cancer can be detected early by having a PAP smear and then it can be treated very quickly and easily.

“We are very concerned about sexually active women who are bread winners for their families. It is so tragic to see women like this suffering and dying from a disease that is entirely preventable.”

Right to Care is a non-profit organisation that offers prevention, care, and treatment for HIV, TB, cervical cancer, medical male circumcision and sexually transmitted infections.

As there are often no physical symptoms for cervical cancer, Goeieman highlights the importance of young women going to regular PAP smears.

Human Papillomavirus

Human Papillomavirus (HPV) is an infection that both men and women can contract. CANSA highlights: “Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 types of HPVs that can infect the anogenital areas of males and females. These HPV types can also infect the mouth and throat.

“HPV can cause serious health problems, including genital warts and certain cancers. There is no certain way to tell who will develop health problems from HPV and who will not. In most cases HPV goes away by itself before it causes any health problems, and most people who become infected with HPV do not even know that they have it.”

CANSA noted: “While the majority of the known types of HPV cause no symptoms in most people, some types can cause warts (verrucae), while others can – in a minority of cases – lead to cancers of the cervix, vulva, vagina, penis, oropharynx and anus.”

There are several different strains of HPV, and these have been categorised into ‘high-risk’ and ‘low-risk’ groups. The high-risk strains are more likely to cause cancer. The low-risk category of HPV strains do not cause cervical cancer, according to CANSA.

“‘Low-risk’ HPV types can cause no symptoms or may cause conditions such as genital warts, but do not cause cervical cancer. Warts can form weeks, months, or even years after sexual contact with a person who has genital HPV. It is also possible that wrts may never appear. In fact, most people with ‘low-risk’ HIV types never know they are infected because they do not get warts or any other symptoms,” reveals CANSA.

Cervical cancer – the whose, the whats and the hows

“The presence of ‘high-risk’ HPV types may lead to abnormal cell changes and can cause genital cancers: cervical cancer as well as cancer of the vulva, anus, and penis. In fact, researchers say that virtually all cervical cancers – more than 99% – are caused by these ‘high-risk’ HPV viruses. The most common of the high-risk strains of HPV are types 16 and 18, which cause about 70% of all cervical cancers,” explains CANSA.

There are a number of symptoms of cervical cancer. CANSA points out that these include:

  • Unexplained pelvic pain. In other words, pain that is unrelated to another condition, such as menstruation or physical exertion.
  • Pain during sexual intercourse.
  • If you experience abnormal vaginal bleeding, heavy periods, heavy spotting between periods or an additional period during your monthly cycle. “Any heavy, sudden onset of abnormal vaginal bleeding should immediately be reported to your medical practitioner,” stresses CANSA.
  • Any abnormal vaginal discharge (with or without an odour) can also be a symptom.

CANSA stresses: “When it comes to screening for cervical cancer, it’s important to go for regular PAP smears that can detect abnormal cells in the cervix (mouth of the womb), that could develop into cervical cancer. CANSA encourages all women ages 18 and 25 who have ever been sexually active should have PAP smears every three years, or two years later after first sexual activity (whichever is later) and continue until age 70.”

The vaccines

There are currently two vaccines for HPV available in South Africa. There is the bivalent vaccine which covers two strains of HPV (types 16 and 18) and the quadrivalent vaccine, which covers four strains of the virus (types 6, 11, 16 and 18). The vaccines are administrable to both men and women to prevent contraction of HPV, and can help prevent women from developing Cervical Cancer.

Goeieman states that “the recommendation is that girls be vaccinated between nine and 12 years before they become sexually active.”

The two cervical cancer/HPV vaccines are:

  • Gardasil: This covers four strains of HPV. This costs around R950 per shot and three shots are needed.
  • Cervirex: This covers two strains of HPV and costs about R700 per shot, and again, three shots are needed.

However, these costs can vary depending on the brand used, the dispensing fee and where the vaccine is administered.

According to Dr Noluthando Nematswerani, Discovery Health clinical specialist, for the three doses required it will cost a total of about R2100, but she highlights that “price may vary according to brand used.”

Fedhealth adds that price may also vary “depending on the dispensing fee that the pharmacy is charging.”

The government in partnership with the Department of Education has campaigned in schools across the country to vaccinate young girls from grade four and up against HPV to help prevent the development of cervical cancer.

“Cervical cancer is a considerable health burden in SA. The intention of the HPV vaccination is to reduce the incidence of cervical cancer, by preventing infection against the viral strains most commonly causing cervical cancer. The vaccine is most effective when given prior to any virus exposure – hence the government roll-out programme with the focus on pre-teenage girls. It is important to note that this will not negate the need for routine PAP smears,” says Fedhealth.

Will your medical aid pay?

There are certain vaccines and treatments that medical aids will not always pay for because they are not seen as necessary, but rather ‘nice-to-haves’. For these treatments and vaccines, medical aids may allow you to pay for them out of your medical savings or benefits, if these are depleted or do not cover the full cost of the vaccine, then medical aid members will be required to pay for the vaccine out of their own pocket.

Dr Noluthando Nematswerani, Discovery Health clinical specialist, explains Discovery Health’s stance on the HPV vaccine: “The HPV vaccine is covered from the member’s day to day benefits. When the member’s day to day benefits are depleted or member’s plan type does not have day to day cover, the funding is from member’s own pocket.”

Fedhealth reveals that the medical aid will cover the cost of the HPV vaccine from “available savings on certain options.”

According to Fedhealth, any contributions that their members may have to make “would be dependent on the amount of savings that the member has available. The member may need to contribute if their available savings amount is insufficient to cover the cost of the vaccine.”

Nematswerani adds: “There is work done through collaborative engagements with government to improve access of HPV vaccination in the private sector. This involves allowing access to these vaccines at state tender prices to make them more affordable to the medical schemes.”

When are you at risk?

While HPV is one of the main causes of cervical cancer, it is not the only one. Below are a few instances that CANSA highlights, where women are more at risk of developing cervical cancer.

  • If you have persistent HPV infections.
  • If you suffer from a weakened immune system, which can be a result of AIDS or of taking immune-supressing medication for auto-immune diseases or after organ transplants.
  • If you or your partner has or have had many sexual partners.
  • If you have not been for a PAP smear within the last two to three years.
  • If you are a smoker.
  • If you are of child-bearing age (between 18 and 40 years of age). CANSA explains: “Most high risk pre-cancerous lesions are found in women of childbearing age. Also, multiple pregnancies increase the risk of cervical cancer when between five to seven full-term pregnancies have been experienced.”
  • Long-term use of oral contraceptives.

It is important to emphasise that you do not have to have experienced any of the above or suffered from HPV to develop cervical cancer. “However, the more risk factors you have, the greater your likelihood of developing cervical cancer,” stresses CANSA.

Lucinda Carter is a ten-year cervical cancer survivor who turned to CANSA for support during that trying time in her life. She says: “It’s been an amazing journey with highs and lows weaved together. I realised how important it is to look after your health and to go for the necessary health checks regularly. CANSA assisted me throughout the seven-week treatment period. I live everyday with hope and encourage other survivors to do the same. A healthy lifestyle is of the utmost importance.”

Bestmed highlights: “A number of general practitioners agree that regular visits to the doctor should form part of your basic preventative healthcare lifestyle. Cancer may come in many different forms and if it’s not prevented it is always important to treat it in its early stages in order to cure it.”