x Abu Dhabi, UAEFriday 19 January 2018

Cost puts women off 'crucial' screening

Dh600 test considered sexually transmitted infection

Residents are reluctant to be tested for a virus that causes cancer because it is not covered by their health insurance.

A gynaecologist in a Dubai Healthcare City hospital says routine tests for the human papillomavirus (HPV), which causes 98 per cent of cervical cancer cases, could save lives.

The Dh600 test is not covered because health authorities consider it a sexually transmitted infection.

"[Insurance cover] would be the ideal way to manage patients, because if we know that someone has high-risk HPV we can monitor them more closely in case they start to develop abnormalities," said the gynaecologist, who asked not to be identified.

"I see it all the time. Dh600 is high enough for people to think twice about getting a test done."

Cervical cancer, the second-most common type of cancer in women and the third-leading cause of cancer-related deaths after lung and breast cancer, occurs in 10 of every 100,000 women in the UAE.

Dr Karim Elmasry, a consultant gynaecological oncologist at Al Ain's Tawam Hospital, said he had never seen more cases than in the Emirates, so regular screening was crucial.

Daman, the national health insurance company, says HPV treatment is only covered within certain customised plans for groups and as part of the premier plan.

But it will cover screening if a doctor puts in a request, said Dr Sven Rohte, Daman's chief commercial officer.

In most HPV cases, the body's immune system beats the infection by itself. The rest, about 20 per cent, develop into precancerous cases in a process that can take up to 15 years.

Dr Ritu Nambiar, an obstetrician and gynaecologist at Abu Dhabi's Al Rahba Hospital, said this gave doctors plenty of time to diagnose cervical cancer and treat it successfully.

Dr Nambiar said regular HPV screening would lead to unnecessary fear: "If I did an HPV test on all of my patients, 80 per cent of them would be positive and then there will be a state of panic."

Dr Jalaa Taher, the head of cancer control and prevention at the Health Authority - Abu Dhabi (Haad), says about 80 per cent of all sexually active people have had HPV at some time.

"It's transmitted through sexual intercourse, which is why there is such a stigma around it here in the UAE," Dr Taher said. "We only do HPV testing if there are some changes in the Pap smear results, and then we monitor the woman closely."

Women are recommended to have a Pap smear, which involves a swab sample of the outer cells of the cervix to detect abnormalities, every three years. It is covered by all UAE health insurers, most of which also cover treatment if the cells start changing into precancerous lesions.

Dr Elmasry said the UAE had a "big quality control issue", as some Pap smear results could be incorrect due to human error in the laboratories.

"With the HPV test it's easy - it's either positive or negative," he said.

But he said other issues would arise if HPV screenings replaced the Pap smear. "Young women are the ones who are most likely to have HPV but they are also more likely to naturally get rid of it as well," Dr Elmasry said.

"If you screen them when they're too young, you'll end up over-diagnosing and over-treating things the body will naturally take care of.

"It really doesn't matter if it's an HPV test or a Pap smear, as long as they just get screened. Because the bottom line doesn't change: screening prevents cervical cancer."

Dr Nambiar said: "We should be aggressively educating the public and physicians, because no one should be dying of cervical cancer. No one should even be diagnosed with it."