Cancer is one of the leading causes of death in the world, and cervical cancer is the leading cause of cancer among women. January is considered a cancer awareness month.
Cancer is an abnormal proliferation of cells causing growth at the primary site and can spread by various routes to several parts of the body such as the liver, lymph nodes and bones.
In India, about 200 people die of cervical cancer every day. It is therefore a health problem of enormous proportions. To put it in relative numbers, India accounts for 27% of the global number of cases and accounts for the same percentage of global deaths due to cervical cancer.
What makes this even more poignant and ironic is the fact that this is a type of cancer that can be prevented as well as diagnosed early to ensure optimal treatment. Since both are life-changing decisions, it is imperative that we are aware of the prevention as well as early treatment of this disease. It is also the most common cancer that kills women compared to all other cancers that can occur in the body.
If we are to prevent this cancer early, we must prevent the causative factors. HPV (human papilloma virus) infection has now been shown to account for up to 99% of cervical cancer cases. In addition to cervical cancer (also called HPV virus), it can cause cancer of the vulva and vagina. It is also implicated in several other cancers such as oral, penile, anal, respiratory, etc.
It takes about 5 to 10 years for the infection to develop into cancer and this is important in the screening process. The natural history is that infection causes benign cervical lesions that can progress to cancer.
However, it is pertinent to note that several other factors are also implicated in the development of cervical cancer, namely early initiation of sexual activity, high parity, long-term use of hormonal contraception, tobacco use, both passive and active , immune suppression, HIV infection, multiple sexual partners, and contracting sexually transmitted diseases.
Symptoms such as continuous vaginal discharge, foul-smelling discharge, recurrent vaginitis, post-coital bleeding (bleeding after sex) and irregular bleeding, especially in the pre-menopausal age group, should alert us to see a doctor.
Cervical cancer is now potentially preventable due to vaccination and screening strategies developed to detect cancer early and initiate early treatment.
The HPV vaccine acts as a primary preventive measure, preventing the development of cervical cancer. The long natural history allows us to screen patients infected with the HPV virus and early detection of cancer and thus acts as a secondary prevention program.
Screening consists of visual examination of the cervix even by paramedical personnel (in low-resource settings) and taking a Pap smear, which allows the pathologist to examine the cells for evidence of premalignant or malignant lesions. The more accurate method is a process called liquid cytology (LBC) and co-testing for the HPV virus.
The recommended age for testing is 21 or when the girl is sexually active. A cytological examination is recommended once every 3 years until the age of 30. After that, the recommendation is to have a cytology once every 3 years and a co-test for HPV once every 5 years. This screening is recommended up to age 65. Screening after age 65 is not recommended. If a hysterectomy was performed for a benign reason, no additional screening is recommended. However, if it was done for a malignant or pre-malignant reason, it is recommended that you continue testing. HPV-vaccinated women are also recommended for continued screening.
Let’s commit to making cervical cancer a preventable disease and save women from this scourge.
(Dr (Brig) Aruna Menon is HOD and Senior Consultant, Center for Obstetrics and Gynaecology, Maitra Hospital, Kozhikode.)
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