All you need to know about cervical cancer

Cervical cancer is cancer that arises from the lower part of the uterus, the cervix. It is the fourth most common cancer in women globally, with more than 90% of these women living in low- and middle-income countries (WHO). In India, it ranks as the second most common malignancy among women. In India, cervical cancer accounted for 9.4% of all cancers and 18.3% (123,907) of new cases in 2020 (Globocan Data 2020).

Despite being one of the few cancers that can be almost completely prevented and cured if detected at an early stage, unfortunately it is found in our country at an advanced stage, and is often incurable. . India accounts for about 1/3 of the deaths due to cervical cancer worldwide. This reflects the lack of awareness, knowledge and social stigma associated with cancer detection and treatment in our society.

Human papilloma virus (HPV) is the causative agent in >95% of cases, and is sexually transmitted. In addition to HPV infection, factors such as young age at marriage, high number of pregnancies, poor genital hygiene, use of oral contraceptives, poor nutritional status, smoking, coexisting HIV infection are associated with the development of cervical cancer.

The most common symptoms include white discharge per vagina, vaginal bleeding and bleeding or spotting after intercourse. Symptoms like pelvic pain, lower back pain can be seen when the disease has spread beyond its origin in the cervix.

Various modalities of treatment include surgery, radiotherapy and systemic therapy, each administered depending on the extent of the disease. For early stages of disease, surgery and radiotherapy with concurrent chemotherapy are highly curative with low morbidity, and chemotherapy with targeted therapy and immunotherapy has improved outcomes in the advanced stage of malignancy.

Screening and prevention – malignancy is always due to HPV infection, and most HPV infections are automatically eliminated by our body. Persistent HPV infection causes the growth of an invasive cancer from a normal cell lining. It takes decades for an aggressive cancer to progress.

These changes can be picked up by a PAP smear test and so regular testing for the HPV virus and PAP smears can help keep sexually active women in check. These tests can be done alone or at the same time (called co-tests). Routine screening has been shown to prevent cervical cancer and save lives.

Screening is recommended starting at age 25, and can be done with co-testing that combines an HPV test with a Papanicolaou (Pap) test every 5 years or every 3 years. In one Pap test alone (according to the American Cancer Society).

In a resource-limited country like ours, more cost-effective tests have been developed and validated in studies such as the VIA (Visual Inspection with Acetic Acid) test performed every 5 years.

Vaccination – This helps prevent the development of HPV infection. There are three FDA-approved vaccines for the prevention of Cervarix (bivalent) and Gardasil (quaternary and 9-valent), both of which are effective against major HPV serotypes 16 and 18, which account for more than 70% of cervical cancers. Huh. The CDC (Centers for Disease Control) recommends routine vaccination of preteens at age 11 or 12. The vaccination series can be started at age 9, and can be given at the same time as other vaccines. According to the Indian Academy of Pediatrics, it has now been included in the Universal Immunization Schedule.

The HPV vaccination schedule is as follows (CDC):

• Two-dose series (0, 6-12 months) for those starting vaccination at ages 9 to 14
• A three-dose series (0, 1–2, 6 months) for those starting vaccination at 15 to 45 years of age and for immunized individuals.

The Government of India has also approved its use up to the age of 45 years in view of the high incidence and mortality rate in our country. The WHO recently announced in a new release that a single shot of HPV vaccine provides protection equivalent to scheduling 2 or 3 doses. This significantly reduces the cost for the patient and makes it more acceptable and accessible to the public.

Given the huge promising data on primary and secondary prevention, we only want the public to adopt the recommended preventive vaccinations and tests. This will profoundly alter the course of this cancer both at the individual and community level, which in turn will produce remarkable results at the national level.

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