Cervical cancer is a type of cancer that affects the cervix, the lowest part of the uterus. It is a significant health concern in India, with one out of every six cervical cancer patients in the world being an Indian woman. This means that one in every 32 Indian women will be diagnosed with cervical cancer and one in 42 will die from it during her lifetime. Globally, cervical cancer is the fourth most common cancer in women. In 2020, the majority of cervical cancer cases were reported in Asia, accounting for 58.2% of the total cases. In India, the age-standardised incidence rate of cervical cancer is 14.7 per 100,000 women, and the age-standardised mortality rate is 9.2 per 100,000 women. These figures are much higher than the global figures.
“Cervical cancer is associated with a number of factors, including poor genital hygiene, young age at marriage, multiple sexual partners, and repeated pregnancies. Other factors such as long-term contraceptive use and smoking are also associated with HPV infection, which can lead to cervical cancer.” Certain populations of women, such as those in correctional facilities, are at a higher risk of cervical cancer than women in the general population, says Dr Nivedita Kaul, Department of Observation and Gynaecology, CK Birla Hospital (R), Delhi it happens.
Cervical cancer cases are increasing in India and globally. This is attributed to several factors such as early onset of sexual activity, unhealthy sexual practices and increase in habits like smoking. These factors put women at a higher risk of developing cervical cancer. It is important to raise awareness about risk factors and preventive measures to combat this disease.
Dr. R. Sankaranarayanan, Director, Preventive Oncology, Carkinos Healthcare, Carkinos Healthcare, says, “Cervical cancer is caused by persistent infection with one of 14 related types of cancer-causing, high-risk human papillomavirus (HPV). These HPV types can cause cervical lesions, which, if ignored and untreated, can progress to cervical cancer within 5–10 years. It is important to be aware of HPV and its associated risks, as well as to have regular cervical cancer screenings and the HPV vaccine when recommended by a healthcare provider.
The goal of screening for cervical cancer is to detect pre-cancerous cell changes at an early stage before they become cancerous and when effective, simple, safe and inexpensive outpatient treatment can halt progression to cervical cancer.
Early symptoms of cervical cancer include
- vaginal bleeding that occurs between periods or after menopause
- vaginal discharge that is thick, foul-smelling, or blood-tinged
- menstruation that lasts longer than usual
- vaginal bleeding or pain during intercourse
- vaginal bleeding during pelvic exam
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How can cervical cancer be prevented?
Cervical cancer is a highly preventable cancer. Cervical cancer can be prevented by regular screening with Pap tests and human papillomavirus (HPV) tests to find and treat any pre-cancerous conditions. It can also be prevented by getting the HPV vaccine.
Dr. Kaul notes additional actions that may help prevent cervical cancer:
- delaying first sexual intercourse until the late teens or older
- limiting the number of sexual partners
- practicing safe sex using a condom
- avoiding sex with people who have had multiple partners
- avoiding sexual intercourse with people who are infected with genital warts or who have other symptoms
- quit smoking
The role of screening in the prevention of cervical cancer
Screening is an important tool for early cancer detection before precancerous changes or symptoms appear. Several screening tests are available for early detection of cervical precancerous lesions, including Pap smear, liquid-based cytology, visual inspection with 5% acetic acid (VIA), and testing for high-risk HPV infection. “Pap smear testing has been in use for more than six decades and is widely accepted. However, the quality and accuracy of the test can vary, necessitating repeated repeats,” says Dr Sankaranarayanan .
On the other hand, HPV testing is highly recommended. World Health Organization (WHO) is the most accurate and preferred cervical screening test compared to Pap smear or VIA screening. This identifies women infected with high-risk HPV types, which cause cervical cancer, and allows early detection efforts to focus on HPV-positive women. “One of the major advantages of HPV testing is its high negative predictive value, meaning that women who test negative for HPV are unlikely to develop cervical precancerous lesions or cancer over the next 10 or more years,” Dr. Sankaranarayanan believes.
The following tests and procedures may be used to check for cervical cancer:
- PAP test. The Pap test is the most common screening test for early changes in cells that can lead to cervical cancer. This involves collecting a sample of cells from the cervix. It is often performed at the time of a bimanual pelvic exam as part of a gynecological examination. Pap testing can be combined with HPV testing.
- HPV test. This test is done on a sample of cells removed from the cervix, the same sample used for the Pap test. HPV testing can be done on its own or combined with a Pap test.
- Visual inspection with acetic acid (VIA). VIA is a screening test that can be done with some equipment and with the naked eye. During VIA, a dilution of white vinegar is applied to the cervix. The health care provider then looks for abnormalities on the cervix, which will turn white when exposed to vinegar. This screening test is very useful in places where access to medical care is limited.
The World Health Organization (WHO) recommends that cervical cancer screening should begin at age 30, with a screening interval of 5–10 years. This is to detect any precancerous changes or early cancer before symptoms appear, and to ensure that appropriate treatment is given in time. It is important to follow your healthcare provider’s recommendations regarding the cervical cancer screening schedule.
What is the right age to get the HPV vaccine?
Worldwide, HPV vaccination is recommended at age 11 or 12, although it can be started as early as age 9. Vaccination is highly recommended for all women up to age 26, especially if they have not been properly vaccinated against HPV before. ,
“The vaccine works best when the person has not yet been exposed to HPV. Since most sexually active people are exposed to HPV, the benefit is limited. The HPV vaccine does not eliminate HPV infection if it is already present. It only helps prevent it. For this reason, it is important that the vaccine is given at an early age,” says Dr Kaul.
What are some of the challenges in preventing cervical cancer in India?
Cervical cancer is the second most common cancer among women in our country. Younger age of marriage, younger age at first intercourse, higher parity increase the risk of HPV acquisition in Indian women. Cervical cancer mostly affects women from rural areas with poor socioeconomic status. Lack of screening and treatment has been identified as a leading factor for the development of aggressive cancer, which leads to death. The situation is worrisome in rural areas where most women are illiterate and sanitation is poor.
High incidence of cervical cancer, poor primary care facilities, poor community health worker practice to participate in the screening program, and delay in introduction of HPV vaccine are challenges to improving cervical cancer screening in the country.
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