CERVICAL CANCER IS PREVENTABLE

The neck of the womb is called cervix. Cancer of the cervix is one of the most common cancers in women. Extensive research has proven that it is caused by a virus called Human Papillloma Virus (HPV).

The incidence of cervical cancer has reduced remarkably in the last two decades due to a screening test called Pap Smear. It is one of the simplest outpatient tests and patients need not panic. It is not painful, but some may experience a mild discomfort.

Screening tests are done on apparently healthy people to identify the risk of disease. If screening tests are positive, we do diagnostic tests to identify the disease.

HPV infection is very common. Approximately 75 to 80 percentage of sexually active adults will acquire a genital HPV infection before the age of 50. There are many types of HPV, and these affect different areas of the body. Most HPV infections are temporary because the body’s immune system effectively clears the infection.

Our objective is to identify the cellular changes occurring in the cervix (precancerous conditions) and treat them early before cancer develops. In the case of cervical cancer, it usually takes 3-7 years for high-grade changes in cervical cells to become cancer. So, the Pap Smear enables early identification of precancerous conditions and allows enough time for treatment. This helps to prevent cervical cancer in women who undergo regular screening Pap Smear tests.

Cervical cancer can be prevented by vaccinating young women against the HPVs and by screening and treating precancerous lesions. However, it is alarming that awareness levels of women-related cancers are low among the general population. Studies have confirmed that screening improves early detection of cancers by 1.5-2.5 times. However, despite the established benefits of screening, coverage for the same in India is low for women. At a national level, there have been regular campaigns against cervical cancer. But this has had little impact on the morbidity and mortality of the disease. The sad aspect is that almost 70% of newly diagnosed cancers are detected in late stages. Late detection also adds to the cost of treatment as estimates indicate that the treatment cost for late-stage cancers is almost 2 times higher than the cost of treatment for early-stage cancers.

Cervical cancer screening includes the Pap Smear test and, for some women, an HPV test. Both tests use cells taken from the cervix. The screening process is simple and fast. The cells are removed from the cervix with a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing: For a Pap test, the sample is examined to see if abnormal cells are present. For an HPV test, the sample is tested for the presence of 13-14 of the most common high-risk HPV types.

The recommendations for screening tests (Pap and HPV tests) are as follows:

• Women aged 21-29 years should have a Pap Smear test alone every 3 years. HPV testing is not recommended.
• Women aged 30-65 years should have a Pap Smear test and an HPV test (co-testing) every 5 years (preferred). It also is acceptable to have a Pap Smear test alone every 3 years.
• Women above the age of 65 need not have a Pap Smear test if they do not have history of moderate or severe abnormal cervical cells or cervical cancer and have had either three negative Pap test results in a row within the past 10 years.
• Women who have had hysterectomy [surgical procedure whereby the uterus (womb) is removed], may still need screening. This depends on whether the cervix was also removed along with the uterus, why the hysterectomy was performed, and whether the woman had a history of moderate or severe cervical cell changes or cervical cancer. This is because even if the cervix was removed at the time of hysterectomy, cervical cells can still be present at the top of the vagina and can develop in to advanced cancer if undetected.
• If a woman has had a history of cervical cancer or cervical cell changes, she will have to continue screening for 20 years after the time of the surgery.

Prevention Through Vaccination

Injections are available in the form of HPV vaccines to prevent cervical cancer. According to world health organisation guidelines, HPV vaccines can be administered to girls from 9-26 years and if needed, even to women till 45 years. The most important condition is that even after vaccination, one should get Pap Smears done regularly.

Let’s all join hands to create awareness about cervical cancer among general population and pledge to prevent and eradicate cervical cancer from the world. Vaccination and screening for cervical cancer for all will make this world free from this disease.

Article by Dr. Karpagambal Sairam, DGO, DNB, MRCOG (LONDON)
Consultant Obstetrician & Gynaecologist and Fertility Specialist
Kauvery Hospital