World Cancer Day: Expert advice on cervical cancer and its preventive strategies

Bengaluru: Cervical cancer is the fourth most common cancer in women worldwide; with India contributing to one-fourth of the global cases. India sees about 1,22,844 cases of cervical cancer every year and accounts for one-third of the global cancer deaths.

These figures are alarming because unlike most other cancers, we have effective screening methods to detect women who are likely to develop cancer in the future and detect cancer at its early stage. This apart, we do have vaccinations against the Human Papilloma Virus which has been clearly identified as the causative agent in more than 99% of cervical cancers.

Inaccessibility of the screening modalities in the rural areas, the cost of the HPV vaccine and a lack of knowledge amongst the general population result in India continuing to see a high number of new cases of cervical cancer till date.

Despite effective screening strategies, only 7% of the general population get their Pap smears regularly and a far few are aware of a preventive vaccine!

Regular screening with Pap smear and HPV DNA for high-risk strains and universal vaccination of young girls have resulted in a drastic reduction in the cases of cervical cancer in the West. With better implementation of screening programs in the rural areas, availability of HPV vaccines to all young girls and regular education of women on the importance of regular screening and vaccination, India is sure to see a drastic reduction in the burden of cervical cancer cases.

How is cervical cancer different from the rest of the cancers?

Unlike most other cancers, we know what causes cervical cancer and that has been a major breakthrough. Human papilloma virus causes most of the cancers and it takes 15-20 years from contracting the infection to developing cancer.

This gives us a large window to identify women at high risk for developing cancer who can be subjected to a close surveillance. The HPV vaccine available in India protects against HPV 16 and 18, the two strains that are responsible for 70% of cervical cancers. In addition, it does confer some cross immunity with the other high-risk types. If given to all girls prior to the onset of sexual activity, it can result in a drastic reduction of the number of cervical cancers in the years to come.

Human Papilloma virus (HPV):

HPV is the most common viral infection of the reproductive tract. Most sexually active women contract the infection at some point in their lives with or without symptoms.

There are more than 100 types of HPV, of which about 14 strains are the high-risk types responsible for cancer. Most infections in women clear without any intervention within 2 years. However, in a few, the high-risk strains of the virus persist in the body beyond 2 years, get integrated with the cells and progress to cervical cancer. Regular screening is the key for early detection of cervical cancer!

Cervical cancer screening:

Pap Smear - What is a Pap smear?

A Pap test looks for changes in the cells of the cervix that might become cancer if not appropriately treated.

How is it done?

It’s done as an outpatient procedure in the doctor’s clinic, where a metal or plastic instrument is inserted to widen the vagina and visualise the mouth of the uterus (cervix). A few cells are taken from the cervix for microscopic examination.

Is it painful?

Although one may feel a slight discomfort similar to that felt during a vaginal examination, a Pap test is not a painful procedure.

Who should be doing a Pap smear?

All women between 21-65 years should get regular Pap smears done every 3 years. If a woman is screened with HPV DNA along with a Pap smear after 25 years (preferred over Pap test alone); the screening interval can be increased to 5 years.

When can one stop screening for cervical cancer?

1.       After 65 years if the previous 3 reports have been normal

2.       After a hysterectomy (removal of the uterus) for a non-cancerous condition.

Should one continue to screen after taking the HPV vaccine?

Yes! As the vaccine is not 100% protective against cervical cancer and doesn’t cover all high-risk strains of the virus, it is important to continue screening even after being vaccinated.

Prevention of cervical cancer

1.HPV vaccine - Ideal age for vaccination: 9-14 years before the onset of sexual activity

 Dosage: 2 doses 6 months apart

 After 15-45 years: 3 doses recommended.

2. Safe sexual practices, use of condoms, limiting the number of sexual partners reduce the risk of one having an HPV infection and thus cancer.

If there is a cancer that can be eradicated in the future, it’s cervical cancer. So, let’s work towards universal vaccination and regular screening to make this a reality.

(Author – Dr Geeth Monnappa is a consultant obstetrician and gynaecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)