“Early indicators that women frequently overlook for cervical cancer” by Dr. Sreedharan, Consultant Surgical Oncologist, Manipal Hospitals Goa.
Cervical cancer is the fourth most common cancer in women worldwide affecting more than 6 lakhs women every year resulting in death of nearly 3.4 lakhs women annually (Globocan 2020 data). In India alone over 77000 women dies of cervical cancer annually making it the second most common cancer related death in India. Nearly 1/4th of all cervical cancer related deaths in the world is reported from India. There is a significant time delay in seeking medical help due to a sense of fear, ignorance or feeling of shame leading to most cases being diagnosed at a very advanced stage.
Cervical cancer develops from the lower most portion of the uterus, the part which connects the uterus to the vagina. Over 90% of cervical cancer is caused due to infection by Human papilloma virus (HPV) which is a sexually transmitted viral infection. Most women who are sexually active are affected by this virus. About 20% of these women develop persistent infection. A persistent infection over 5-15 years leads to cancer development. There are over a hundred different types of HPV but only HPV 16 and 18 causes most of the cervical cancer. Vaccination can prevent 99% of cervical cancer. HPV vaccines are typically administered in 2 doses at a 6 months interval between 9-14 years of age. Alternatively, a 3-dose regimen (0,1,6 months) can be administered in age 15-26 years. It is important to note that the vaccine acts by preventing HPV and is not useful in women who already have HPV infection. So, the vaccine should be given before the commencement of sexual activity.
The most common symptom is unusual bleeding from vagina such as after menopause or in between the periods cycle or after sexual intercourse. The other common symptoms include foul smelling discharge which can be mixed with blood and new onset recurrent pelvic pain. Presence of any of these symptoms should alert the person or family members to seek medical help at the earliest. The doctor might ask you to get a PAP smear test or a biopsy test depending on the clinical findings.
Many of the women with cervical cancer can be without symptoms. So, it is important for all women who are sexually active to undergo screening tests. A screening test detects cancer at its very early stage before the development of symptoms. Commonly a pap smear test is done where in a special brush is used to remove some cells from the cervix and send it for testing. It is completely painless and is repeated once in every 3 years. Recently tests to detect DNA of the HPV is developed and they can be done once in 5 years. For women who live in remote villages without healthcare access can undergo visual inspection with acetic acid test (VIA) from a trained auxiliary nurse and midwife (ANM) in the primary health center or the sub-centers for early detection.
On 19th May 2018, the then WHO director-General Dr Tedros Adhanom Ghebreyesus made a global call for action towards the elimination of cervical cancer. He stated “It is no longer acceptable that any woman should die from a disease that is completely preventable and treatable.” A 90-70-90 target was set for 2030 for countries to eliminate cervical cancer, 90% of girls vaccinated against HPV, 70% women undergone screening test and 90% of women identified with cervical disease are treated. To achieve this target, India is currently in the process of making indigenous HPV vaccine “CERVAVAC”, which will make vaccines cheaper and widely available. Cancer when detected early can be completely curable and the treatment much less invasive and cheaper.