Cervical Cancer: Screening and vaccination

With regular screening, it's possible to prevent cervical cancer that is notorious for claiming the life of one woman every seven minutes

women happy togetherWhat makes cervical cancer the most dreaded cancer in women is that it strikes them in their prime and often there are no visible symptoms until it’s too late. It’s the only cancer with a known cause and that can be prevented. Ironically, many women are not even aware what the cervix is and what causes this cancer.

How the cancer grows

Cervix is the lower most part of the uterus or the mouth of the uterus that dips into the vagina. In a normal state, the cervix constantly changes in response to fluctuating hormonal levels.

The tissues in our body have a predetermined growth. Exposure to carcinogenic [cancer causing] factors can trigger abnormal growth in tissue cells. As a result, these cells do not perform their functions optimally, grow in an unruly fashion and spread beyond their requisite boundaries.

The Human Papilloma Virus [HPV] is responsible for causing cervical cancer. Usually, an infection of this virus clears on its own. However, if it persists, it can cause cervical cancer. HPV may also cause genital warts, cancers of the vulva and vagina. Genital warts are lump-like growths in the genital region. As the disease progresses, one may notice abnormal vaginal bleeding, bleeding between periods, or after sexual contact and increased white discharge that may be foul smelling.

Who is at risk?

Did you know?

In India, 74,000 women die every year due to cervical cancer.

All sexually active women, across all segments of society are at risk. However, there are certain preventable factors that add to the risk.

  • Early sexual exposure, either through premarital sex [which is often clandestine, and therefore, without any protection] or because of an early marriage. This exposes the girl to loads of infections. The risk is higher in such cases, because at this age the body is not always mature or healthy to fight infections.
  • Anaemia adversely affects immunity. In case of Indian women, this can be an important influencing factor as nearly 70 per cent – 80 per cent women in India have haemoglobin levels below 11g/dl.
  • Frequent termination of pregnancy, especially using over-the-counter medications and emergency contraceptives. This adds to the risk because even though the pregnancy is terminated, the hormonal changes in the cervical tissues increase the susceptibility to infections.
  • Repeated pregnancies and sexually-transmitted infections.
  • Smoking increases a woman’s risk of developing precancerous and cancerous conditions.
  • Lack of proper personal hygiene, poor nutrition and absence of contraception make a woman susceptible to infections.

All the above situations act as an ideal milieu for the HPV virus to thrive.

How to prevent the cancer

All it takes to prevent this cancer is regular screening and vaccination.

Screening

Women should regularly screen themselves with Pap smear, which involves testing naturally shed cervical cells on a slide and staining them. The test is reliable and helps detect the disease in its precancerous stage, when the treatment is simple and may not require surgery.

Ideally, women should start screening by Pap smear within three years of becoming sexually active and continue every three years till the age of 65 years. Women who find this option cumbersome should at least test themselves once at 35 years of age or after that [recommends the World Health Organization].

Two other simple tests that give instant results are the VIA [Acetic acid] or VILI [Lugol’s iodine].

In these tests, the cervix is smeared with diluted acetic acid or Lugol’s iodine and examined for a precancerous condition. These are done by gynaecologists or trained health workers and are comparable alternatives to the Pap test. In case the tests results are positive and the doctor suspects a precancerous lesion, the woman is subjected to colposcopic examination. A colposcope is a device that enables examining the cervix through a magnified lens. The affected tissue is then either excised for biopsy or cauterised.

The HPV DNA test is the current gold-standard in cervical cancer screening and can detect the presence of high-risk HPV types covering more than 95 per cent of the cervical cancer cases. It is USFDA approved and has more than 300 publications to support its strength and utility. It involves collecting the specimen from the cervix with a small brush-like tool, which is then used to detect the HPV DNA. The collection procedure takes less than five minutes.

If the test results are negative, there is a negligible risk of cancer with an amazing 99.7 per cent certainty and can reduce the screening interval to once in 3 – 5 years. If the test results are positive, there is an increased risk of progression due to the presence of high-risk HPV. An immediate follow-up is essential to treat the disease before it becomes cancerous. A repeat test may be advised in 12 months.

HPV DNA is recommended for women who are 30 years of age or older. It is done for primary screening and also in case of abnormal/inconclusive Pap smear results or cervical disease to determine the follow-up procedures. The test beats the disadvantages posed by other currently available tests in the market.

Vaccination

Two types of vaccines, are available in the Indian market for cervical cancer [Ask your doctor for details]. Vaccination is given in three doses over a period of six months [offers lifelong immunity]. For the best protection, it is important to get all the three doses of the vaccination as per schedule. Vaccination also protects the women against HPV infections from different strains of the virus that might cause cervical cancer in the future. However, regular screening should be continued after vaccination to offer best possible protection against the cancer.

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Girija Wagh
Girija Wagh, MD, FICOG, diploma [Endoscopy], is a practising gynaecologist for the past 17 years in Pune. She is also the Joint Secretary of FOGSI 2010 and a professor at Bharati Vidyapeeth University Hospital in Pune. Her other interests include playing basket ball, sitar and katthak.

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