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ARE YOU ARMED AGAINST CERVICAL CANCER ?

Cervical cancer is the primary cause of cancer-related deaths in developing countries


In India, cervical cancer is the most common woman-related cancer, followed by breast cancer. About 122,844
new cervical cancer cases are diagnosed annually (estimations for 2012). It mostly affects middle-aged women
(between 40 and 55 years), especially those from the lower economic status who fail to carry out regular health
check-ups. The early stages of cervical cancer are asymptomatic, later stages may present with abnormal
vaginal bleeding, foul-smelling vaginal discharge, low back pain, bleeding and pain during urination or pain during
sex . Human papillomavirus (HPV) infection is now a well-established cause of cervical cancer. Several cofactors
associated with HPV persistence are smoking, promiscuity, long-term oral contraceptive use and other sexually
transmitted infections like HIV. At least 50% of sexually active men and women get HPV at some point in their
lives which usually resolves spontaneously; however, only 3-10% of women develop persistent infections, and
are at high risk of developing cervical cancer.
Tools for prevention:
Lifestyle Changes

Avoid multiple sexual partners, delaying first sexual intercourse, reducing tobacco use.
Since early detection predicts better prognosis, one of the most effective ways of preventing and controlling
cervical cancer is regular screening by Pap Smear, VIA and early diagnosis.
Screening

Screening by cervical cytology Pap smear (scrapings from the cervix) has lead to marked reduction in cervical
cancer incidence. The test is not considered for women below the age of 25 years and over the age of 65 years.
A 3-yearly examination is recommended for women between the ages of 25 -49 years while for the age group
between 50-64 years a Pap smear once in every 5 years is recommended. The problem with pap smear
screening is its low compliance among Indian women.
HPV Vaccines
Prevention by vaccination is emerging as the most effective option. Among the several strains of HPV infection
two strains: HPV 16 and 18, account for more than 70% of all cancer cases worldwide. HPV vaccines that
prevent against HPV 16 and 18 infection are now available and have the potential to reduce the incidence of
cervical and other anogenital cancers.
The currently available vaccines are safe and efficacious. The protection is seen only when the vaccine is given
before infection with HPV, the vaccine should be given prior to sexual debut. The vaccine should preferably be
introduced to parents as a cervical cancer preventing vaccine and not as a vaccine against a sexually transmitted
infection. The HPV vaccination is therefore of public health importance.
Two vaccines licensed globally are available in India; a quadrivalent vaccine (GardasilTM marketed by Merck)
and a bivalent vaccine (CervarixTM marketed by GlaxoSmithKline). These vaccines do not protect against the
serotype with which infection has already occurred before vaccination. The bivalent and quadrivalent vaccines
available are prophylactic, not therapeutic.
Prevention is better than cure. This saying does not seem to hold good for Indians as far as health care is
concerned with only around 10 per cent of adults opting for vaccines
Treatment of established cervical cancer
Cancer in very early stages may be removed surgically. In later stages, radiation and chemotherapy maybe
employed alone or after surgery

Author:
DR APRAJITA SINGH, MD,DNB,MNAMS
OBSTETRICS & GYNAECOLOGY
Consultant, Director & Founder
Aaditri Multispeciality Clinic

R-274, Greater Kailash Part-1, New Delhi 110048 (INDIA)


aaditriclinic@gmail.com +91-11-65658647

Attending Consultant
Indraprastha Apollo Hospitals, New Delhi