Cervical cancer: Know causative factors to prevent it early

Cancer is one of the leading causes of death the world over and Cervical Cancer is the leading cause of cancer among women. January is observed as the month to create awareness about this cancer.

Cancer is the abnormal proliferation of cells causing a growth at the primary site and can spread through different routes to several parts of the body like liver, lymph nodes and bones.

In India, as many as 200 people die due to Cervical Cancer each day. Hence it is a health issue of gargantuan proportions. To put it into relative figures, India accounts for 27% of the global number of cases and accounts for the same percentage of global deaths due to Cervical Cancer.

What makes this even more poignant and ironic is the fact that this is one type of cancer that can be prevented as well as diagnosed early to accord optimal treatment. Both these being life-changing solutions, it is imperative that we are aware of the prevention as well as early treatment of this disease. It is also the most common cancer that kills women as compared to all the other cancers that can occur in the body.

If we must prevent this cancer early, we have to prevent the causative factors. It has now been proven that infection by HPV ( Human Papilloma Virus ) accounts for as much as 99% of cervical cancer. Besides Cancer cervix (also referred to as HPV virus) can cause vulval and vaginal cancer. It is also implicated in several other cancers such as of the mouth, penis, anus, respiratory system, etc.

It takes about 5 to 10 years for the infection to develop into cancer and this is important in the screening process. The natural history is that infection causes benign cervical lesions which may progress to cancer.

However, it is pertinent to note that several other factors are also implicated in the development of cervical cancer , namely, early initiation of sexual activity, high parity, long term use of hormonal contraception, tobacco use, both passive and active, immune suppression, HIV infection, multiple sexual partners and contracting sexually transmitted diseases.

Symptoms such as continuous vaginal discharge, foul smelling discharge, repeated vaginitis, post-coital bleeding (bleeding after sex), and irregular bleeding especially in the premenopausal age group should alert us to visit a doctor.

Cervical cancer is now potentially preventable because of vaccination and screening strategies developed to detect cancer early and institute early treatment.

The HPV vaccine acts as a primary preventive measure by preventing the development of cervical cancer. The long natural history allows us to screen the patients infected with the HPV virus and in early detection of cancer and thereby acts as a secondary prevention program.

Screening consists of visual examination of the cervix even by paramedical personnel (in low-resource settings) and taking a PAP smear which allows a pathologist to examine the cells for evidence of premalignant or malignant lesions. The more accurate method is a process called Liquid-based cytology (LBC ) and co-testing for HPV virus.

The recommended age for testing is from 21 years or whenever the girl is sexually active. It is recommended to test with cytology once in 3 years till the age of 30 years. Thereafter, the recommendation is do cytology once in 3 years and to co-test for HPV once in 5 years. This screening is recommended till 65 years. Screening is not recommended after 65 years. If a hysterectomy has been done for a benign reason, no further screening is recommended. However, if it has been done for a malignant or premalignant reason, it is recommended to continue testing. HPV-vaccinated women are also recommended for continued screening.

Let us pledge to make Cancer cervix a preventable disease and save women from this scourge.

(Dr. (Brig) Aruna Menon is HOD & Senior Consultant, Centre For Obstetrics and Gynaecology, Meitra Hospital, Kozhikode.)