Consultancy Corner: Need more awareness on cervical health of women

January is the Cervical Health Awareness Month. In India, Cervical cancer kills nearly 200 women every day but the disease is virtually always preventable with vaccination and appropriate screening (Pap and HPV tests). Each year, an estimated 12,000 women are diagnosed with cervical cancer, and, of those, about one-third will die as a result of the cancer. But cervical cancer is also a highly preventable and treatable cancer, thanks to improved screening and vaccination.

Cervical cancer is a cancer arising from the cervix. Symptoms may include abnormal vaginal bleeding, pelvic pain, or pain during sexual intercourse.

Human papillomavirus (HPV) infection appears to be involved in the development of more than 90 per cent of cases most people who have had HPV infections, however, do not develop cervical cancer. Other risk factors include smoking, a weak immune system,birth control pills, starting sex at a young age, and having many sexual partners, but these are less important. Cervical cancer typically develops from precancerous changes over 10 to 20 years. Diagnosis is typically by cervical screening followed by a biopsy. Medical imaging is then done to determine whether or not the cancer has spread. 

HPV vaccines protect against between two and seven high-risk strains of this family of viruses and may prevent up to 90 per cent of cervical cancers. As a risk of cancer still exists, guidelines recommend continuing regular Pap smears. Cervical cancer screening using the Pap smear or acetic acid can identify precancerous changes which when treated can prevent the development of cancer. 

The early stages of cervical cancer may be completely free of symptoms. Vaginal bleeding, contact bleeding (one most common form being bleeding after sexual intercourse), or (rarely) a vaginal mass may indicate the presence of malignancy.

Infection with some types of HPV is the greatest risk factor for cervical cancer, followed by smoking. HIV infection is also a risk factor. Not all of the causes of cervical cancer are known, however, and several other contributing factors have been implicated. 

Human papillomavirus types 16 and 18 are the cause of 75 per cent of cervical cancer cases globally, while 31 and 45 are the causes of another 10 per cent. 

Women who have many sexual partners (or who have sex with men who have had many other partners) have a greater risk. Of the 150-200 types of HPV known, 15 are classified as high-risk types. Long-term use of oral contraceptives is associated with increased risk of cervical cancer. Women who have used oral contraceptives for 5 to 9 years have about three times the incidence of invasive cancer, and those who used them for 10 years or longer have about four times the risk. 

The Pap smear can be used as a screening test, but is false negative in up to 50 per cent of cases of cervical cancer. Confirmation of the diagnosis of cervical cancer or precancer requires a biopsy of the cervix. 

Two HPV vaccines reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93 per cent and 62 per cent, respectively. They are 92 to 100 per cent effective against HPV 16 and 18 up to at least 8 years. 

Prognosis depends on the stage of the cancer. In India, the number of people with cervical cancer is rising, but overall the age-adjusted rates are decreasing.