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Cervical cancer or cancer of the cervix (The Lower part of the Uterus) is India's second most common cancer. With nearly 1.2 lac patients per year being diagnosed with this dreaded disease, most patients are diagnosed in advanced stages, and that accounts for high mortality. It is a highly preventable disease and it is now time for India to leapfrog toward eliminating this disease.
Understanding The Causative Agent:
Nearly 99.7 % of cervical cancers are caused by Human Papilloma Virus (HPV). HPV is the most common sexually transmitted infection. There are nearly about 140 types of HPV strains. According to WHO, HPV 16 and 18 cause around 70% of cervical cancer cases, and in India they account for nearly 80% of the cases. These viruses cause precancerous changes and eventually these changes transform into cancer. It takes 15 to 20 years for cervical cancer to develop from precancerous lesions in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Ways To Prevent Cervical Cancer:
1. PRIMARY PREVENTION STRATEGY- Nipping It In The Bud
Top Oncologists of cervical cancer treatment in Delhi releases its latest guidelines on precaution and treatment procedures. The HPV vaccination promotes the production of antibodies in the body. If there is an encounter with HPV in the future, these antibodies will prevent the virus from attacking the cells and causing cancer. Here are some of the important aspects to remember:
The Currently Available Vaccines In India:
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Three Types Of Vaccines Are available For Cervical Cancer
Cervarix, Gardasil and the latest Gardasil 9. Serum Institute of India is already making its own vaccine Cervavac and has got approval from govt. to roll it out by this year and is expected to be a game changer in view of its projected to cost of nearly 5 $ only.
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The Doses Recommended
Two doses spaced at 6 months are enough in the 9-14 years age group (THIS IS THE BEST AGE GROUP FOR VACCINATION TO BE MOST EFFECTIVE) whereas a three-dose regimen (0, 1-2, 6 months) are recommended in the age group 15-26 years.
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Catch-up Vaccination
For married women with no previous immunisation against HPV, they would have to go for an examination and a PAP smear for initial screening which would decide whether the vaccination will be of any help or not. HPV vaccination cannot be taken during pregnancy, and if pregnancy is to be planned then it is important to keep in mind that it would take 6 months to complete the vaccination schedule. To this effect, post-partum offers the best opportunity to doctors for HPV vaccination for women. It is safe to take it during lactation.
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PAP Testing/ HPV DNA Test Would Still Be Important
These vaccines can only work to prevent HPV infection. They cannot treat an HPV infection on the cervix which is already present. That is why cervical cancer vaccines should be given before a woman is exposed to HPV or before the onset of sexual activity. It is also important to know that no vaccine can provide complete protection against all cancer-causing HPV viruses. So even after vaccination, routine PAP Tests or HPV DNA testing would still be important.
2. SECONDARY PREVENTION (Catching Those Early Changes)
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For a very long time, visual inspection aided with acetic acid (VIA) and PAP smear testing (taking a cellular smear from the cervix on the slide and studying the same under a microscope) have been cornerstones in catching cervical cancer early. Generally, it is recommended to repeat Pap testing every three years for women ages 21 to 65.
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Women aged 30 and older can consider Pap testing every five years if the procedure is combined with testing for HPV.
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The Newer And Bolder Recommendations By Who For Preventing Cervical Cancer
WHO now recommends an HPV DNA-based test as the preferred method, rather than a visual inspection with acetic acid (VIA) or cytology (commonly known as a ‘Pap smear’), currently the most commonly used method globally to detect pre-cancer lesions. HPV-DNA testing detects high-risk strains of HPV which cause almost all cervical cancers. Unlike tests that rely on visual inspection, HPV-DNA testing is going to leave no space for ambiguity in results. This HPV DNA-based testing has been widely tried in India as well under a study by TMH Mumbai and has been found to be a convenient way of testing with acceptance of nearly above 97 % in ladies living in urban slums of Mumbai and in Mysuru. The next feather in the cap is the indigenously developed testing kit which is going to be rolled out soon by the name of Cervichek by Vadodara-based start-up Pragmatech Healthcare this year.
Elimination Of The Problem:
The definition of elimination of cervical cancer has been set up as a country reaching the threshold of fewer than 4 cases of cervical cancer per 100 000 women per year. To reach this threshold by the end of the 21st century, WHO has set up 90-70-90 targets to be reached by 2030 and to be maintained.
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90% of girls fully vaccinated with the HPV vaccine by age 15.
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70% of women are screened with a high-performance test like HPV DNA by 35, and again by 45 years of age.
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90% of women identd with the cervical disease receive treatment (90% of women with treatment treated; 90% of women with invasive cancer managed).
Since the above two ways (Vaccination and Self-assessment kit) of prevention of cervical cancer are emanating from the “Make in India” strategy, it is expected that the availability and accessibility would be there for a large group of the population which was actually vulnerable to this disease.
Now is the time to create awareness about cervical health so that this disease could be the next one to be eradicated from the globe. Hence January should not only be about cervical cancer awareness month but about cervical health awareness. We at Manipal Hospitals always use these occasions to spread awareness about the disease. Connect with our best oncologists in Delhi who can guide you about all the aspects related to it from diagnosis, and treatment to post-treatment care. We also invite you to bookmark our blog page to read accurate content on various topics related to health by highly qualified and experienced doctors.
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