Cervical Cancer: Now Preventable?

                                   

Despite Cervical Cancer being highly preventable and treatable, it  is still ranked as the second most common cancer in India and patients continue to die from this. Each year, more than one lakh women are diagnosed with cervical cancer and half of them do not survive.

In May 2018, the World Health Organization (WHO) issued a call for elimination of cervical cancer by 2030 through widespread HPV vaccination, screening (early diagnosis and treatment of cervical pre-cancer and cancer).

 What is cervical cancer and How is it caused?

The cervix is at the lower end of the uterus and above the vagina. The cancer of this part is called Cervical cancer. Cervical cancer is caused by sexually transmitted high risk “Human Papilloma Virus” (HPV).

What are the risk factors for infection with High risk HPV ?

Since this virus is sexually transmitted,  the risk factors include having multiple sexual partners and having non monogamous male partners.

 

Do all females infected with high risk HPV develop cervical cancer ?

No, most of the time HPV infections will resolve on its own. However, in some patients, the virus is not cleared and remains in the cervix. This persistent infection, when coupled with other risk factors, may lead to cervical precancerous lesions and cancer. In simple words, HPV infection of the cervix is necessary to cause cancer, however the good news is that only a fraction of women, with the below mentioned risk, may progress to have cancer.

 

What are the risk factors for developing cervical cancer ?

Persistent HPV infection is the first requisite.  Other risk factors include  poor genital hygiene, early marriage, repeated pregnancies, smoking, weak immunity and genital herpes.

 

What are the preventive strategies currently available to avoid cervical cancer ?

 

Currently, two preventive approaches are available.

 

I.     Primary Prevention through Vaccination

II.    Secondary prevention: Detect and treat cervical precancerous lesions

 

I.              How does  vaccination Help?

 

Vaccination prevents HPV infection. No HPV infection means no cervical cancer. The vaccination was introduced in 2008.  Studies have shown that this vaccine is safe and effective in preventing cervical cancer.

 

What are the vaccines available in India? What age and how many doses of vaccination need to be administered ? 

 

There are two vaccines available in India. Gardasil and Cervarix.

Our indigenous vaccine CervaVac from Serum Institute of India will be also available soon.

 

Gardasil Vaccine:

Ideal age: 9 to 14 years of boys and girls,  two doses 6 months apart

 

Cervarix Vaccine:

Ideal age: 9 to 25 years, both genders, three doses (0,1,6 months)

 

Note: The reasons for vaccinating boys

1. HPV can also cause other cancers like anal and oral cancers,

2. Males can transmit the infection.

 

Other Age Groups up to 45 years can be vaccinated too. However less likely affective if they were already sexually active. However, it is still can be considered, after detailed discussion with your doctor.

 

 

 

II.             How does screening help?

 

Screening helps in detecting cervical precancerous lesions and cancers at early stages which can then be treated. There are three types of methods available for screening of cervical cancer:

 

1. Visual inspection with acetic acid

2. Cytology (Pap smear)

3. HPV DNA typing.

 

Though HPV DNA testing is the preferred method, depending on resources available, the doctor will suggest what is the best for an individual.

 

How frequently should screening be done ?

Once a woman is infected with HPV, it usually takes 10 to 20 years to develop the cancer. Hence, it is recommended to screen woman from age 30 to 60 years (Every 5 to 10 years) in the general population.  Women with HIV infection and other high risk woman need to talk to their doctor regarding screening recommendations intended for them.

 

Do vaccinated women still need to undergo screening?

Yes, the current guidelines recommend screening even for those who have received the HPV vaccine. However, as rates of HPV vaccination increase, we may see changes in screening recommendations down the road.

 

Take home message

• All girls and boys between age 9 to 14 years should be vaccinated
• People between age 15 to 45 years people can consider vaccination 
• All woman between 30 to 60 years of age need to be screened for HPV infection and precancerous lesions

 

Contact: 

Dr Jayanthi Undamatla

9502709941

 

Disclaimer: The information provided here, is for educational purposes only, does not substitute for professional advice.