Scourge of Women
Scourge of Women
Cervical cancer is the second most common cancer in women after breast cancer. There are no early symptoms for cervical cancer, yet regular screening can help!
By Team Double Helical
| Cervical cancer is a type of cancer that develops in a woman’s cervix. Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause. |
The cervix is the lower, narrow end of the uterus (the organ where a foetus grows). The cervix leads from the uterus to the vagina (birth canal). The main types of cervical cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in the thin, flat cells that line the cervix. Adenocarcinoma begins in cervical cells that make mucus and other fluids.
Abnormal bleeding doesn’t mean that you definitely have cervical cancer, but it should be investigated by doctors as soon as possible. If your doctor thinks you might have cervical cancer, you should be referred to see a specialist within two weeks.
Dr Suman Yadav, Senior Gynaecologist and Obstetrician, Pushpanjali Hospital, Gurgaon, elaborates, “Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these precancerous cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage and treatment can reduce the risk of cervical cancer developing.”
Many cancer hospitals offer a cervical screening programme to all women from the age of 25. During cervical screening (previously known as a “smear test”), a small sample of cells is taken from the cervix and checked under a microscope for abnormalities.
An abnormal cervical screening test doesn’t mean you definitely have cancer. Most abnormal results are caused by an infection or the presence of treatable precancerous cells, rather than cancer itself.
Women aged 25 to 49 years of age are offered screening every three years, and women aged 50 to 64 are offered screening every five years. For women who are 65 or older, only those who haven’t been screened since they were 50, or those who have had recent abnormal tests, are offered screening.
What causes cervical cancer?
Dr Nirupma Singh, Senior Gynaecologist and Obstetrician, Mother and Child Clinic, Vaishali, observes, “Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman. There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer.”
Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection don’t have any symptoms, so many women won’t realise they have the infection. However, it’s important to be aware that these infections are relatively common and most women who have them don’t develop cervical cancer.
Using condoms during sex offers some protection against HPV, but it can’t always prevent infection, because the virus also spreads through skin-to-skin contact of the wider genital area. Since 2008, a HPV vaccine has been routinely offered to girls aged 12 and 13.
Treating cervical cancer
If cervical cancer is diagnosed at an early stage, it’s usually possible to treat it using surgery. In some cases, it’s possible to leave the womb in place, but in others it may need to be removed. The surgical procedure used to remove the womb is called hysterectomy.
Radiotherapy is an alternative to surgery for some women with early stage cervical cancer. In some cases, it’s used alongside surgery. More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy. Some of the treatments used can have significant and long-lasting side effects, including early menopause and infertility.
Complications
Many women with cervical cancer will have complications. These can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, chemotherapy and surgery. Complications associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina or having to urinate frequently, to life-threatening, such as severe bleeding or kidney failure.
Dr Suman Yadav said, “The stage at which cervical cancer is diagnosed is an important factor in determining a woman’s outlook. The staging, given as a number from one to four, indicates how far the cancer has spread. The chances of living for at least five years after being diagnosed with cervical cancer are – stage 1 – 80-99%, stage 2 – 60-90%, stage 3 – 30-50% and stage 4 – 20%.”
It’s possible for women of all ages to develop cervical cancer, but the condition mainly affects sexually active women aged between 30 and 45. Cervical cancer is very rare in women under 25.
Abnormal vaginal bleeding like bleeding after sex (vaginal intercourse), bleeding after menopause, bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual, bleeding after douching or after a pelvic exam are among the common symptoms of cervical cancer.
No early symptoms
Says Dr Nirupma Singh, “Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until a pre-cancer becomes a true invasive cancer and grows into nearby tissue leading to experience of pain during sex (vaginal intercourse). You must then consult your doctor.”
These symptoms can also be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. Still, if you have any of these problems, you should see your health care professional right away − even if you have been getting regular Pap tests. If it is an infection, it will need to be treated. If it’s cancer, ignoring symptoms might allow it to progress to a more advanced stage and lower your chance for effective treatment.
Long-lasting infections with certain types of HPV cause almost all cases of cervical cancer. Vaccines that protect against infection with these types of HPV can greatly reduce the risk of cervical cancer. Having a Pap test to check for abnormal cells in the cervix or a test to check for HPV can find cells that may become cervical cancer. These cells can be treated before cancer forms.
According to Dr Akanksha Rathi and Dr GS Meena, Department of Community Medicine, Maulana Azad Medical College, New Delhi, if we look at statistics, cervical cancer is the second most common cancer in females after breast cancer. Out of all those who develop cervical cancer, more than half of the women die within 5 years.
The disease toll is around 70,000 deaths each year. The disease causes not just deaths but lot of suffering, loss of working hours and big expenses on its treatment. The financial burden that this disease poses over Indian economy is more than any other chronic disease with the exception of cardiovascular disease. Due to high number of cervical cancer cases in the population, it has the highest total cost of secondary care (100,000 INR per 100,000 population) relative to all other cancers.
India shares one-fifth of the cervical cancer burden of the world. The reason for such a high incidence of this disease is that the various risk factors for the disease are prevalent in our country like early marriage, early child bearing, poor genital hygiene, multiple sexual partners, high parity, smoking, low socio-economic status, infection with Chlamydia trachomatis, micronutrient deficiency and use of long term birth control pills. The most important causative organism is HPV.
Vaccines against HPV
The recognition of the importance of HPV in etiology of cervical cancer has led to the development of vaccines against HPV. Two different vaccines that have been developed to prevent infection from HPV 16 and 18 and one of these offers added protection against HPV 6 and 11 (which cause genital warts). The quadrivalent and bivalent vaccines have been licensed for use in over 100 countries. Studies have shown these vaccine to be highly effective (90-100%).
The World Health Organization (WHO) has stated that these vaccines have excellent safety profile. Both vaccines need to be administered with 3 doses over a 6-month period, can be given to females aged 9-26 years (catch-up vaccination up to 45 years), and are most effective if given before the female’s first sexual encounter. Since the vaccines should preferably be given in adolescence or pre-adolescence phase thus more than 50 countries have introduced this vaccine in national immunization programme for girls. Australia, the first country to introduce the vaccine, now has the lowest cervical cancer incidence in the world.
Despite the high incidence of cervical cancer and effectiveness of the vaccine against it, there is little awareness about the disease, its screening and its vaccine. Lately, the advisory bodies in India like Indian Academy of Pediatrics (IAP) and Federation of Obstetric and Gynecological Societies of India (FOGSI) recommended HPV vaccines to females 9 to 45 years of age for prevention of cervical cancer. However, few young girls have access to the vaccine.
The vaccine is costly and primarily available with the private sector. It is presumed that the cost of the vaccine along with the operational costs will be humongous ($120 per dose). The Indian Government is still struggling to improve the immunization status of under-5 children and vaccination of adolescent girls is nowhere on its priority list.
The awareness about the vaccine even among high socio-economic groups is quite low. A survey in Eastern India among educated urban men and women, with at least one girl child and belonging to middle or high socio-economic group, revealed that 72% had never heard of HPV. Only 46% of parents were in favor of vaccinating their daughters against an STI; however, after going through a brief information sheet about the HPV vaccine, 80% agreed to vaccination. The most common reason for not accepting the vaccine was uncertainty about the safety of a new vaccine.
The main reason for the high mortality from cervical cancer in India is late detection of this disease. Government and private health care providers can join in this effort and offer these services. It is extremely important for sexually active women over 30 years of age to get screened every 3-5 years. The age of developing this disease is decreasing and now it is recommended that the screening should start at 25 years of age. Screening approaches in India can reduce the lifetime risk of cancer by approximately 25-36%. Thus, screening is imperative if we want to bring down the mortality rates of this disease.
“Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman. There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer”
Dr Nirupma Singh, Senior Gynaecologist and Obstetrician, Mother and Child Clinic, Vaishali
“Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these precancerous cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage and treatment can reduce the risk of cervical cancer developing”
Dr Suman Yadav, Senior Gynaecologist and Obstetrician, Pushpanjali Hospital, Gurgaon
India shares one-fifth of the cervical cancer burden of the world. The reason for such a high incidence of this disease is that the various risk factors for the disease are prevalent in our country like early marriage, early child bearing, poor genital hygiene, multiple sexual partners, high parity, smoking, low socio-economic status, infection with Chlamydia trachomatis, micronutrient deficiency and use of long term birth control pills