Cervical cancer is cancer of the cervix; the lower part of the uterus. It is one of the leading causes of mortality and morbidity among women in India, whereby approximately 1.32 lakh new cases are diagnosed and 74 thousand deaths occur annually – this accounts for nearly one-third of cervical cancer deaths across the world. Unlike many cancers, cervical cancer occurs early and strikes during the productive years of a woman’s life. Cervical cancer is attributable to persistent infection by certain strains of the Human Papilloma Virus (HPV), which is transmitted from person to person through sexual contact. Prevention Today approximately 400 million women in India are at risk for developing cervical cancer, however with a multidisciplinary preventive approach, including education, social mobilisation, vaccination, screening and treatment, it is largely preventable. Prevention for cervical cancer can be largely carried out in two phases; primary prevention (avoiding exposure to risk factors and vaccination) and secondary prevention (detecting pre-cancerous lesions through screening and taking appropriate treatment). Risk Factors Primary prevention is the most cost effective prevention method, it aims to reduce the incidence of cancer by risk factor modification. There are numerous risk factors associated with cervical cancer;
The cervix is a lot more susceptible to HPV during adolescent years. Since HPV is only first contracted through sexual activity, age of first sexual encounter is an important determinant for cervical cancer.
Having multiple partners increases the probability of contracting HPV.
Women with 3 or 4 full-term pregnancies have a 2.6 times higher risk of developing cervical cancer.
Those who use contraceptives for 5-9 years, have approximately three times the incidence of invasive cancer, caused by hormonal imbalances.
Smoking is an important environmental cofactor that influences the risk of cervical cancer, it is strongly associated with the development of pre-cancerous cervical lesions.
Obesity is associated with both an increased risk of developing cancer and of mortality.
An improvement in living standards has resulted in a reduction of cervical cancer incidence. More over low immunity associated with such a lifestyle is also responsible for exacerbating the spread of the disease once contracted. Cervical Cancer Vaccine Vaccination forms a vital part of cervical cancer prevention. There are two vaccines now available for primary prevention, which protect against the four HPV strains that are responsible for 70% of cervical cancers. The vaccines are licensed by the Food and Drug Administration for use in girls/women aged 9-26 years. The vaccine has been shown to confer nearly 100% protection against cervical cancer in girls who have not yet been exposed to HPV. Therefore the earlier the vaccine is given, the better the protection it provides. While the most appropriate age depends on the age at which individuals first get exposed to HPV, the ideal target population as determined by the Centre of Disease Control and Prevention, is 9-13 years, as at such a young age the recipients would mount a better immune response. However, vaccination for sexually active women of any age is recommended regardless, as it will still protect them against other strains of HPV and re-infection. Cervical Screening – Pap Smear At its early stages, cervical cancer is largely asymptomatic, making it imperative to undergo regular screening and achieve an early diagnosis. Vaccinations alone don’t protect against all HPV strains, and therefore don’t account for as many as 30% of cervical cancers. Pap Smear screening programs have been found to have successfully reduced incidence of mortality and morbidity. Annual screening is recommended for all women above the age of 30 years, or women who have been sexually active for three years. Vaccination, regular screening, in conjunction with avoiding risk behaviours, maintaining cervical hygiene and sexual behaviour counselling can together constitute the paradigm for primary prevention of cervical cancer. Warning sings