Termed a ‘silent killer’, cervical cancer is one of the most common forms of cancer among women globally. It is also highly prevalent in India, with one in 53 Indian women estimated to develop this disease, compared to one in 100 women residing in developed nations.
Approximately 1.25 lakh Indian women are diagnosed with the condition annually, primarily affecting women between the age groups of 45-55 years. Nearly 95% of the cases are caused by human papillomavirus (HPV) infections.
While these numbers paint a grim picture, cervical cancer is definably preventable. The situation can be more problematic for people from the lower economic strata, where there are multiple knowledge gaps and ill-equipped infrastructure.
In addition, factors like age, sexual activity, genital hygiene, use of contraceptives, nutrition, tobacco usage, or weak immune system also contribute to rising cervical cancer prevalence. Thus, there is a pressing need to implement community-centric plans focusing on educating women and strengthening the existing healthcare systems to track and prevent cervical cancer burden in rural as well as urban areas.
However, one may not know about the disease until it starts to spread. While HPV vaccines are available today, early screening and detection are important to reduce the cervical cancer burden. Cervical cancer is one form of cancer that can be prevented.
Challenges with detection and treatment
The good news is that cervical cancer can be prevented through early screening tests available in India. Early screening helps in the detection of any pre-cancerous signs which can be easily treated and reversed, thus significantly reducing cervical cancer cases and deaths.
However, despite the significant benefits of screening, only a handful of women reported getting screened, with a majority constricted to urban areas. With most women unaware of the availability of preventive screening, most of the cases are detected after the onset of symptoms. The unavailability of accessible and cost-effective HPV test(s) and vaccines can also hinder widespread adoption.
Eliminating cervical cancer with preventive strategies
As per international guidelines, cervical cancer screening is recommended every five years. Conventionally, cervical cancer screening is done with the help of a PAP smear test or Visual Inspection with the Acetic Acid (VIA) method. It is the most common method to detect cervical cancer.
The Department of Health proposes three smears per lifetime, with a 10-year interval between each smear, commencing at not earlier than age 30 years. There must be a referral system in place, and patients with a normal Pap smear must be informed of their next Pap smear date.
Less invasive liquid-based cervical cytology (LBC) tests are also available and gaining more traction since the accuracy of diagnosis is greatly improved with this technique. The new and emerging screening modality in the form of HPV mRNA testing which detects traces of active HPV infection is a great tool for accurate and early detection of any abnormality before it develops into full-fledged cancer!
Cervical cancer is preventable and treatable
An integrative approach based on awareness based on timely screening and treatment is fundamental in tackling the health burden and social ramifications of cervical cancer. It is essential to establish adequate infrastructural support to ensure accessibility and affordability.
Women who have been screened should be instructed to return to the screening centre to collect the results. Depending on the conditions, the interval between screening and follow-up should be between 1 and 4 weeks.
In addition to enhancing screening and sensitization, there is a need to curtail misinformation and stigma that hinders women from seeking help. While the development of the indigenous vaccine is a laudable effort, enhanced screening and mass immunization for vulnerable populations can pave the way for equitable access to care and save countless lives.
The author is a Senior Consultant in Gynaecology, Max Nanavati Super Specialty Hospital, Mumbai