Women don’t need to die of cervical cancer because the disease develops slowly, after initial infection with the human papillomavirus. Unlike most other types of cancers, it is preventable when precursor lesions are detected and treated.
But millions of women around the world are never screened for cervical cancer—whether because of the long journey to the nearest clinic, local myths and fears about cervical screening, or poor health services. The result is that a half-million new cases of cervical cancer are diagnosed each year, with a quarter-million women dying from the disease.
Incidence and mortality of cervical cancer vary according to age, reaching a peak in women aged around 40 years.
The age distribution of cervical cancer is pyramidal with a higher percentage of younger women being diagnosed with pre-cancer symptoms and invasive disease. These women remain undetected for many years because of lack of opportunistic screening of hospital-visiting women for cervical pre-cancer abnormalities, and thus become major contributors for higher rate of women mortality and morbidity when presented to the clinicians with the early—to advanced stages of invasive carcinomas. Not only the cost of treating such patients by radical surgeries or chemo-radiotherapies is enormous but also the success rate is very poor. These patients keep adding to the new cases every year posing a continuous challenge to healthcare professionals and the government GDP annually.
Risk Factors: There are a number of risk factors attributed to cervical cancer. These are early age at marriage or early onset of sexual activity, multiple pregnancies, pregnancies in quick succession, more than one sexual partner, long-term use of oral contraceptives, malnutrition, unhygienic genital health, individual's immune status, and smoking or even genetic predisposition. But infection due to high risk human papillomavirus (HPV) types constitute a single most critical virologic risk factor in comparison to other socio-economic, demographic or behavioral risk factors in triggering the oncogenesis. More than one cancer causing types of HPV have been found in over 99 percent of cases of cervical cancers all across the world.
Women are generally infected with HPV in their early teens, twenties or thirties when they first become sexually active. HPV is the most common STD, occurring at some point, in up to 75 percent of sexually active women. In many women, the interval from becoming infected with the HPV and developing cancer can be from five years to as long as 20 years.
Like most cancers, cervical cancer is largely asymptomatic disease till the time it becomes invasive. Also the high-risk HPV infection is non-inflammatory in nature, hence the precursor lesions often confuse pap results. However, the observed clinical symptoms manifested are, pain in the pelvic region (more often due to chlamydial infection than HPV), persistence vaginal discharge, which may be watery, pale or dark colored, sometimes foul smelling. There could be abnormal bleeding, between menstrual cycles, during or after the intercourse. Often, co-infectivity due to herpes or HIV has also been observed to be adding to the risk of HPV persistence followed by the development of cervical cancer.
Testing for HPV DNA for such symptomatic women gives fairly reliable clinical prediction of the progression, persistence or regression of the clinical disease.
Preventive measures:
Screening for cervical cancer by a very simple procedure, pap smear test, introduced over sixty years ago has led to a significant decline in its incidence and mortality among western countries where annual screening program was introduced.
The irony of cervical cancer is that it is largely a preventable disease, often without hysterectomies or surgical or chemo-radiotherapy interventions. Primary prevention measures include—vaccination and social education to control high-risk behavior and efforts to reduce or avoid exposure to HPV and other STDs such as by the use of condoms. Condom use, however, is not totally protective in preventing HPV infection. Secondary prevention measures include treatment of precancerous lesions before they progress to cervical cancer. This, however, implies that a screening test, such as cervical cytology or HPV testing is available with certain degree of expertise. Unfortunately, in India, the pap test is not universally or widely available.
A vaccine to protect against the strains of HPV that are most likely to cause cervical cancer has been developed. However, it isn't a complete protection against all strains. As it can take 10 to 20 years for cervical cancer to develop after HPV infection, it will take many years for an effect on the rates of cervical cancer to be seen. Many parents are questioning whether their children should be vaccinated and many women are also voicing their concerns over vaccination.
Deaths from cervical cancer have fallen over the last 8 years to some extent. This reduction is mainly because of the cervical screening programs which may detect changes in the cells of the cervix at a pre-cancerous stage. If abnormal cells are caught early, cancer can be prevented or treated. Although the vaccination program against HPV has started to be implemented, the screening program remains a vital process and shouldn’t be ignored.
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