What you must know about Cervical Cancer

Cervical Cancer is a major public health problem in India with an incidence of 96,922 new cases and mortality of 60,078 cases every year. Cancer of the cervix is the 2nd most common cancer amongst Indian women aged 25-44 years after breast cancer. It is to be noted that if detected early, this cancer is fully curable. 

Cervical cancer usually begins as a sexually transmitted infection with cancer causing genotypes of HPV. Infection with Human Papilloma Virus (HPV), particularly high risk genotypes HPV16 & 18 may in some women lead to cervical cancer. 

HPV infection occurs in majority of the young couples when they become sexually active but majority of women are also able to clear the genital infection with the help of their immunity in the subsequent 6 to 12 months. However, in few women in whom the infection persists for longer periods, it can lead to abnormalities in cervical cells that may progress from precancer of the cervix to invasive cancer. Progression from early disease to invasive cancer occurs slowly—over more than 10 years. 

The main treatment approaches for cervical cancer are surgery, radiation, and chemotherapy. After initial treatment is provided, patients are monitored regularly for at least 2 years. 

Vaccines have been developed that have proven effective at preventing infection from viruses that are responsible for the majority of cervical cancer cases. Since these vaccines are most effective when given prior to beginning sexual activity, guidelines recommend routine administration to girls age 9 to 15 years.

The Federation of Obstetric and Gynecological Societies of India (FOGSI) mentions that due to lack of an organized cervical screening program, the disease burden is high in India. Single round of screening in women > 35 years has led to 25% reduction in life time risk of cervical cancer. Screening programs involve either a PAP test or HPV test or both.

Major health organizations like World Health Organisation(WHO) & American Society of Clinical Oncology(ASCO) also highlight the importance of primary screening in diagnosing & managing cervical cancer. 

Primary prevention with HPV vaccine is strongly recommended. FOGSI endorses the WHO recommendation that the preferred age group is under 15 years, where two doses can be administered at an interval of 6 months. It is to be emphasised that screening must be continued in all vaccinated women too.

The WHO has stated that screening, vaccination & treatment are important pillars of CaCx elimination alongwith vaccination. WHO has laid down goals for cervical cancer elimination by 2030 & states that 90% of girls should be fully vaccinated with HPV vaccine by 15 yrs of age, 70% of women should be screened at 35 & 45 yrs of age & 90% of women identified with cervical disease should receive treatment.

By: Dr Richa Bansal