By: Dr. Nalini Gupta
Every eight minutes, a woman dies of cervical cancer in India, reveals the National Institute of Cancer Prevention and Research. Come 2020, an additional 148,624 new cases of cervical cancer will be added to the existing disease burden, each year. Primarily caused by sexually acquired infection (Human Papilloma Virus or HPV), cancer begins with precancerous cellular abnormalities in the cervix. It can be years before a woman advances to the later stage of cancer and fully registers the disease.
Therefore, being cognizant of the precancerous stage become extremely important to manage a highly preventable cancer. With advanced screening mechanisms such as liquid-based cytology (LBC) test, a patient can be correctly diagnosed for the presence of even the minutest cellular abnormalities as well. Because it is a highly preventable form of cancer, it’s imperative to raise awareness on the need for timely screening procedures. Failing to address precancerous lesions in the initial stages can stall the case for reducing the burden of cervical cancer.
A similar situation is witnessed in India wherein the lack of awareness around advanced screening procedures, is the reason behind the galloping rise in patient numbers. As per the current estimates, every year 96,922 women are diagnosed with cervical cancer and 60,078 lose their battle to the disease. Moving beyond the common myth that cervical cancer affects only postmenopausal women, the government should establish regular screening programmes for women of all groups and socio-economic background. But before opting for a clinical examination, women must understand the disease profile carefully.
Understanding cervical cancer: the disease profile and possible screening options
- Cancer first develops as treatable precancerous cellular abnormalities in the lower part of the uterus that connects to the vagina.
- Scientists believe that HPV, a group of viruses, out of these, type 16 and 18 are directly responsible for around 70% of cervical cancer cases globally.
- The HPV virus can sustain in a patient for years, causing cervical cells to become cancer cells.
- Typical symptoms of cervical cancer include vaginal bleeding after intercourse, between periods or after menopause, watery or bloody vaginal discharge that may have a foul odour, pain in the pelvic region during intercourse, etc.
- As a progressive disease, cervical cancer requires multiple screenings at regular intervals of 2-3 years to check its development. In such times, we need to action a two-pronged approach i.e. self-analysis and consulting a specialist.
- According to experts in oncology, timely screening of cervical cancer leads to a 93% survival rate.
- Women of all groups, starting from puberty onwards, must prioritise their reproductive health to lead a better quality of life.
Since early-stage cervical cancer generally shows no signs or symptoms, it is recommended to opt for advanced screening procedures at regular intervals.
A case in point: the Scandinavian countries invested heavily in building a medical environment that encourages women to regularly screen their bodies. The result is, the disease burden came down to the level of a rare disease i.e. 1 to 2 patients per 100,000 population.
In the Indian scenario, the lack of awareness about the disease profile and possible diagnostic solutions has reduced the median age from 50 years to 38 years. The findings are startling. Hence, it’s time we encourage women to take extra care of their health.
Emerging technologies to fight cervical cancer
With innovative breakthroughs in the field of oncology, detection of even asymptomatic cervical lesions has become extremely feasible. Conventional screening procedures such as a ‘Pap smear test’, which requires several samples for detecting multiple subsets of cancer has now been substituted by much more sophisticated technology. Take, for instance, the LBC test. LBC allows clear visualisation of even the minutest cellular abnormalities. This, in turn, allows a doctor to use the same residual sample to conduct future tests to confirm presence of high-risk HPV in the sample. LBC, therefore, allows screening for important additional follow-up tests without the need for repeat sampling.
Furthermore, the new test allows storing the sample for up to 6 months, facilitating the detection of high-risk HPV. A leap from pap smear tests, wherein the sample was collected with a spatula and resulted in a meagre 30% recovery by the time it reached the slide for observation. With LBC, the sample can be collected through a brush, which allows complete recovery of the sample. Because 95% of women who develop cervical cancer test positive for HPV, assessing pilot sites for the HPV is possible with LBC.
The subtleness of early symptoms such as abnormal menstrual bleeding and vaginal pain usually become the reason for overlooking these symptoms as potential triggers of cervical cancer. In my career, I have observed that women who voluntarily opt for screening have fewer chances of suffering from cervical cancer. There is also a general fear that by screening younger women, we expose them to unnecessary follow-up procedures with no real benefit.
What we must understand is that cervical cancer develops over years of undetected precancerous abnormalities. Hence, screening for cervical cancer at regular intervals is the plausible solution to controlling the disease burden as well as saving millions of future patients.