Cancer of the cervix, the lower part of the uterus that connects the womb and the vagina, is the most common cancer affecting women in India. Nearly 200 women die everyday due to cervical cancer in the country. Worldwide, cervical cancer accounts for 15 per cent of all cancers in women, 80 per cent of these occurring in developing countries.
In the past, as a medical student, I remember that we saw at least one patient suffering from cervical cancer per outpatient day in a government hospital, usually with the cancer having spread so much that we could not really help her. But today, with Pap Smears being routinely done we hardly see any invasive cancers. A Pap test or Pap Smear is a simple test by which we take a smear from the cervix and look at it microscopically for abnormal cells.
Unfortunately in our country, even though most of the women in urban areas have access to private healthcare, they are unaware of the advantages of Pap Smears. Rural women are not even aware of the existence of the Pap Smear.
A simple examination of the cervix on a routine gynaecological examination may show abnormalities like an erosion, hypertrophy or may just look unhealthy. These make a gynaecologist suspect that there could be something wrong. On the other hand, the cervix may look absolutely normal, but the Pap Smear may show some abnormal cells which need to be further evaluated. There are various ways in which the cervix can be further evaluated; the commonest being colposcopy and cervical biopsy. Colposcopy is the magnification of the cervix via a colposcope which helps to pin point the abnormal areas on the cervix, so that a biopsy could be taken from there.
There are various risk factors in women which are associated with cervical cancer. There is a progressive increasing risk with age and with increasing number of children a woman bears. Multiple sexual partners and the first sexual intercourse at a younger age are also risk factors. Sexually transmitted infections mainly ‘HPV’ i.e. the human papilloma virus infection contribute to the development of cervical cancer. Other co-factors are necessary for the progression of cervical cancer after infection with HPV virus. Tobacco smoking, long term hormonal use, and co-infection with HIV are established co-factors. There are other probable factors like herpes, immune suppression, and dietary deficiencies. The role of genetics has been suggested, but not yet clearly defined.
HPV infection is commonly found in approximately 70 per cent of sexually active men and women, either silent or with evidence of lesions. The role of HPV infection among women with cervical cancer has been well established. The two most common HPV types which are responsible for 70 per cent of cervical cancer are HPV 16 and 18.
Today, for the first time in the science of cancer there is a vaccine available to prevent cervical cancer. The vaccine is an HPV vaccine which prevents the infection in women. Since HPV infection is the major cause of cervical cancer, use of this vaccine can prevent cervical cancer in a majority of women. As HPV infection is sexually transmitted it is ideal to administer this vaccine before a girl becomes sexually active. Annual Pap Smears for girls who are sexually active are also recommended. Women with children should also have an annual gynaecological examination which will help them to prevent a problem before it becomes a problem!
The writer is a gynaecologist affiliated with Breach Candy Hospital, Mumbai.