The month of January is also regarded as Cervical Cancer Awareness month, in an attempt to educate people, across the globe, about its severity and prevention. We, at Yoddhas, take this opportunity to highlight pivotal information about one of the most commonly occurring, but not very familiar cancer, Cervical Cancer.
In India, cervical cancer is second most frequent cancer among women. Around 1.32 lac cases are diagnosed annually in the country. Incidence rate of cervical cancer is 22 per 100,000 women, per year. Globally, India accounts for 1/3rd of cervical cancer deaths. It is most prevalent in middle-aged and older women, with the risk rising in early 30s and peaking between 55-65 years of age. In India, this risk starts developing for women above 15 years of age.
As evident from the name, cervical cancer develops in cervix (reproductive part) of the women. In most cases, around 70-80%, it is caused by Human Papillomavirus and is sexually transmitted. Other sexually transmitted viruses may also turn cancerous, like human immunodeficiency virus (HIV) and warts. Though it is common to get HPV and other sexually transmitted infections, as they clear up naturally, sometimes these infections go on to become cancerous. This could be mainly due to early onset of sexual activity, unprotected sexual intercourse, multiple sexual partners, high parity and poor genital hygiene. Other common, subtle factors that progress this infection include use of contraceptives and nutritional deficiencies. Though India has recently made striking progress of providing basic defecation facilities in many rural homes, around 40% of households still have to defecate in open, wild areas. In addition, basic genital hygiene products, including sanitary napkins and feminine wash, are not accessible to majority women in the country. This situation is further stressed by the social taboo associated with the terms that is ‘cervical’ and ‘pads’. It should go without saying that maintaining proper genital hygiene is necessary for one’s overall health. With increasing rate of infections, it is more so to prevent cancer is the reproductive parts. Both men and women should be educated about practicing safe sex and be aware of all the red signs associated with reproductive health.
Since it is common to have vaginal infections, it is difficult to detect cervical cancer in early stages. After it has reached an advanced stage, one or many of the following symptoms and signs are prevalent: abnormal vaginal bleeding and discharge, vaginal discomfort, back and pelvic pain, fatigue, weight loss, loss of appetite and swollen leg. Though these are some common signs of a cancerous infection, any other abnormal behaviour, not mentioned above, should be reported to and checked by a gynaecologist immediately.
Even though cervical cancer may not show any early, obvious signs, it is possible to detect precancerous cells and infections by routine check-up. Commonly, if a gynaecologist suspects cervical cancer or other high risk infections, they will perform a pap smear test, in which cells from cervical lining are collected and viewed under microscope for abnormalities. Another way to test for cervical cancer is using diluted acetic acid solution in suspected areas (Visual Inspection with Acetic acid). Abnormal tissue will turn white and cells can be collected from there for biopsy.
Like most other cancers, cervical cancer can be treated by chemotherapy, radiation therapy and/or surgery, depending on stage and progress of cancerous cells. While surgery directly removes the cancerous tissue, with margins, radiation uses rays to kill those cancerous cells in body. Toxic medicines are used as a part of chemotherapy to control rapidly divide cells in the body. There is also an option of hysterectomy, specially for post-menopausal women, in early stages. For advanced, incurable stages, a woman is given palliative care to reduce pain and improve the quality of life. Sometimes a minor surgery may be performed in cases where cancer has advanced to a level that it obstructs bladder and bowel movement.
Cervical cancer can be prevented in the first place. In combination with basic genital hygiene routines, women above 21 years of age, who are sexually active, should get regular screening done every 5-10 years. There is 3-dose vaccination against HPV for 9-13 year old girls to prevent infections and hence the cancer. Since these vaccines do not treat any current HPV infections, they need to be administered before onset of sexual activity. They prevent infections from most common strains of HPV but not all. Screening, later in life, is recommended to all women, regardless of the vaccination. Vaccines against HPV is available in India. However, they are not yet a part of Universal Immunisation Program due to its cost. Each shot of vaccine costs ₹2,000-₹3,000, making it inaccessible to the most prevalent group in the country, low income middle-aged women. There are talks at the central government level to include these vaccines in UIP, which is a step in the right direction. In the meanwhile, there is serious need of awareness, not only about cancer, but about general sexual health and hygiene, right from a very young age. All young adults must be educated about the significance of genital hygiene and should be openly able to discuss any health problems. It is appalling to know how many health issues go unreported just because of hesitation and shame. Moreover, educational institutions should have programs and seminars discussing practice of safe sex and sexually transmitted diseases like HIV, warts and cervical cancer. There needs to be more awareness ad campaigns about cervical cancer so they could be detected at an early stage. Women should be encouraged to get tested and vaccinate their young girls.
Cervical cancer is something that can be prevented and diagnosed early. Let’s not miss those early signs.
More information about cervical cancer can be found in this specially focused WHO guide:
Author: Kruttika Aggarwal (Yoddhas Ambassador)
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