Cervical Cancer: Prevention & Control

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Cervical Cancer  is a type of cancer that develops in cervix (the entrance to the womb from the vagina) of a woman. It often has no symptoms in its early stages. The most common symptom of Cervical Cancer is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.

Abnormal bleeding doesn’t always mean that you definitely have cervical cancer, but you should consult with your GP as soon as possible. If your GP thinks you might have cervical cancer, you should be referred to see a specialist within two weeks.

womens-health-cervica-cancerCervical cancer is the 5th most common cancer in humans, the 2nd most common cancer in women worldwide and the most common cancer cause of death in the developing countries. The most important risk factor for cervical cancer is Sexually transmitted human papilloma virus (HPV) infection.

Unlike many other cancers, cervical cancer occurs early and strikes at thecervical cancer1 productive period of a woman’s life. The incidence rises in 30–34 years of age and culminates at 55–65 years, with a median age of 38 years (age 21–67 years). Estimates suggest that more than 80% of the sexually active women acquire genital HPV by 50 years of age. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are:-

  • Early marriage
  • Multiple sexual partners
  • Multiple pregnancies
  • Poor genital hygiene
  • Use of oral contraceptives
  • Lack of awareness.

INDIAN SCENARIO OF HPV INFECTION

cervical cancer

Cervical cancer is ranked as the most frequent cancer in Indian women. India has a population of approximately 365.71 million women above 15 years of age, who are at risk of developing cervical cancer. The current estimates reveal approximately 132,000 new cases diagnosed and 74,000 deaths annually in India, accounting to nearly 1/3rd of the global cervical cancer deaths. Indian women face a cumulative lifetime risk of 2.5% and cumulative death risk of 1.4% from cervical cancer. At any given time, about 6.6% of women in the general population are estimated to harbor cervical HPV infection.

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There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer. HPV serotypes 16 and 18 account for nearly 76.7% of cervical cancer in India.

Causes of Cervical Cancer

cervical_cancerNecessary cause of cervical cancer is HPV, but it is not a sufficient cause. Other co-factors are necessary to convert cervical HPV infection to cancer.

  • Long-term use of hormonal contraceptivescervical cancer 5
  • High parity
  • Multiple sex partners
  • Early initiation of sexual activity
  • Co-infection with HIV have been identified as established cofactors;
    • Chlamydia trachomatisand herpes simplex virus type-2,
    • immunosuppression
  • cervical cancer3Low socioeconomic status
  • Poor hygiene
  • Tobacco smoking
  • Diet low in antioxidants

are other probable co-factors. Genetic and immunological host factors and viral factors such as variants of type, viral load and viral integration are likely to be important, but have not been clearly identified.

Cervical Cancer Symptoms

cancer-cervical-symptoms-part-11It often has no symptoms in its early stages. Therefore it’s so important to get a regular Pap test to ensure early detection and treatment of precancerous lesions. The Cervical Cancer symptoms typically only appear when the cancer cells grow through the top layer of cervical tissue into the tissue below it. This occurs when the precancerous cells are left untreated and progress to invasive cervical cancer.

At this point, people often mistake common symptoms as being benign, such as irregular vaginal bleeding and vaginal discharge.

Irregular bleeding

Irregular vaginal bleeding is the most common symptom of invasive cervical cancer. The bleeding may occur after sex or between menstrual periods. Sometimes, it shows as blood-smeared vaginal discharge, which usually gets dismissed as spotting.

Vaginal bleeding can also occur in women who no longer have menstrual periods. This is never normal and could be a warning sign for cervical cancer or other serious Health problem. Immediately consult  a doctor if this happens.

Vaginal discharge

Along with bleeding, many people may also experience unusual vaginal discharge. The discharge may be watery, white, clear, foul smelling, brown, tinged with blood.

Advanced symptoms

cancer-cervical-symptoms-part-11Vaginal Bleeding and discharge may be early symptoms  of cervical cancer, more severe symptoms will develop in later stages. Symptoms of advanced cervical cancer can include:

  • back pain or pelvic pain
  • fatigue
  • difficulty in urinating
  • swelling of one or both legs
  • weight loss

CANCER SCREENING

cervical-cancer-screeningHPV transmission is influenced by sexual activity and age. Almost 75% of all sexually active adults are likely to be infected with at least one HPV type. However, vast majority of the infections resolve spontaneously and only a minority (<1%) of the HPV infections develop to cancer. The lifetime risk for genital HPV is 50–80% and genital warts is approximately 5%.[11] In women who undergo routine screening, the risk of having an abnormal Papanicolou (Pap) smear is 35%, CIN 20% and ICC is <1% approximately. However, in women without routine screening, the risk for cervical cancer is up to 4%.[12]

The Pap test is carried out to find cellular abnormalities in cervical tissue, helping early diagnosis. Majority of the women become infected with HPV at some point in their lives, soon after the initiation of sexual activity.

An abnormal cervical screening result doesn’t mean you definitely have cancer. Most abnormal results are caused by an infection or the presence of treatable precancerous cells, rather than cancer itself.

Women aged 25 to 49 years of age are offered screening every 3 years, and women aged 50 to 64 are offered screening every 5 years. For women who are 65 or older, only those who haven’t been screened since they were 50, or those who have had recent abnormal tests, are offered screening.

Prevention of cervical cancer

cervical-cancer-preventionHPV is necessary for the development of cervical cancer. Therefore, preventing HPV infection can prevent cervical cancer. This can be achieved by complete abstinence from sexual activity or by a vaccine. Primary prevention involves a risk reduction approach through behavioral intervention for sexual or through mass immunization against high-risk Human Papilloma Virus (HPV).

The objective of cervical screening(secondary prevention) is to prevent invasive cervical cancer from developing by diagnosing and treating women with CIN2/3 lesions, and the effectiveness is determined by reduction in incidence and mortality. The critical elements of a screening program are a good quality screening test, swift diagnostic investigations, suitable treatment, and effective post treatment follow-up. There is strong support from non-experimental studies in developed countries such as Denmark and Finland that the incidence and mortality of cervical cancer can be lowered by screening. Ensuring high levels of participation and sufficient health care infrastructure and human resources are important for a screening program to succeed. It is also important for screening to be guided by equity considerations for those who are more vulnerable or with lesser access to health care services because of social, economic, or demographic factors.

WHY VACCINATION IS THE BEST FORM OF PREVENTION

Currentpreventive-stepsly, all genital HPV infections cannot be prevented except by abstinence and lifetime mutual monogamy. There is no clear evidence that the contraception, condoms can protection against HPV infection. Secondly, except for genital warts, the infection is asymptomatic. Adherence to routine screening by the susceptible women through periodic Pap smears even in developed countries has been unsatisfactory, whereas in developing countries like India, large-scale routine screening is difficult to achieve.

The most common adverse reactions are local reactions like pain (mild to moderate) in 83%, swelling with erythema in 25% and systemic adverse effects such as fever in 4% of the vaccines. No serious vaccine-related adverse events have been reported.

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The vaccine is not recommended for use in pregnant women. Any exposure to the vaccine during pregnancy must be immediately reported. Lactating women and immuno-suppressed female patients can receive the vaccine. The efficacy and the degree of immune response could be poor in the immuno-suppressed group.

Vaccines are not 100% protective against cervical cancer and not a replacement for periodic screening. Hence, screening programs should continue as per recommendations. The Advisory Committee on Immunization Practices currently recommends routine vaccination of females aged 11–12 years with 3 doses of the HPV vaccine. Vaccination can be given to women as young as nine years as well as in those aged 13–26 years who have not previously completed immunization. Pap testing and screening for HPV DNA or HPV antibody before vaccination is not required. Routine cervical cancer screening should be continued.

CONCLUSION

cervical cancerHuman Papilloma Virus (HPV) vaccination is a primary preventive measure (serotype-specific with limited cross-protection) of carcinoma cervix. A cost-effective second-generation human papilloma virus (HPV) vaccine is needed for many developing countries to address various issues specifically linked to the region. However, till such time, secondary prevention through periodic cervical cancer screening should be in place to use the existing infrastructure and cost-effective screening methods such as Pap smear and HPV DNA tests. There is no risk of getting an human papilloma virus (HPV) infection from the vaccine as the vaccine does not contain live virus. human papilloma virus (HPV) vaccination and regular screening are the most effective ways to prevent cervical cancer.

Important Links –
World Cancer Day 2018 …
Breast Cancer Risk Factors with Unclear Effect
Breast Cancer Symptoms…
Your Menstrual Cycle
Your Myths, Facts, Things that helps reduce cancer and Things that causes cancer.

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