Wonder why we are talking about cancer of the cervix during breast cancer awareness month? As is the norm every October, this time too we’ve had pink ribbon campaigns. What most women don’t know is that the number of cervical cancer deaths in India is far more than that of breast cancer. The incidence of the former is greater in the rural belt while urban regions have predominant cases of breast cancer and hence the spotlight on it.

Of late, though, efforts are on to advocate the need for early vaccination to prevent cervical cancer. This year, vaccination has been taken up as pilot projects in both Gujarat and AP to immunise at least 15,000 girls under the age of 18. In AP, three mandals in Khammam are part of the pilot project.

“We don’t have a tumour registry exclusively for AP. But going by the Madras Tumour Registry, the incidence of cervical cancer is highest in the world among South Indian women (30-35,000 among 100,000 women). The reason is largely due to lack of screening that helps early detection,” says Dr. Mohana Vamsi, chief surgical oncologist, Indo American Cancer and Research Centre.

Dr. L. Jayashree, gynaecologist, cites the risk factors as, “Early marriage (before 16 years), unhygienic sexual conditions, tobacco consumption in women, lower immunity as a result of multiple pregnancies which can make women prone to infection by certain strains of Human Papilloma Virus (HPV), multiple sex partners and the partner having had sexual partners other than the spouse. Sexually Transmitted Diseases (STDs) and Herpes virus infection have also been cited as a causative co-factor.”

Though the risk is higher in older women, there are exceptions to the rule: doctors cite cases of young women, even as early as 19, being treated for cervical cancer. The symptoms include foul-smelling vaginal discharge, post-coital bleeding, weight loss, inter-menstrual bleeding and pain in genital areas. Gynaecologists recommend a simple pap smear test to screen cervical cancer. “A pap smear test and examination can help in detection of pre-malignant and malignant stages,” says Dr. Jayashree. Pre-malignant conditions take as much as 10 years to progress to cancer.

Surgery is recommended in early stages (until stage 2A). As the individual case may be, uterus-saving surgeries are possible. Doctors consider retaining ovaries for younger women to avoid the need for hormone replacement therapy. “Patients may be advised to undergo a simple or radical hysterectomy. In later stages, radiation and chemo therapy are required,” says Dr. Vamsi. Colposcopy is done post the pap smear test and in certain cases, laproscopic surgeries are recommended.

The stark increase of cervical cancer cases across the world has shifted the focus on vaccination. Vaccination is recommended as early as 9 or 12 years and is best done before marriage. The vaccine is administered in three shots, under guidance, at least six months before marriage. “This doesn’t mean married women don’t require vaccination. Ongoing research suggests that women up to the age of 45 can be vaccinated,” says Dr. Vamsi.

Dr. Jayashree says married women need to undergo pap smear test and then take the vaccine. She stresses the importance of annual follow-ups for post treatment for cervical cancer.

The incidence of this cancer is lower in the West, says Dr. Vamsi, due to regular screening. “Screening can help predict the risk and hence prevent the disease. Ninety to 95 per cent of cervical cancer is curable when detected early.”

Need for vaccination

Unlike other viral infections such as chicken pox or H1N1, infection by human papilloma virus doesn’t make the body immune to further infections. Hence, vaccination becomes necessary.

Post vaccination, women are advised to appear for screening every three to five years.

In some countries, efforts are on to vaccinate boys as well to help immunise the entire population.

In India, an estimated 132,000 new cases and 74,000 deaths are reported annually.