Cervical cancer detection at an advanced stage remains a cause for concern: experts

Being the second most common cancer among women, oncologists raise a number of concerns: one of which is the stage at diagnosis of cervical cancer, as at least 50% women are still diagnosed in the advanced stage of the disease. With January being observed as Cervical Cancer Awareness Month, oncologists say more needs to be done to improve awareness on screening and vaccination

Every year, an estimated 7,500 women are newly diagnosed with cervix cancer in Tamil Nadu. Cervical cancer, being the second most common cancer among women, oncologists raise a number of concerns: one of which is the stage at diagnosis as at least 50% women are still diagnosed in the advanced stage of the disease.

R. Swaminathan, professor and head, Department of Epidemiology, Biostatistics and Cancer Registry, Associate Director, Cancer Institute (WIA), puts out the data: “Cervix cancer is the second most common cancer among women in India and Tamil Nadu; it is the most common cancer in the majority of rural parts of India. In Chennai, it was the most common cancer until 2001 before being overtaken by breast cancer as number one. The rate of occurrence has fallen from 33.7 per 1,00,000 women in 1985 to 15.7 in 2015 at an average of 2% per annum.”

With January being observed as Cervical Cancer Awareness Month, oncologists say more needs to be done to improve awareness on screening and vaccination.

Jayashree Natarajan, gynaecologic oncologist, associate professor, Cancer Institute, said the stage at diagnosis of the disease in women presenting with the symptoms has not changed much over the years. “Most of the women present with disease in the advanced stage in which it is not amenable for surgery, and the prognosis is bad. When detected early, there is a good prognosis but very few come at that stage,” she said.

Malliga J. S., head, preventive oncology at the institute, added : “There is definitely an improvement in early presentation due to better awareness and accessible health service but being a preventable cancer, we still see more than 50% of women presenting in locally advanced stages. The incidence is mostly seen in women aged between 45 and 55 years.”

Cervix cancer is 95% preventable with the Human Papillomavirus (HPV) vaccine, Priya Kapoor, consultant Surgical Oncology, Apollo Cancer Centres, Chennai, said, adding: “One of the main concerns is diagnosing cervical cancer in the advanced stages as women do not come for Pap smear. Though it is still treatable, the chances of recurrence are more when diagnosed in the advanced stage.”

Dr. Jayashree noted that there is a huge window of opportunity for preventive measures as the time between the infection with HPV causing cervical cancer and the occurrence of the disease is very long. “Vaccination and screening are crucial but the uptake of preventive methods is low as people are either not aware or hesitant. Motivating women to get screened for cervical cancer and vaccinating young girls against HPV infection is the way forward to eliminate cervical cancer,” she said.

Despite strong evidence in terms of research, there is still no policy on screening and vaccination in the country, Dr. Malliga said, adding: “This needs urgent attention and we need a cervix cancer control policy.”

Screening at 35 and 45 years with HPV DNA testing is key. “We have outreach programmes in which HPV DNA testing in six districts in government-provided spaces in headquarters hospital is done. We have so far screened 1.63 lakh women aged 30 to 60 years. We found high risk HPV DNA testing for cervix screening to be more effective. In this, self sampling is possible and hence, has more takers,” she said.

“A lot of work needs to be done at the vaccination front. Women from the age of 21 should get a Pap smear done once in five years with HPV testing. Any post-menopausal bleeding or discharge should be checked,” Dr. Priya Kapoor said.