January 13, 2021
Dr Nisha Buchade, Gynaec Oncologist
A large percentage of cervical cancer deaths happen due to delayed diagnosis and late treatment, which are in turn caused due to lack of awareness.
As we mark January as Cervical Cancer Awareness Month, it is high time we make the women among and around us understand cervical cancer as a disease and use the right measures to reduce its risk.
Despite being the 4th most common cancer among women around the world and one of the most common cancers among Indian women, cervical cancer is considered to be one of the most preventable and treatable types of cancer. In developed countries, the incidence of cervical cancer is gradually decreasing due to increased awareness and proactiveness shown towards prevention and early detection through regular screening. Among women in developing countries, awareness has to be created, which will eventually help them learn and follow the measures to prevent cervical cancer.
As a first step towards understanding and preventing cervical cancer, women should know the common causes or the risk factors that may trigger cervical cancer development.
Common Cause of Cervical Cancer
Almost all cervical cancers occur due to Human papillomavirus or HPV infection, which is a common infection of the reproductive tract in women. HPV infection is transmitted through sexual contact. Most of these infections and the precancerous lesions that are caused due to the infection clear up spontaneously. However, there are also chances of these HPV infections becoming chronic and the pre-cancerous lesions progressing to develop cervical cancer.
Apart from HPV infections, there are various risk factors that could lead to an increased risk of cervical cancer. Below are the major risk factors associated with cervical cancer development:
Compromised Immune System: Women with weaker immune systems are more susceptible to cervical cancer. In women with healthy immune system, it takes up to 15-20 years to develop cervical cancer; whereas, among women with weaker immune system, it just takes 5-10 years. For example, having HIV or other immunocompromised conditions may lead to increased cervical cancer risk.
Smoking: Studies show that the risk of cervical cancer is 2 times higher among women who smoke. Smoking also leads to reduced immunity, which is also a risk factor.
Age: The risk of developing cervical cancer begins during late teens and goes on till the mid-60s. Cervical cancer is mostly diagnosed among women who are aged between 35 and 44. About 20% of cervical cancer cases are seen among women aged over 65.
Other risk factors include poor hygiene, a history of chlamydia infection or herpes, family history of cervical cancer, socioeconomic factors, excessive usage of oral contraceptives, and a diet low in fruits and vegetables.
Preventing Cervical Cancer
Vaccination and screening are two ways to reduce the risk of developing cervical cancer.
HPV vaccination can bring down the risk of cervical cancer; it is recommended among women aged 9-45 years. However, it is still important for the women, who are vaccinated to undergo screening as vaccinations do not offer 100% protection.
Since it takes 15-20 years for the precancerous lesions to transform into cervical cancer, screening may be extremely helpful for women in early detection, which leads to successful treatment of cervical cancer.
Screening tests are taken by apparently healthy women, who show no symptoms of cervical cancer. Upon screening, if the HPV infections or precancerous lesions are detected, appropriate consultations and treatments will follow.
There are several screening tests for cervical cancer, and the most common among them is the PAP smear or liquid-based cytology, which involves gathering cell samples from the cervix using the instrument, Ayre’s spatula. This can also be done as a part of the general gynaecological checkup. This test can be combined with an HPV test, where women are tested for strains of HPV that are most commonly linked to cervical cancer.
Ideally, women should undergo their first PAP smear/LBC (liquid-based cytology) at the age of 21. Moving on, the PAP smear test is recommended every 2-3 years if the results from the first test are normal. Among women who are 30 or above, the PAP test is combined with the HPV test, and if the test results are normal, the next test is recommended after 5 years. Women over 65 years may stop undergoing screening tests, if the results from the tests in the past are normal or if they have undergone a hysterectomy.
The best screening method that is recommended for cervical cancer is colposcopy. A special instrument known as colposcope is used to get a lighted and magnified view of the cervix lining. This procedure helps doctors have a closer look at the cervix and find if there are any abnormal lesions. Depending on the type of lesion, the doctor may either treat it in the same visit or perform a biopsy.
Early detection still remains the best way to beat cervical cancer. With a comprehensive approach towards screening and treatment, it is possible to eliminate this disease within a generation.
Frequently Asked Questions on Cervical Cancer Prevention:
1. Can poor hygiene cause cervical cancer?
Yes, poor hygiene increases the risk of cervical cancer. Poor hygiene leads to infections, which when chronic, may lead to cervical cancer. Therefore, it is important for women to maintain healthy genital hygiene.
2. Is cervical screening painful?
Both PAP smears and colposcopy are not painful. However, during PAP smear, the speculum that is inserted into the vagina may cause discomfort and pressure in the pelvic region among few women. This discomfort disappears as soon as the procedure ends.
3. Can you test for cervical cancer at home?
Although there are home-kits available for cervical cancer screening, it is always better to visit a specialist for the procedure, as he/she ensures that the screening test is performed correctly, which is necessary to get accurate results.
4. How long does a cervical screening take?
The entire procedure of PAP smear takes around 5 minutes. The results may take up to 2-6 weeks. Colposcopy takes 15-20 minutes. The doctor will share the results of the colposcopy right away. However, if a biopsy is recommended during the procedure, the results might take up to 2-8 weeks.
5. What should you not do before a smear test?
Women should avoid intercourse or using any vaginal medicines, creams and other products for two days before the PAP smear, as these activities wash away the abnormal cells if any.