Women who appear to be healthy and show no signs of cervical cancer are subjected to screening. If HPV infections or precancerous lesions are discovered during screening, necessary consultations and suitable medical interventions will follow. There are two methods available for cervical cancer screening:

Pap Test: Pap test, also known as Pap smear or liquid-based cytology, involves gathering cell samples from the cervix using a specialised instrument called Ayre’s spatula. This can also be done as part of a routine gynaecological examination. This test can be paired with an HPV test, in which women are screened for HPV strains associated with cervical cancer.

• Women should have their first Pap test when they are 21 years old. If the findings of the initial test are normal, the doctor may recommend the next test after 2-3 years.
• The Pap test is combined with the HPV test in women aged 30 and up, and if the findings are normal, the next test may be recommended after five years.
• Women over 65 years may stop taking Pap tests upon consulting a gynaecologist, especially if the findings of previous tests have been normal or if they have had a hysterectomy.

Colposcopy: Colposcopy is the most effective screening procedure for cervical cancer. During this procedure, a specialised tool, called a colposcope, is used to obtain a lighted and magnified view of the cervix lining. This test allows doctors to examine the cervix more closely and detect any suspicious abnormalities. The doctor may treat the lesion during the same visit or perform a biopsy, depending on the type of lesion.

The risk of cervical cancer increases due to HPV infection. It is crucial to get HPV vaccination to reduce cervical cancer risk significantly. You should get HPV vaccination if you are between 9-13 years of age. You are also eligible for HPV vaccination if you are between 13-26 years of age, not previously vaccinated and have never been diagnosed with cervical cancer. Even after vaccination, you need to visit for regular screening as vaccination may not completely prevent the development of cervical cancer.

Most cases of cervical cancer occur due to HPV infection, which transmits through sexual intercourse. When women engage in sexual activity, it is crucial to use protective barriers to prevent HPV infection. Always use condoms during sexual intercourse. Although condoms reduce the risk of HPV infection, certain areas are not covered with condoms but still have the potential to transmit disease.

Some of the common symptoms of cervical cancer are abnormal discharge from the vagina, pain during sexual intercourse, bleeding between the menstrual cycles or after engaging in sexual activity, or heavy bleeding during the cycle.

Healthy lifestyle is crucial in reducing cervical cancer risk. Smoking increases the risk of cervical cancer by 2-3 times in women who are already infected with HPV. It includes both smokers and those who are exposed to second-hand smoking. Therefore, it is important to quit smoking. It is also necessary to exercise and maintain a healthy weight as this helps you reduce your risk of getting cervical cancers, along with various other types of cancer.

If you are a high-risk individual, you should consult your doctor to understand your chances of getting cervical cancer. Follow your doctor’s advice in reducing the risk of cervical cancer. Enquire about HPV vaccination and schedule for Pap smear test. Further, if you experience any symptoms that are alarming, immediately contact your doctor. The doctor will conduct a thorough examination to rule out cervical cancer. Never ignore the warning signs of any cancer, including cervical cancer. Delay in diagnosis and treatment results in poor outcomes.

The first thing you should know about cancer is that prevention is always better than cure, and it is not any different in the case of Cervical Cancer. With proper preventive measures, anyone can reduce their cervical cancer risk easily.

Presently, cervical cancer prevention is achieved through vaccination and screening. Screening is a clinical procedure that checks for the early signs of cervical cancer among apparently healthy women.

Vaccination, on the other hand, reduces one’s risk of developing cervical cancer by preventing chronic HPV infection, which is strongly associated with cervical cancer incidences. It is reported to be one of the effective methods to prevent cervical cancer.

In 2019, a meta-analysis report presented strong evidence on HPV vaccination’s efficacy against cervical cancer.

Do All HPV Infections Lead To Cervical Cancer?

Cervical cancer is the second most common cancer and accounts for 22.86% of the total cancer burden among Indian women. Human Papillomavirus (HPV) is identified as the causative factor for more than 90% of cervical cases.

More than 100 types of Human Papillomavirus have been identified, and of these, about 15 are high-risk types with the potential to cause various types of anogenital cancers, namely cervical, vulval, vaginal, anal and oropharyngeal cancers. Of all, HPV 16 and 18 types are observed to cause 70% of cervical cancer cases and precancerous lesions.

HPV infections are usually transmitted through sexual contact. About 90% of the HPV infections are self-limiting, i.e., they spontaneously clear up within two years by the virtue of the body’s own immune mechanisms. In other words, the majority of HPV-infected women do not develop cervical cancer.

However, a small percentage of HPV infections, especially those that are caused due to high-risk HPV types don’t clear up. If left untreated, these infections may lead to precancerous lesions and cervical cancer eventually.

There are several risk factors, which are associated with the progression of these precancerous lesions to cancer. The main risk factors include tobacco use, early sexual activity, early age pregnancy, multiparity, related sexually transmitted infections, immunocompromised conditions, etc.

Preventing Cervical Cancer with HPV Vaccine

Pap smears help reduce the risk of cervical cancer by detecting precancerous lesions caused due to HPV infections. However, the development of HPV vaccines has created opportunities for more effective cervical cancer prevention.

Currently, there are two HPV vaccines available – Gardasil and Cervarix. Gardasil 9 is the third type, which was recently approved by the USFDA HPV infection prevention, and it is slowly being made available in India.

Both Cervarix and Gardasil vaccines offer protection against HPV 16 and 18. Gardasil offers additional protection against the virus types HPV 6 and 11 that are associated with 90% anogenital warts. Cervarix also offers protection against other HPV types through the cross-protection mechanism. Gardasil 9, however, offers additional protection against 7 oncogenic types (HPV 16, 18, 31, 33, 45, 52 and 58) along with HPV 6 and 11 types. It covers almost 90% of virus types with cancer-causing potential.

How Does HPV Vaccine Work?

HPV vaccines work just like other immunisations. These vaccines contain purified, inactive protein particles from the virus. These particles can trigger the formation of HPV-specific antibodies or other immune mechanisms.

This way, when the infection actually occurs, your immune system is ready to fight against it. This vaccine effectively curbs persistent HPV infections and thereby helps in preventing the formation of precancerous lesions and subsequent cancer development.

However, HPV vaccination should be considered a preventive measure only and not as a treatment method for precancerous conditions or cancer itself.

Getting the HPV Vaccination

Ideally, the vaccine is administered before women become sexually active. In other words, the vaccine must be given before there is any contact with the relevant HPV types.

HPV vaccination is recommended starting from the age of 9, with catch up vaccination that can happen till the age of 26. However, HPV vaccination among sexually active women till the age of 45 years is globally approved, as it still offers protection of a certain degree.

HPV vaccination is basically administered with a 2-dose schedule that is recommended between the ages of 9 and 14 years. However, a 3-dose schedule is recommended for those who get vaccinated after the age of 15.

HPV vaccination does not cause any major side effects. However, in rare cases, pain, swelling, itching, bruising, redness at the injection site, headache, fever, nausea, dizziness, vomiting and fainting could be observed, which wear off after some time.

Making Cervical Cancer Prevention Effective

Australia was the first country to introduce a National HPV Vaccination programme in order to achieve the elimination of cervical cancer. Such programmes are necessary for countries like India, where the incidence is high.

Globally, the WHO has set a 90/70/90 target that is to be achieved by 2030. As per this programme, 90% of adolescents shall be vaccinated, 70% of women will be screened for HPV at least twice in their lifetime, and 90% of women will be treated effectively for precancerous lesions or cancer itself.

That said, awareness among the masses is the key to beat any disease. Awareness of cervical cancer should be created on both individual and community levels, through which the risk of cervical cancer can be successfully brought down among women.

Frequently Asked Questions

1. Can I get an HPV vaccine if I am over 26?

Yes, you can get the HPV vaccine even if you are above 26 years old. It is both safe and effective. It is also a better option over not getting vaccinated and making yourself more susceptible to HPV infections and other complications associated with it.

2. Is HPV vaccine safe?

Yes, several studies have shown that HPV vaccines are safe. It offers protection against HPV infections and other complications, such as anogenital cancers and warts.

Just like any other vaccine, the HPV vaccine may also cause temporary side effects. Many women do not experience any side effects at all. However, if you have any questions about the side effects, you can discuss them with your doctor, who will help you with all the necessary information.

3. Does HPV vaccine contain a live virus?

No, the HPV vaccine does not contain a live virus or even its DNA particles – so they cannot multiply and cause an infection when injected. This vaccine is made of inactive, purified protein particles from the virus that trigger antibody production and other immune mechanisms, which help in preventing HPV infections.

4. Who should not get an HPV vaccine?

HPV vaccine should be avoided by pregnant women and by those who are moderately or severely ill. Also, this vaccine should be avoided by those who are allergic to the components of this vaccine. It is always better to discuss your allergies with your doctor before the vaccination.

5. Will HPV vaccine cause infertility?

No. There is no evidence that the HPV vaccine causes infertility. Several studies have found that there is no relationship between the HPV vaccine and infertility.

However, if you have any concerns, you can talk to your doctor, who will provide you with sufficient information on the HPV vaccine’s safety.

6. Do women still need Pap tests after getting the HPV vaccine?

Yes, women will still have to undergo pap tests after getting HPV vaccines, as these vaccines do not offer 100% protection against cervical cancer. However, it is important to note that HPV vaccines can bring down your cervical cancer risk remarkably.

This article is contributed by Dr. Abhilasha Narayan, Consultant – Gynaec Oncology, HCG Cancer Centre, Bangalore.

Cervical cancer is the second most common cancer among Indian women.

Again, in India, this cancer is more prevalent among women living in rural areas than those living in urban regions.

Despite being one of the most common cancers, cervical cancer is also one of those cancers whose risk can be easily brought down.

Now, what are the measures you can take to reduce your cervical cancer risk?

Before learning the measures, it is important to know about the factors that increase one’s cervical cancer risk.

Factors That Increase the Risk of Cervical Cancer

There are several factors responsible for the increased risk of cervical cancer among women; the key risk factors are listed below:

1. Chronic HPV infection: Human Papillomavirus (HPV) infection is a common infection of the reproductive tract in women. Sexual contact is a common mode of transmission for this virus.

In most cases, HPV infections and precancerous lesions disappear on their own. However, there are chances of these HPV infections becoming chronic and the precancerous lesions proceeding to form invasive cervical cancer.

2. Weaker Immune System: Having a weaker immune system is another risk factor. Studies have found that cervical cancer can take up to 15-20 years in women with a stronger immune system, while it only takes 5-10 years in those with a weaker immune system.

Having HIV or other immunocompromised diseases can also increase the risk of cervical cancer.

3. Smoking: According to studies, cervical cancer is two times more likely to develop in women who smoke. Smoking also lowers immunity, which is another risk factor.

4. Age: Cervical cancer risk begins during the late teens and goes on up to the mid-60s. Women between the ages of 35 and 44 have a higher risk of developing cervical cancer.

5. Family History of Cervical Cancer: Having a family member or close relative who has been diagnosed with cervical cancer is also a risk factor for this cancer type.

If you have a family history of cervical cancer, you should talk to your doctor to understand your risks and the measures that help you reduce your cervical cancer risk.

Other risk factors for cervical cancer include having multiple sexual partners, prolonged usage of oral contraceptives, poor personal hygiene, having a history of chlamydia infection, unhealthy diet, etc.

Importance of Regular Screening

It takes about 10-15 years for HPV infection to cause precancerous lesions, and finally, cancer. Before showing as true cancer, the changes could be minimal, moderate, or severe. This provides women with adequate time to be checked for early cancer symptoms and treated as needed.

There are different screening and prevention methods available that can help you bring down your cervical cancer risk:

1. Vaccination: Many assume that the vaccination directly prevents cervical cancer formation. However, this vaccination, also known as HPV vaccination, works by preventing chronic HPV infections. By doing so, it helps in reducing the risk of cervical cancer.

Girls between the ages of 9 and 26 can receive these immunisations. These immunisations are administered in three doses within six months (0, 1 or 2, 6-month schedule).

Depending on the risk, women between the ages of 27 and 45 can also receive the HPV vaccine after discussing their risk of new HPV infections and the potential benefits of vaccination with their doctor.

It has been discovered that these immunisations can prevent cervical cancer in nearly 90% of women. Nevertheless, this does not imply that women can skip their screening.

2. Screening: Women who appear to be healthy and show no signs of cervical cancer are subjected to screening. If HPV infections or precancerous lesions are discovered during screening, necessary consultations and suitable medical interventions will follow. There are two methods available for cervical cancer screening:

• Pap Test: Pap test, also known as Pap smear or liquid-based cytology, involves gathering cell samples from the cervix using a specialised instrument called Ayre’s spatula. This can also be done as part of a routine gynaecological examination. This test can be paired with an HPV test, in which women are screened for HPV strains associated with cervical cancer. Women should have their first Pap test when they are 21 years old. If the findings of the initial test are normal, the doctor may recommend the next test after 2-3 years. The Pap test is combined with the HPV test in women aged 30 and up, and if the findings are normal, the next test may be recommended after five years. Women over 65 years may stop taking Pap tests upon consulting a gynaecologist, especially if the findings of previous tests have been normal or if they have had a hysterectomy.
• Colposcopy: Colposcopy is the most effective screening procedure for cervical cancer. During this procedure, a specialised tool, called a colposcope, is used to obtain a lighted and magnified view of the cervix lining. This test allows doctors to examine the cervix more closely and detect any suspicious abnormalities. The doctor may treat the lesion during the same visit or perform a biopsy, depending on the type of lesion.

Bottom Note

Like any other cancer, cervical cancers are fought best when detected early. Regular screening is one way to catch cervical cancers in their early stages. These screening tests are both simple and cost-effective.

HCG urges every woman out there to opt for regular screening and timely vaccination, as these are the most effective ways to put oneself a step ahead of cervical cancer.