By Dr. Gautam Wankhede
Cervical cancer is the second most common cancers of women in India, despite being largely preventable. India accounts for the highest number of cervical cancer cases as every year approximately 1.25 lakhs women are diagnosed with cervical cancer, and over 75 thousand die from the disease. Lack of awareness of the cervical cancer in India which is one of the leading cause of deaths in females despite the disease being largely preventable.
Several factors including poor awareness of cervical cancer, low screening uptake, insufficient availability and access to screening and vaccines contribute to the high burden of disease in India. The incidence of cervical cancer is higher in the rural population where the majority of women have low awareness of the risk factors associated with development of the disease. Further, the reluctance to undergo internal examination during screening test leads to poor participation.
Cervical cancer is caused by persistent infection with high-risk types of Human Papillomavirus (HPV)
A large majority of cervical cancer (more than 95%) is attributed to the human papillomavirus (HPV). HPV is the most common viral infection of the reproductive tract and can be transmitted through skin-to-skin sexual contact. Most sexually-active women contract the infection at some point in their lives with or without symptoms. However, in 9 out of 10 people who get HPV, the infection clears on its own. In some cases, the high-risk strains of the virus persist in the body, get integrated with the cells and progress to cervical cancer.
There are more than 200 types of HPV, of which about 14 types (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) are considered high risk for causing cancer. Two of these, HPV 16 and HPV 18, are responsible for 83% HPV-related cancers. It is reported that four out of five cervical cancers reported in India were caused by infections from HPV types 16 and 18. Low-risk HPV types, such as HPV 6 and HPV 11 are not associated with cancer, but cause genital warts.
The individuals who have family history of cancer or have multiple sexual partners and sexual debut at an early age are pre-disposed to developing cervical cancer.
Screening is the core pillar of cervical cancer control
HPV testing is key for cervical cancer prevention, which requires a comprehensive set of interventions across a woman’s life course. Cervical cancer is the only type of cancer caused by HPV that can be detected early by screening. However, it is observed that lack of awareness and knowledge about cervical cancer, lack of access to information, low risk perceptions, inadequate skills among service providers, and lack of equipment and supplies are the major barriers for cervical cancer screening.
Several screening methods, such as Pap-Smear, visual inspection with acetic acid, HPV DNA testing are used for early detection and prevention of cervical cancer. Traditionally Pap-Smear has remained the cornerstone of cervical cancer screening programs in India up till now. To eliminate cervical cancer, screening of women with a highly sensitive test is imperative.
Currently, the most accurate and highly sensitive test available for cervical cancer is the HPV DNA test. In this test, vaginal and cervical cells are tested using a polymerase chain reaction or PCR test (the same PCR test used for Covid or tuberculosis) to check for HPV DNA. If positive, then further evaluation for cervical cancer needs to be done, but if negative, the chance of cervical cancer is almost zero. Some of the benefits of HPV DNA test include higher sensitivity, ability to be
automated, more cost-effective than Pap-Smear, if deployed for high volume testing. It provides an opportunity to improve the efficiency and effectiveness of a cervical cancer screening program. Another method, HPV testing via self-sampling may offer an opportunity to increase cervical cancer screening especially in low-resource settings where there is currently a shortage of providers and facilities for cervical cancer screening.
It is important that the industry and policymakers identify the barriers and enablers for early detection of cervical cancer and provide solutions so that the targets of cervical cancer elimination can be achieved.
Prevention through Vaccination
There are HPV vaccines available that can protect women against cervical cancer. The vaccine is known to be most effective when given to girls before they become sexually active, hence, it is recommended that 9–14 years as the ideal time for vaccination. It is important to note that while vaccines can greatly reduce the risk of HPV, they cannot neutralize the virus in people already infected. Also, vaccination doesn’t replace screening – Even if you get the HPV vaccine, you need to get screened for cervical cancer.
Information dissemination, awareness building regarding the risk factors of cervical cancer, along with well organised screening programme with HPV DNA testing method and HPV vaccination are key strategies to prevent cervical cancer.
(The author is a Director-Medical Affairs, Mylab Discovery Solutions. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)