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On World Cancer Day Dr Rishma Dhillon-Pai, consultant gynaecologist, Lilavita, Jaslok, and Hinduja healthcare hospitals, Mumbai talks about cervical cancer and measures to prevent it.  In India, cervical cancer was responsible for around 60,000 deaths in 2018 alone. One of the key reasons that the disease continues to kill women is because of limited awareness and/or misconceptions around the disease and persistent socio-cultural taboos around women’s sexual and reproductive health.

What is cervical cancer?

Cervical cancer is cancer that affects the cervix. The cervix is the opening or the mouth of the uterus, or the womb. It is the part of the womb that opens during delivery.

How is cervical cancer caused?

In most cases, cervical cancer is associated with the Human papillomavirus (HPV). Human Papillomavirus is a very common sexually transmitted virus. There are more than 100 different strains of HPV. Most of them are not dangerous. You can have an infection and it may disappear on its own. But some high-risk varieties – such as 16 and 18 – are the ones that you have to look out for, because those can predispose you to cervical cancer.

There are more than 100 different strains of HPV. Most of them are not dangerous.

Who can get cervical cancer?

Any woman can be affected by cervical cancer, but women who are sexually active early, have had multiple partners, are immunocompromised or are socio-economically disadvantaged are the most vulnerable to the disease.

What are the symptoms of cervical cancer?

Early stages of cervical cancer will usually have no symptoms whatsoever, but subsequently, once the disease becomes more advanced, symptoms could include excessive vaginal discharge, bleeding post-intercourse bleeding or bleeding in-between menstrual cycles. However, all of these symptoms are of late-stage cervical cancer. Early stages of cervical cancer usually have no symptoms, which is why you need to rely on tests.

Early stages of cervical cancer usually have no symptoms, which is why you need to rely on tests.

 So, what are the tests available to detect cervical cancer?

There are several screening methods available such as the Pap test. Today, we also have a test available for HPV, where you scrape the cervical canal – just a gentle touch of the cervix with a brush – which you can send that to the lab to analyse to see if there is a presence of HPV. Pap smear and testing for HPV can be done at the same time and takes only one or two minutes.

Even just a simple examination of the cervix by the gynaecologist, even if you don’t do a Pap smear, can go a long way.

Is cervical cancer treatable?

Today, we have a lot of tests available for detecting HPV. With these tests, you can identify a patient who has been exposed to high-risk strains of HPV. Once it is detected, you can test the patient regularly and you can identify early stages of cervical cancer. If you pick it up in the early stages, you can simply treat it by a small, conservative surgery. But if you miss the early stages and the disease spreads, then it becomes difficult to treat.

Is there a way to prevent cervical cancer?

The most important factor in prevention is information and awareness through sex education. Now we also have the cervical cancer vaccine. Many young girls, between the ages of nine to fourteen years, before they become sexually active, are being recommended the HPV vaccine – a total of two or three injections to be given over a period of six months, and this gives you good protection from the high-risk HPV strains.

The most important factor in prevention is information and awareness through sex education.

What can I do to protect myself against cervical cancer?

Once again, sex education is key. Vaccinating young girls, using protection such as condoms during intercourse and regular screening are key.

 How often do I need to get screened?

It is recommended to start screening at 21 and then do it every three years. If you’re testing for HPV and taking the Pap smear together, you can do it once in five years.

I’m just finding out about cervical cancer now. Can I take the vaccine now?

It’s advisable to take the vaccine before you’re sexually active. But you can still take it in your twenties. Some studies show that there are also some benefits, although reduced, of taking the vaccine up to the age of forty. If you have already been exposed to one strain of HPV, the vaccine could still protect you from other strains.

If you have already been exposed to one strain of HPV, the vaccine could still protect you from other strains.

Any final thoughts on World Cancer Day?

The developed world has really managed to conquer cervical cancer to a very large extent through spreading awareness and putting routine screening techniques in place. If those countries can control cervical cancer – because it’s a treatable, preventable condition – India can also do it.

Dr Rishma Dhillon-Pai is the President Indian Society of Assisted Reproduction (ISAR), and Indian Association of Gynaecological Endoscopists (IAGE). The views expressed are the author’s own.

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