By Dr Suman Singh
Cervical cancer is caused by the human papillomavirus; it begins in the cervix which is the lower part of the uterus. Here there is an uncontrolled growth of the cells which displaces normal healthy tissue causing abnormal intermenstrual/post-coital bleeding and discharge. Ultimately it spreads to the surrounding structures leading to morbidity and death.
How big is the problem?
About every 9 minutes one Indian woman loses her battle with cervical cancer. India accounts for approximately 20% of HPV-related cancers worldwide. The mortality rate of HPV-related cancers is 60%.
Who is at risk of cervical cancer?
Becoming sexually active at a young age, those with a greater number of sexual partners, those whose partners have had multiple partners, those who smoke, have poor hygiene, who have had induced abortions, and those who have used birth control pills over a long period of time are susceptible in developing cervical cancer. Around 31 % of women are HPV positive within the first year of sexual intercourse and 50% within 3 years.
What are the signs of cervical cancer?
Early cervical cancer usually has no signs which is why screening is so important. Those who are symptomatic will have vaginal spotting or bleeding after sexual intercourse, in between menstrual cycles or after menopause and they may also have foul-smelling discharge which does not go away even after treatment.
How is cervical cancer diagnosed?
The most common screening test is the Pap smear test where the doctor will collect a sample of the cells from the cervix and send it for examination. Unfortunately, less than 5% of women are regularly getting themselves screened in India. Cervical cancer is the second most common cause of death in women after breast cancer and most affected individuals are unaware that they are infected, hence may unknowingly spread the virus.
What is HPV?
It is a small non enveloped ds DNA virus that affects the squamous epithelial cells. More than hundred types are identified of which 30 to 40 infect the genital area of women and men. The low-risk types causing genital warts are HPV 6 and 11 and the higher-risk oncogenic types causing cancer are HPV 16,18,31,33,45,52,58. These 9 serotypes may cause 55 million cases of HPV cancers and diseases in India. HPV causes more than cervical cancer. These high-risk serotypes are responsible for 98% of cervical cancer, 95% of vulvar cancer, 77% of vaginal cancer, and 73% of anal cancer.
How common is HPV infection?
HPV infection is quite common. About 80% of women would have acquired an HPV infection in their lifetime. Over 80% of HPV infections are transient, asymptomatic, and resolve spontaneously so for every one million women infected with HPV, 1600 develop invasive cervical cancer if left untreated. Since cervical cancer takes around 10 to 15 years to develop it is important to vaccinate young adults in their teens and early life in order to prevent the disease later. In women apart from cervical cancer it causes anal cancer, vulval cancer, oro-pharyngeal cancer, vaginal cancer, anogenital warts, and recurrent respiratory papillomatosis.
HPV affects only women or men also?
As per a global study, 6.5 out of 10 men have an HPV infection. Men are highly susceptible and have a low rate of seroconversion following HPV Infection. It causes oropharyngeal, anal, and penile cancers, anogenital warts, and recurrent respiratory papillomatosis in men.
Need for prevention of cervical cancer?
Vaccines produced by recombinant DNA technology help in creating neutralizing antibodies thereby improving the natural immunity and clearance of the HPV virus. The vaccine efficacy is 100% against genital warts and vulval and vaginal pre-cancers and 90% against cervical cancer when taken correctly. Impressive declines were detected within four years after vaccine availability in various countries like Australia, the United States, Denmark, etc.
What is the recommendation for vaccination?
Young girls less than 14 years of age need only two doses of the vaccine at 0 and 6 months. Above 14 years of age 3 doses of the vaccine are required at 0, 2, and 6 months intervals. All three doses should be given within a one-year period. It is an intramuscular injection in the deltoid region, the second dose should be administered at least one month after the first dose and the third dose should be administered at least three months after the second dose. Vaccination is not given in pregnancy but it’s perfectly safe and encouraged to be taken post-delivery during breastfeeding. There is no need for a booster dose and three doses give lifelong protection. Cervical cancer vaccine has been included in the National Immunization Program of India for less than 15 years of age in 2023.
Contraindications?
Contraindications include being hypersensitive or having an allergy to active substances, and excipients (such as yeast or latex), as well as being pregnant or experiencing severe acute illness.
Dr Suman Singh is Consultant Obstetrician and Gynecologist at Birthright by Rainbow Hospital, Bannerghatta Road, Bangalore