There is a lot of scare about cancer in the air. With all the scientific advancements so far, we have come to a remarkable solution to eliminate one of the leading cancers in women! In this post, I have made an attempt to outline basics about cervical cancer and pap smear to clear doubts and enable all to do their bit in preventing cervical cancer.
A. Worldwide, cervical cancer is the fourth most common cancer in women( with around 569, 847 new cases in the year 2018)and fourth most common cancer-causing mortality in women. In developing countries like India, cervical cancer is the second most common cancer occurring in women accounting for 96,922 new cases in 2018.
Cervical cancer, which at present is the cause of so many cases of cancer in women, can be preventable. It is rare for cancer to be preventable but the worldwide implementation of certain measures has led to a steady decline in the incidence of cervical cancer. Women are sometimes shy or scared about discussing symptoms which might be pointing to cervical cancer and we need to know all about the disease to fight against it.
The cervix is the lower part of the uterus and connects it to the vagina (birth canal). Because of its location, symptoms of cervical cancer include unusual vaginal discharge, abnormal vaginal bleeding (bleeding in between periods or after intercourse), heavy or prolonged periods, pelvic pain, discomfort in passing urine, generalized weakness, weight loss and body pain.
Cervical cancer is treated by surgery, radiotherapy or both. In advanced cases, chemotherapy is also used. Consult the best gynecologist at Manipal Hospitals, Panaji, Goa.
Since the cervix is exposed to the outside environment, it is exposed to many infections. One such infection caused by the Human Papilloma Virus (HPV) is responsible for around 99% of cases of cervical cancer. HPV is transmitted sexually. About 80% of sexually active individuals would have had HPV infection at some time in their life. Apart from cervical cancer, HPV is also associated with vaginal cancer, vulvar cancer, penile cancer, anogenital warts and oropharyngeal cancer. There are over 120 types of HPV of which 14 types are considered high risk for cervical cancer. Amongst the 14 high-risk types, HPV type 16 and 18 are associated with more than 75% of cervical cancer.
HPV infection is very common in sexually active individuals. Majority of women (>90%) are able to clear the infection within a year. However, in some women, the infection persists and the virus causes a mutation in the genetic makeup of cervical cells. The cells then progress from low-grade lesions to high-grade lesions and finally, to the irreversible stage of cancer. The time period from the first infection to cancer ranges on an average, from five to ten years.
Since it is a sexually transmitted infection; women who have multiple sexual partners, exposure to intercourse at an early age or concurrent other sexually transmitted infections (STDs) tend to have a higher risk for cervical cancer. Also, women with low immunity are also at a higher risk of cervical cancer.
HPV infection can be asymptomatic and not cause any health issues for a long time. As it starts to cause lesions in the cervix, it can cause abnormal vaginal discharge, unusual vaginal bleeding, pelvic pain, urinary problems and other problems. Early infection with HPV and precancerous lesions can be detected by screening with Pap smear and colposcopy. At the early stages, these precancerous lesions can be completely treated and cervical cancer can be prevented.
Pap smear is a screening test in which cells from the cervix are gently scraped with a brush or spatula and examined under a microscope for atypical or cancerous cells. The procedure is done on outpatient visits. The vaginal examination might be slightly uncomfortable but is not painful and does not cause long-lasting effects.
Pap smear should ideally be done when a woman is not on her periods. Women should also avoid sexual intercourse, douching or use of spermicidal products on the day before Pap smear as these may wash off the cells and decrease the effectiveness of Pap smear result.
All sexually active women after the age of 21 years should get routine Pap smear tests done once in three years. The tests can be stopped after the age of 65 years if the previous reports are fine. Nowadays, HPV test which tests for viral DNA is also available. In women who undergo HPV testing with or without Pap smear, once in five-year tests are sufficient according to current guidelines. Though most cases of HPV infections occur through sexual transmission, some cases have occurred without any history of sexual contact. Hence, women with no prior history of sexual intercourse are also advised to undergo routine Pap smears after the age of 21 years.
Abnormal cells in pap smear may show the possibility of a low-grade lesion, high-grade lesion or cancer. In cases of certain low-grade lesions, repeat Pap smears are taken yearly to see if the woman clears the infection on her own. If repeat Pap smear/HPV DNA testing shows clearing of infection, women are kept on routine screening. If repeat testing shows the persistence of infection, women are advised to undergo colposcopy (examination of cervix under magnification) and biopsy.
In women with high-grade lesions or cancer, women undergo colposcopy and biopsy and further treatment is decided as per biopsy reports.
There is no sure way of preventing HPV infection. Certain lifestyle choices like a monogamous relationship, use of condoms, early treatment of STDs can decrease the risk of high-risk HPV infection.
Nowadays, vaccines are available in the market which provides immunity against high-risk HPV. Though these vaccines reduce the risk of infection from certain high-risk HPV types, they do not cover all the high-risk HPVs. Hence, women are advised to continue Pap smear screening even if they have had HPV vaccines.
Ideally, HPV vaccination should be given before the first sexual intercourse so that immunity is there before exposure to the virus. They can be given starting from 9 years of age with many programs focusing on immunizing girls in the age group of 9 to 14 years. However, it is licensed for use up to 45 years of age though it may be less efficacious if a woman is already sexually active.
The incidence of cervical cancer is decreasing globally with the use of vaccination and routine Pap smear screening. We can prevent cervical cancer with the routine implementation of these services along with spreading awareness and educating women about their health. An initiative by women and policymakers can bring about a radical change by eliminating cervical cancer.
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