Q: What is cervical cancer?
A: Cervical cancer is the cancer of the opening/ mouth of the uterus, called the cervix. The cervix connects the uterus to the vagina and is covered by a thin layer of tissue made up of cells. Healthy cells grow, divide and are replaced continuously. Cancer of the cervix occurs when cells become abnormal. Cancer cells divide more rapidly and grow into deeper and surrounding tissue.

Q: How common is it?

A: India accounts for nearly one fourth of the world’s cervical cancer deaths. It is the second most common cancer in Indian women (breast cancer being the first). Unlike women in developed world who have regular screening programmes to detect cervical cancer early , women in India are often diagnosed too late because of the lack of self screening, and the stigma and shame associated with a pelvic examination. Therefore, many women are diagnosed only in advanced stages, thus making treatment and recovery difficult.

Q: What are the symptoms of cervical cancer?

A: Cervical cancer in very early stages usually does not have any symptoms. The longer a woman has cervical cancer without diagnoses, the more likely she will have symptoms.

1. Abnormal vaginal bleeding

Bleeding /spotting between cycles; after intercourse; after menopause

• Unusual vaginal discharge

While vaginal discharge is considered normal, the type of discharge you experience could be an indicator of vaginal/cervical health. With cervical cancer you may notice discharge that is foul smelling and pink, brown or bloody in color. Sometimes there can be foul smell associated.

• Weight loss, painful bowel movement, painful intercourse and obstruction to urine flow may be seen in advanced stages.

Q: What  are the risk factors for cervical cancer?

A: 1) HPV infection.

 The most important risk factor for cervical cancer is infection with Human Papilloma Virus (HPV) .More than 90% of cervical cancers are linked to the virus. There are many types of HPV. The high risk types can cause cancer of cervix, anus, vulva, vagina and penis.

It is important to note that most healthy women infected with HPV do not develop cervical cancer, and most HPV infections will eventually go away on its own. When exposed to HPV, the body’s immune system typically prevents the virus from doing harm. However, in a small percentage of people, the virus survives for years, contributing to the process that causes some cervical cells to become cancer cells.

The following risk factors increase your risk of becoming infected with HPV

• Early age at first intercourse (especially younger than 18)
• Multiple sexual partners
• Smoking: women who smoke are about two times more likely to get cervical cancer , compared to non smokers
• History of sexually transmitted infections especially gonorrhea, Chlamydia and syphilis
• Poor hygiene and sanitation and low economic status
• Weakened immune system as in HIV infection or in patients on immunosuppressant medications and steroids

2) Not getting screened

    Cervical cancer is most often found in women who have not been screened with the Pap test in more than five years or who have never been screened at all.

3) History of cervical dysplasia (abnormal cell growth) which has not been adequately followed up or treated.

Q :How can cervical cancer be prevented?

A: There’s no single way to completely prevent cervical cancer, but there are certain measures that can reduce your risk.

• Screening tests

Cervical cancer is preventable by screening women for precancerous cervical lesions. Cervical cancer has a long pre cancerous period, generally 10 to 15 years. This provides a considerable window of opportunity to detect pre malignant lesions. Early detection of the pre malignant conditions allows the disease to be cured completely. If regular screening is made part of the routine check-up of all women who are susceptible, the onset of cancer can be detected and combated effectively.

• HPV vaccine

The link between the development of cervical cancer and some types of HPV is clear. Although the vaccine may protect against only four subtypes of the virus( 16, 18, 51, 55), these account for majority of cervical cancer cases.

HPV vaccines work best if administered prior to exposure to HPV. Therefore, the World Health Organization recommends vaccination for girls aged between 9 and 14 years, when the sexual activity has not started

An important point to be noted is that vaccine does not replace cervical cancer screening.

• Avoiding multiple sexual partners

 The more sexual partners a woman has, higher is the risk of transmitting HPV virus

• Delaying first sexual intercourse

The younger the woman is when she has sexual intercourse for the first time, the higher the risk of HPV infection becomes. The longer she delays it, the lower her risk

• Stopping smoking

Q: How long does it take for pre cancerous lesions to become cancerous?

A: It takes many years for cervical cancer to develop and spread.

In the early stages cell changes that occur before cancer is detected are called dysplasia. Many women are diagnosed with precancerous cell changes in their 20s and 30s but the average age of diagnosis of cervical cancer is age 49, which indicates the slow progression of the disease.

Q: what are the different screening tests available?

A: 1) Pap smear is the most commonly used cervical cancer screening test.

    2) HPV DNA test for high risk HPV types

3)  Visual inspection with acetic acid (VIA) inspects the cervix using acetic acid to identify abnormal changes on the cervix

Q: What is a pap smear/test?

A: Pap smear is a screening test to find conditions that may lead to pre cancer or cancer of cervix.

Regular Pap smear screening is the best way to identify abnormal changes in the cells of the cervix at an early/ pre cancerous stage.

Pap smear can be done during routine gynecology check up. It is procedure done without anesthesia and it involves collecting of cells from cervix and vagina by a gentle applicator or brush.

 Pap smear screening recommendation (American cancer society 2020)

<25 years: no screening

25 to 30 yr: Pap smear every 3 years

30 to 65 years: Pap smear every 3 years or Pap + HPV testing every 5 years

>65 years: No screening if consistent negative screening in last 15 years. However women with no prior screening should undergo tests once at 65 years, and if negative, exit screening. Women who have had a  total hysterectomy with removal of the cervix also do not need to ne screened al

Q: What is HPV test

This test looks for cervical infection by high risk types of HPV. The HPV test and the Pap test are done the same way and both can be done together (co test). However the HPV test is costlier as compared to a conventional pap test.

The take home message is that cervical cancer is one of the most preventable cancers today.

Knowledge and awareness about regular screening can help in early detection and significantly reduce the associated complications and disease burden.