A cancer, that is the third most common cancer in the nation and the second leading cause of death in women, comes with a clause. One can prevent it. While most cancers just happen and one can at maximum detect them early, or treat them with the various armaments, cervical cancer is a unique cancer with a long latent period and availability of a vaccine, that one can prevent it.
In order to understand how we can prevent it, we need to understand what causes cervical cancer. Most common cause of direct causality is an infection with the Human Papillom Virus (HPV). It’s a DNA virus that infests the vagina, cervix and vulva. Over 90% of the cases of infection clear out by the natural immunity of the body. In about 10% cases, the infection persists and causes the start of a cancer-causing pathway. In these cases, the virus infects the normal cells and the viral DNA merges with the DNA of the cells in the lower genital tract. Through a series of well-cascaded events it develops into a pre-neoplastic lesion and over the course of 10-15 years a mere viral infection can progress into a full-blown cancer.
A clear-cut understanding of the pathogenesis of this cancer, brings us a step closer to mitigate it’s effects. Screening for cervical cancer is available and is an effective method to catch it young, even before cancer develops. The screening involves cytology, Pap’s smear or the latest and more efficacious liquid-based-cyology (LBC), which is done by taking a smear from the cervix. LBC is superior to Pap’s smear in terms of it’s higher sensitivity and not being affected by blood as a content.
A more sensitive test for screening is detection of HPV. The test is conducted in the same manner as cytology based tests. The presence of high-risk or the cancer causing HPV strains doesn’t mean that cervical cancer has developed or will definitely develop. It’s presence mandates further work-up and tests as there is a higher-risk to develop cervical cancer. HPV testing is to be initiated after 30 years of age as higher chances of positive results occur before this, as most infections clear out by 30 years.
Another prong in prevention is adminstration of HPV vaccination. It is highly effective in preventing cervical cancer in over 90% cases. Administration should begin from 11 years of age in young girls with two doses, 6-12 months apart and in those over 15 years three doses are recommended at 0, 2 and 6 moths. These vaccines are most effective when given before the onset of sexual activity. The upper age limit specified by the international Centre for Disease (CDC) guidelines is 26 years, yet it’s best to take them as early as possible as the efficacy reduces thereafter. There are various kinds of vaccines available including the latest nonavalent – Gardasil-9, the quadrivalent Gardasil-4 and bilvalent – Cervarix. The latest vaccine Gardasil-9 provides immunity against 9 strains including 7 cancer causing variants of HPV and 2 genital wart causing strains. An important point to remember is that despite vaccination status, screening with LBC and HPV is a must and should be done routinely as per the guidelines.
Practising safe sex with barrier protection, maintaining hygiene, a wholesome diet to boost immunity, quiting smoking, limiting the use of oral contraceptive pills (debatable – given its’s benefits in ovarian cancer risk-reduction) are few other lifestyle changes that can help reduce risk of development of HPV infection.
Let’s make all the noise around cervical cancer prevention, because we effectively can. These simple methods of screening with cytology and HPV testing can help us detect any abnormal development of pre-cancerous lesions at their onset so that treatment can prevent development of cancerous lesions. Vaccination is a higly effective method if adminstered at the right time and reduce the burden of HPV infection at the society level.