Elsa Angel Rose
25% of global cervical cancer deaths are in India, making the country the biggest in Asia for cervical cancer cases (World Health Organisation GLOBOCAN 2022 data). After breast cancer, cervical cancer is the leading cancer in women in India, with the Indian Council of Medical Research estimating around 1.2 lakh new cases being diagnosed every year. Scientific evidence shows that nearly all cervical cancer cases result from persistent infection with high-risk strains of Human Papillomavirus (HPV), especially HPV types 16 and 18, which are responsible for over 80% of cervical cancer cases in India. HPV is one of the most common viral infections worldwide, and in most cases, the virus that enters a woman’s body is naturally cleared by the immune system within a year or two. However, in some cases involving high-risk HPV strains, this does not happen, leading to changes in cervical cells and the formation of precancerous lesions. “In nearly 90% of individuals, the immune system clears HPV infection naturally within one to two years. However, when high-risk HPV strains such as HPV 16 and 18 persist for many years, they can gradually cause abnormal changes in cervical cells. These changes may progress from precancerous lesions to cervical cancer if not detected early,” said Dr Manasa G V, Associate Consultant of Obstetrics and Gynaecology at Manipal Hospital. Risk factors that can increase the chances of progression of the disease include smoking, low immunity, early sexual activity, multiple sexual partners, and untreated sexually transmitted infections. Cervical cancer usually develops slowly, mostly being asymptomatic, but develops over a span of years. “Before it becomes cancer, there are often early changes in the cervix that can be found through screening tests (precancerous lesions). If these changes are detected early, they can be treated before they turn into cancer. Screening tests available are Pap smear, HPV DNA test and colposcopy,” shared Dr Kinjal Avdhut Kothari, another gynaecologist and obstetrician, Manipal Hospital. Common screening tests of cervical cancer include the Pap smear and the HPV DNA test. Itis when abnormalities are detected that further evaluation through colposcopy and cervical biopsy is advised. The cause of cervical cancer is mostly Human Papillomavirus (HPV). Hence, HPV DNA testing is certainly a major advancement in cervical cancer prevention as it detects the presence of high risk HPV strains even before abnormal cell changes appear. “This helps identify women at risk much earlier than conventional screening methods. Early identification allows closer monitoring and timely treatment, significantly reducing cervical cancer risk,” said Dr Manasa. Treatment for cervical cancer depends on the stage of the cancer. “Early-stage disease may be treated with surgery. In more advanced cases, treatment usually includes radiation therapy, chemotherapy, or both. Brachytherapy is also an important part of treatment for some patients, which is unfortunately not available in GMC or private hospitals in Goa. Patients are referred to KLE or Kolhapur or Bangalore,” shared Dr Kinjal.
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BARRIERS TO EARLY CERVICAL CANCER DETECTION REMAIN
Despite the availability of tests and treatments, lot of women are still diagnosed late. Low awareness is the propelling factor for this late diagnosis. “Many women do not know about screening or the importance of regular check ups,” said Dr Kinjal. Social stigma, fear and embarrassment also prevent women from seeking screening tests or treatments. Dr Kinjal shared, “In some places, access to screening and specialist care is also limited, especially in rural areas. Cost, travel difficulty, and waiting time can also delay diagnosis and treatment. So the gap is not only about medical facilities; it is also about awareness, access, and timely action.”
HPV PROTECTION STARTS WITH VACCINATION
Cervical cancer is a highly preventable cancer in today’s world, given that vaccination and regular screening tests are carried out. “Commonly known HPV vaccines include Cervavac and Gardasil 9. Among these, clinicians increasingly recommend Gardasil 9 because it protects against nine HPV strains, including strains responsible not only for cervical cancer but also for several benign conditions such as genital warts,” explained Dr Manasa. Two important advantages of HPV vaccination is that it is not gender specific and it is often considered a once in-a-lifetime schedule with no routine booster dose currently recommended. “Both males and females can harbour, transmit, and be affected by HPV-related diseases, including cancers of the cervix, anus, penis, throat, and genital region. Therefore, vaccination is recommended for both boys and girls,” said Dr Manasa. Vaccination is highly effective, but when combined with regular screening tests, it is even more beneficial.
