Things every women should know about Cervical Cancer

Cervical cancer is a growth of cells that starts in the cervix. The cervix is the lower part of the uterus that connects to the vagina.

Various strains of the human papillomavirus, also called HPV, play a role in causing most cervical cancers. HPV is a common infection that’s passed through sexual contact. When exposed to HPV, the body’s immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years. This contributes to the process that causes some cervical cells to become cancer cells.

You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.

When cervical cancer happens, it’s often first treated with surgery to remove the cancer. Other treatments may include medicines to kill the cancer cells. Options might include chemotherapy and targeted therapy medicines. Radiation therapy with powerful energy beams also may be used. Sometimes treatment combines radiation with low-dose chemotherapy.

When it starts, cervical cancer might not cause symptoms. As it grows, cervical cancer might cause signs and symptoms, such as:

Vaginal bleeding after intercourse, between periods or after menopause.
Menstrual bleeding that is heavier and lasts longer than usual.
Watery, bloody vaginal discharge that may be heavy and have a foul odor.
Pelvic pain or pain during intercourse.

Causes

Cervical cancer begins when healthy cells in the cervix develop changes in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The changes tell the cells to multiply quickly. The cells continue living when healthy cells would die as part of their natural life cycle. This causes too many cells. The cells might form a mass called a tumor. The cells can invade and destroy healthy body tissue. In time, the cells can break away and spread to other parts of the body.

Most cervical cancers are caused by HPV. HPV is a common virus that’s passed through sexual contact. For most people, the virus never causes problems. It usually goes away on its own. For some, though, the virus can cause changes in the cells that may lead to cancer.

Types of cervical cancer

Cervical cancer is divided into types based on the type of cell in which the cancer begins. The main types of cervical cancer are:

Squamous cell carcinoma. This type of cervical cancer begins in thin, flat cells, called squamous cells. The squamous cells line the outer part of the cervix. Most cervical cancers are squamous cell carcinomas.
Adenocarcinoma. This type of cervical cancer begins in the column-shaped gland cells that line the cervical canal.

Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix.

Risk factors

Risk factors for cervical cancer include:

Smoking tobacco. Smoking increases the risk of cervical cancer. When HPV infections happen in people who smoke, the infections tend to last longer and are less likely to go away. HPV causes most cervical cancers.
Increasing number of sexual partners. The greater your number of sexual partners, and the greater your partner’s number of sexual partners, the greater your chance of getting HPV.
Early sexual activity. Having sex at an early age increases your risk of HPV.
Other sexually transmitted infections. Having other sexually transmitted infections, also called STIs, increases the risk of HPV, which can lead to cervical cancer. Other STIs that increase the risk include herpes, chlamydia, gonorrhea, syphilis and HIV/AIDS.
A weakened immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
Exposure to miscarriage prevention medicine. If your parent took a medicine called diethylstilbestrol, also known as DES, while pregnant, your risk of cervical cancer might be increased. This medicine was used in the 1950s to prevent miscarriage. It’s linked to a type of cervical cancer called clear cell adenocarcinoma.

Prevention

To reduce your risk of cervical cancer:

Ask your doctor about the HPV vaccine. Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers. Ask your health care team if an HPV vaccine is right for you.
Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix. These conditions can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
Practice safe sex. Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections. This may include using a condom every time you have sex and limiting the number of sexual partners you have.
Don’t smoke. If you don’t smoke, don’t start. If you do smoke, talk to a health care professional about ways to help you quit.

India plans a national drive to vaccinate girls between nine and 14 years against the human papillomavirus (HPV) that causes cervical cancer, the country’s finance minister has announced .

While the country has not announced the exact date for the campaign, finance minister Nirmala Sitharaman said in her interim annual budget speech in February, “Our government will encourage vaccination for girls in the age group of 9 to 14 years for the prevention of cervical cancer.” India goes to the polls in April 2024, and the final annual budget will be presented in July by the incoming government.

The country records one new case of cervical cancer every four months, and one death every seven minutes.

Although the HPV vaccine was introduced in India in 2008, it is yet to be included in the country’s universal immunisation programme. “HPV vaccination was introduced into immunisation programmes in Punjab and Sikkim (states) in 2016 by the respective governments,” Prashant Mathur, director of the National Centre for Disease Informatics and Research, Bengaluru, told VaccinesWork. “The coverage was high, with 97% of the targeted girls successfully vaccinated. At the national level, it is being planned to be rolled out.”

India’s efforts are in line with the all-out international drive to eliminate the vaccine-preventable cancer among women. In March, global health organisations including the World Health Organization (WHO) and Gavi announced major new policy, programmatic and financial commitments by governments, donors and multilateral institutions, including nearly US$ 600 million in new funding, to eliminate cervical cancer.” The global health partners stated, “If these ambitions to expand vaccine coverage and strengthen screening and treatment programmes are fully realised, the world could eliminate a cancer for the first time.”

Long road ahead

While rates of cervical cancer are declining in India, there is a long road ahead to elimination. The country records one new case of cervical cancer every four months, and one death every seven minutes. Currently, there are 340,000 cases in the country. It is the third most common cancer in India, and second most common among women, with over 127,000 new cases and about 80,000 deaths reported in 2022.

Cervical cancer accounts for one tenth of all cancers in Indian women, says Mathur. The country’s north-eastern states record both the highest and lowest incidence rates – Papum Pare in Arunachal Pradesh and Aizawl in Mizoram are hard-hit, with 27.7 cases and 27 cases per every 100,000 women respectively. The lowest rates of cervical cancer are observed in Dibrugarh district in Assam, with about 5 cases per 100,000 women.

Currently, roughly two thirds of the Indian women diagnosed with cervical cancer will die of the disease. This can only mean women are presenting with late-stage cancers, and that preventive services are not reaching the majority of girls and women

In India, cervical cancer is screened by the visual inspection of the cervix for abnormalities after applying diluted acetic acid, mostly as part of the public health system, says Mathur. Screening is covered under the country’s national programme for prevention and control of non-communicable diseases.

Estimates of the percentage of women screened in India for HPV vary widely, but concur that screening is below par. For example, a 2019 study by Ravi Mehrotra, adjunct professor at the Rollins School of Public Health, Emory University, US, and director of the non-profit Indian Cancer Genome Atlas Foundation, found that less than one third of the women surveyed reported having been screened, and these were mostly women in urban areas. Meanwhile, data from a factsheet of the HPV Information Centre managed by the Catalan Institute of Oncology (ICO) and International Agency for Research on Cancer (IARC) indicates that 2% of women have been screened for the cancer, which is aligned with India’s fifth National Family Health Survey NFHS-5 survey’s data of cervical cancer screening at 1.97%.

Vaccine products

In India, two HPV vaccines were licensed in 2008: a quadrivalent vaccine known commercially as Gardasil, and a bivalent vaccine called Cervarix. Both vaccines provide approximately 90% protection from cervical cancer with the antibodies remaining stable for at least 10 years. In September 2022, India launched a home-made product marketed as Cervavac.

Currently, HPV vaccines in India are only available under prescription by private practitioners. “HPV vaccination uptake in India is low due to its high cost, misinformation regarding safety and effectiveness, and discouraging cultural perceptions for vaccines,” says Mehrotra. The vaccine costs approximately 3,000 rupees or US$ 36 per dose.

Those cultural perceptions include the stigma surrounding reproductive health issues in India, especially related to sexual organs like the cervix, and low awareness of the need for HPV vaccination, he elaborates. Other observers note that the same concerns can negatively impact uptake of screening.