Cervical cancer is a leading cause of cancer death in women in both rural and urban India. India contributes to over 25% of the disease burden and more than 26% of the deaths due to cervical cancer worldwide. More than 75% of the cases presenting in the late stage of the disease renders poor prospects for survival and cure.
Risk factors are :
- HPV- Human Papilloma Virus
- Sexual intercourse at an early age
- Multiple sexual partners
- Sexual partners who have had multiple partners
- HIV positive status
In India, currently only 4.9% of urban women and only 2.3% of rural women aged 18-69 years are screened every year. For prevention of cervical cancer women should be educated early on to think of cervical cancer as an extension of of a sexually transmitted disease .
Behavioral changes to reduce the risk of cervical cancer include limiting the number of sexual partners, delaying initial age of sexual intercourse,and avoiding sexually transmitted disease. The association of cigarette smoking with cervical cancer should also be emphasized. An HPV vaccine (GARDASIL ,CERVARIX) needs to be promoted especially in the age group of 9 years to the age of first sexual debut. Data shows that this vaccine reduces the incidence of both HPV 16 infection and HPV 16 related cervical intra epithelial neoplasia (CIN).
Screening tests available in India are:
- Visual inspection
- Visual inspection with acetic acid(VIA)
- Visual inspection with lugol iodine
- PAP (Papinacolou) smear both conventional and liquid base cytology
- HPV DNA testing
PAP Smear and HPV DNA testing are being used commonly at secondary and tertiary care level for women of age 30-65 years. PAP smear alone is to be done every 3 years and combined testing is done every 5 years. Above 65 years screening is not recommended for women who have had adequate prior csreening and are not high risk for cervical cancer. Post hysterectomy no screening is required if it was done for benign lesions and no history of high grade CIN. For HPV vaccinated women screening is done as per age . When both are done together it is called HPV cotesting ,it is to be performed only if the woman has crossed 30 years of age as most of the HPV infection clears by then with natural immunity. if both PAP and HPV are negative , the screening interval is increased. Colposcopy and directed biopsy is done for screen positive women for diagnostic confirmation .
Dr Poonam Rudingwa