The cancer of the cervix (lower part of the uterus) continues to be a major killer in Indian women. Every year more than 1,00,000 cases of cervical cancer are diagnosed and many may actually be going unreported.
Many women are diagnosed in an advanced stage when treatment outcomes have low survival rates. The condition is known to remain silent for long periods and when women do develop symptoms, the condition is unfortunately, very advanced. Women are forced to live (or should we say, just exist) with foul malodorous vaginal discharge, incontinence of urine and/or stool (due to growth of cancer into the urinary bladder and rectum, respectively), and kidney problems (uremia). Such women become socially isolated and uncared for in the last days of their lives. Even palliative radiotherapy and chemotherapy become impossible.
The tragedy in compounded by the fact that cervix is an easily accessible organ, just like the breast and oral cavity. Simple checkups can avert many slow, painful deaths. However, unlike the inspection of breast and oral cavity, which a person can do by herself, cervical examination requires a visit to the gynaecologist.
The developed world has a continuous screening programme for cervical cancer which includes pap smear and colposcopy. This has resulted in early detection and treatment of not only cancer, but also of lesions even before they have progressed to become cancer. It is rare to find a woman in the advanced stage of cervical cancer in the developed world.
Pap smear t is the screening test used to detect early cancer of the cervix and pre-cancerous conditions of the cervix. It is relatively inexpensive and painless. The test is done by a gynaecologist by taking a scraping from the cervix. The report is given depending on whether abnormal cells are detected, and, also depending on the degree of the abnormality detected.
Remember, pap smear is a screening test and not a diagnostic or a confirmatory one. It can be ‘false positive’, ie, abnormal even when none present, or, ‘false negative’, ie, normal even when some abnormality is present. Abnormal pap smears should be followed by a colposcopic examination.
What is colposcopy
It is a specialised test done by a gynaecologist. Colposcope is a low magnification microscope that enables the colposcopist to study the cervix in detail and take biopsy form suspicious areas.
A hysterectomy (removal of the uterus) should never be done for an abnormal pap smear report without a prior colposcopic examination. This is because woman may be harbouring a silent cancer, which requires radical surgery and/or radiotherapy. By undergoing a ‘simple hysterectomy’ the woman is under the impression that she has been cured, but the cancer is still growing. And when the woman finally presents with cancer after some years, the disease is usually unresectable. Unlike the west where colposcopy is an expensive investigation, the cost in India doesn’t exceed a few hundred rupees.
Vaccine offers hope
The advent of recombinant DNA vaccine against Hepatitis B has made liver cancer a vaccine-preventable cancer. Now, with the introduction of a vaccine against cervical cancer, it may probably become the next vaccine-preventable cancer known to mankind. The Human Papilloma Vaccine (HPV) vaccine should ideally be given to teenage girls before commencement of sexual activity. The risk factors for the development of cervical cancer are: early age of first intercourse, multiple partners, multiple deliveries, low socioeconomic status, genital infections and smoking. The common factor in all the above factors is HPV infection. HPV vaccine, now available in India, protects against infection and is thus able to prevent cervical cancer.
(The writer is a gynaecologist specialising in colposcopy attached to Elbit Diagnostics)
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