Regular screenings will help prevent cervical cancer

A woman dies of cervical cancer every eight minutes in India

Regular screenings could help detect cervical cancer at an early stage.

Cervical cancer is one of the most common type of cancer among women in the country, second only to breast cancer. It is estimated that cervical cancer will occur in approximately 1 in 53 Indian women during their lifetime. A survey by the oncologists of HGC Cancer Centre found that about 850 cases are recorded every year in Bengaluru alone, accounting for 21.1 per cent of the total cases of cervical cancer in India.

However, unlike other forms of cancer, cervical cancer can be prevented. Vaccination, regular pap smears, pelvic screening, along with practising safe sex can help bring down these numbers. 

How to prevent cervical cancer?

In India, there are two vaccines that are equally protective against cervical cancer, with their difference being the number of dosages. The vaccination is most effective if administered to girls between the ages of nine and 16. “As it is a preventive method, it is best to provide them with the vaccination before they become sexually active. However, one can take the vaccination up to 45 years of age even if they are sexually active. However, the longer you are sexually active and the older you are, makes the vaccination less effective,” says Dr Soumya Holla, Oncologist at Apollo Hospital.

Since it is a slow-growing form of cancer, taking anywhere between 5-20 years to develop, regular check-ups also help. An abnormal pap smear alone would reveal pre-cancerous lesions. “All women above 21 years or anyone who is sexually active should get regular pap smear examinations done,” says Dr Sowmya KN, OB-GYN, BGS Gleneagles Global Hospital. “One should practice safe sex, regardless of whether they have a single partner or multiple partners because semen analysis is the only way for one to know if they carry the infection. It is always better to be safe,” she adds. 

This form of cancer does not cause any noticeable symptoms in its initial stages. To further complicate matters, common symptoms can often be confused for symptoms of other ailments. For instance, cervical cancer can cause vaginal bleeding between menstrual periods or after sex, which is often misconstrued as irregular periods. As cervical cancer progresses, more severe symptoms may appear, however, treatment might not prove to be effective in these situations. The National Family Health Survey-4 had found that Karnataka has the least number of women who have their cervix screened during their lifetime, leaving the state’s women extremely vulnerable to the disease.

The stigma around HPV

Since HPV gets transmitted only via sexual contact, many parents, and even doctors, wrongly discourage the use of the vaccine. Many studies have shown parents are often unwilling to get their daughters vaccinated due to lack of knowledge of HPV vaccine, and socio-cultural, economic and religious issues. Many believe that the vaccination would make sex safe, leading to promiscuity. 

“We have to be realistic. I often give the example of my own daughter to make parents feel at ease. I understand their concern, but I rather give my daughter vaccinated and have her future secured,” says Dr Holla. The government should also make efforts to create more awareness around HPV. The vaccine should preferably be introduced to parents as a cervical cancer-preventing vaccine and not as a vaccine against a sexually transmitted infection.

Educating children about safe sexual practices play an important role as well. “It is one’s own prerogative to have sex. However, it is the responsibility of the adults to inform their children,” Dr Sowmya says. The stigma around premarital sex has played a huge role in placing a stigma around the vaccination. Parents need to be made to understand that there is a difference between being orthodox and being responsible, she adds.

High cost is another deterrent 

Current estimates suggest that one woman dies of cervical cancer every 8 minutes in India. Yet there is no nationwide government-sponsored screening or vaccination program. Since no Indian company has ventured into its manufacturing, the price of the vaccination ranged between Rs 30,000 to Rs 40,000 per dosage, makes it inaccessible to the common people. A government initiative could lower the prices to at least five to six thousand, doctors suggest. “It is not included in the vaccination schedule like the others since private companies are manufacturing it. The government needs to step up and find ways to make the medicine accessible, along with employing programs to increase awareness,” she says. 

Women of lower socio-economic background face a higher risk of contracting HPV. Lack of awareness about safe sex practices, or the lack of availability of the vaccinations in the first place, and poor access to health care facilities play a huge role in this. The government needs to acquire the vaccination or have a private player manufacture a vaccination that is provided to people at a much lower rate, she adds. 

The Supreme Court litigation following the 2009 trails of HPV that was carried out illegally among girls from poorer socio-economic background in Gujarat and Andhra Pradesh could be one of the reasons the government has not made any efforts to make the vaccination mandatory. Several girls died during the course of the trial. Even though the vaccinations were proven to not be the cause of death, the government found fault with the NGO Program for Appropriate Technology in Health (PATH), a non-profit based in Seattle, that launched the trail, the Indian Council of Medical Research and the Drugs Controller General of India.

This decision is believed to have placed a halt on all clinical trials and future efforts of developing a vaccination in India. However, keeping in mind the benefits of the vaccination, the government needs to take step to incentivise researchers to create a solution that is accessible to women across the country. Until then, regular pap smears are your friend. 

What is cervical cancer?

Cervical cancer is a form of cancer that affects the cells of the cervix, the lower part of the uterus that connects to the vagina. It is caused by the human papillomavirus (HPV), a virus that is generally transmitted through sexual contact.

This is the leading form of cancer in Indian women and the second most common cancer in women worldwide. 

What is HPV?

Human papillomavirus (HPV) is a group of viruses that are commonly transmitted through sexual contact. Estimates suggest that more than 80 per cent of sexually active women acquire HPV. However, out of the 100 or more types of HPV virus, only two (16 and 18) are cancer-causing.

Often, other environmental and lifestyle factors such as smoking, having multiple sexual partners and having sex at a young age are often cited as contributing factors. "HPV infection has been identified in almost 99.7 per cent of cervical cancer patients. There are many theories around how lack of hygiene and the number of sexual partners can play a role, but none of them has been proven," he says. However, someone with HIV or other sexually transmitted diseases could place one at a higher risk, he adds.  

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