In matters of health, ignorance is not bliss. In fact, it’s the opposite. Ignorance can be life-threatening, whereas knowledge can save lives. January 2024 is cervical health awareness month and the theme this year is Learn Prevent Screen.
The cervix is the lower part of the uterus that connects to the vagina. A healthy cervix is important for the genital health of any woman. This 3.5 cm long organ lies within the vaginal cavity and is prone to develop infections, ulcer sores (erosions), and even polyps or fibroids just like those in the uterus. Some women may have symptoms like post-menopausal bleeding, pain during intercourse, contact bleeding, foul-smelling vaginal discharge, or spotting between menses. Pelvic pain or low back pain may also be experienced.
Hormonal changes from puberty up to menopause do affect the cervix, and it undergoes atrophy (shrinkage) after menopause. Maintaining proper hygiene of the genital area is of utmost importance to prevent infections. Practising safe sex because most infections are sexually transmitted, having a diet rich in anti oxidants, quitting smoking if you are a smoker and regular visits to your Gynecologist for cervical screening are good investments for your health as untreated lesions of the cervix can progress to cancer.
But what if I told you that there’s a cancer which is detectable early, preventable AND curable? You would be shocked right ? Because these are NOT words you usually associate with the dreaded C (cancer). However, cervical cancer is all of the above. And yet close to 3 lac women die of cervix cancer every year. It is the fourth most common cancer in women globally. To put things in perspective : one life is lost to cervix cancer every two minutes.
The most important cause of cervical cancer is Human Papilloma virus infection. Commonly known as HPV, this virus causes warts in a variety of locations including skin and genital organs. While more than 100 types of HPV exist, only about a dozen of them are associated with cervical disease. Out of those, HPV 16 and HPV 18 are called high risk HPV as they account for 70 percent of all cervical disease.
In 99 percent cases it is a self limited disease which does not progress and gets cured on its own in 1 or 2 years. But it does persist in 1 percent of the affected population and can progress to cancer. In HIV positive individuals this chance of developing cancer goes up to even 5 or 6 percent.
It is a sexually transmitted virus, but easily preventable by simple measures like limiting the number of sexual partners and practising safe sex. The chances of infection go up if sexual intercourse occurs at young age and hence awareness must be created among the youth about importance of delaying sexual intercourse. There is also an effective vaccine available against HPV which should be given between the ages of 9 to 26 years. India has developed an affordable vaccine and its inclusion in the Universal Immunization Program will spearhead HPV prevention in our country.
HPV infection has a strong socioeconomic corelation as 90 percent of all cases occur in low and middle income groups due to lack of hygiene, lack of awareness and lack of access to screening and treatment. The HPV infection does not cause any symptoms and hence it may go unnoticed until it leads to genital warts. After being infected it takes many years to develop into cancer going through stages called as dysplasia (pre cancer). If it is detected during this early stage it can be managed effectively.
This understanding of the link between HPV and cervix cancer prompted the WHO to devise the 90-70-90 strategy in the year 2020. This means that by the year 2030 , 90% of girls under 15 years should get fully vaccinated with the HPV vaccine, 70% of women between the age of 35 to 45 years must be screened by Pap smear and 90% of women with pre-cancer or cancer should be managed.
Many women are either embarrassed or scared to get a Pap smear done. They equate Pap smear with cancer and avoid getting tested. As a pathologist, I have always been fascinated by the Pap smear technique for detecting cervical cancer. It is a boon to all women because it is an easy and noninvasive technique used for screening which can detect early changes in the Cervix before they progress to cancer. All that is involved is gently scraping the cervix of the uterus with a brush or spatula and sending the cells for study. As they would say in a popular advt on TV it’s as easy as apple pie.
The patient can walk out within a few minutes after the procedure and she can expect her results to be ready in a few days. It is quick, easy and painless. Many conditions other than cancer like fungal infections or ulcers can be detected and treated. Talking to your Gynecologist can help remove your fear. To quote another popular advt डरकेआगेजीतहै. So ladies, this January let’s all pledge to get a Pap smear test done and beat the dreaded C before it beats us.