FARIDABAD, January 18 – Cervical cancer is the second most common cancer in Indian women accounting for about 18% of all cancers occurring in this demographic group. Every year, over 1,20,000 new cases of this disease are diagnosed out of whom more than 77,000 cases succumb to death owing to diagnosis during advanced stages of the cancer, bringing the mortality rate to approximately 63%, said a doctor at Amrita Hospital, Faridabad.
A major cause of high burden of cervical cancer in India is lack of awareness and lack of cervical screening. Morbidity and mortality owing to late detection and lack of access to required treatments constitute the driving evils of cervical cancers. On the contrary, early screening of the disease can help find changes in the cervix before cancer develops. It can also detect cervical cancer before the malignant cells spread and is amenable to curative treatment.
Dr. Neha Kumar, Senior Consultant, Gynaecological Oncology, Amrita Hospital, Faridabad said, “Nearly all cases of cervical cancer can be attributed to persistent Human papillomavirus (HPV) infection. Other risk factors are marriage at a very young age, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, smoking, immunosuppression including HIV infection, prolonged use of oral contraceptives, and lack of awareness and screening. Warning symptoms or early signs of cervical cancer include irregular vaginal bleeding, bleeding in between periods or after sexual intercourse, postmenopausal bleeding, and foul-smelling vaginal discharge. Some patients may also experience lower back pain or lower abdominal pain.”
Cervical screening by conventional methods requires Pap Smear and HPV tests which require pathology and laboratory services that may not be available in all parts of the country, especially the remote and rural areas. An effective way to screen women in these areas are by methods known as VIA (Visual Inspection with Acetic Acid) and VILI (Visual Inspection with Lugol’s Iodine). These methods use substances like acetic acid and Lugol’s iodine to see changes in cervix which can be detected by the naked eye. Using this, one can identify abnormalities in cervix, if any, and such patients can be referred to district hospitals to gynecologists for cervical biopsies and further management.
“Peripheral health workers can play an extremely important role in cervical screening in rural areas, where facilities for conventional Pap smear and HPV tests may not be available. Further, these tests, are at present expensive, and may not be affordable to a large section of the society. Visual inspection of the cervix with acetic acid and Lugol’s Iodine can serve as an effective screening method in these regions, and peripheral health workers can be trained to do these procedures. Trained health workers can identify abnormalities in cervix, if any, with these methods and refer the women with abnormal findings to gynecologists. Women with normal findings can stay under regular screening and surveillance by VIA and VILI done by these workers,” added Dr. Kumar.
Cervical cancer, in spite of its high morbidity and mortality rates, is a preventable cancer and it is hence vital to take a step towards curbing its occurrences in India. This can be done through bridging the gap in screenings. HPV vaccination for young girls is essential, although not part of India’s Universal Immunization Program. Challenges in treatment availability need to be addressed with equal concern, with efforts poured towards widespread access, especially in remote areas.