Cervical cancer: Preventable but neglected disease affecting Indian women

January 24, 2018

January is the month for awareness on cervical cancer. Cervical cancer is the fourth most common cancer among women worldwide and second most common cancer among women living in less developed regions. The worrying fact is that India has the highest number of cervical cancer patients in the world and the incidence is high in rural areas. According to the World Health Organization (WHO), every year 1,22,844 women are diagnosed with cervical cancer and 67,477 die from the disease. In India cervical cancer is the most common cancer among women and also the second most common cancer among women between 15 and 44 years of age.

The cervix is an important part in the woman’s reproductive structure. The lower part of the cervix (ectocervix) lies within the vagina and the upper two thirds of the cervix (endocervix) lies above the vagina. Most cervical cancers originate in the area where the endocervix and ectocervix join. The initial signs of cervical cancer are not specific and include vaginal discharge with a foul odor, blood in the vaginal discharge and pain in the lower abdomen. Once the disease progresses, symptoms can include bleeding during intercourse, pain and loss of weight.

Nearly all cases of cervical cancer can be attributable to the human papillomavirus (HPV) infection. HPV is a group of viruses and one of the causative agents in sexually transmitted infections (STIs) in men and women with and without clinical lesions. HPV is a group of over 150 viruses that cause warts in various parts of the body. The other epidemiological risk factors for cervical cancer are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness.

Cervical cancer can be prevented by vaccinating all young females against the HPVs and by screening and treating precancerous lesions in women. However, it is alarming that awareness levels of women-related cancers are low among the general population. Studies have confirmed that screening improves early detection of cancers by 1.5-2.5 times. However, despite established benefits of screening, coverage for the same in India is low for women. At a national level, there have been regular campaigns against cervical cancer. But this has had little impact on the morbidity and mortality of the disease. The sad aspect is that almost 70% of newly diagnosed cancers are detected in late stages. Late detection also adds to the cost of treatment as estimates indicate that the treatment cost for late-stage cancers is almost 2 times higher than the cost of early-stage cancers.

What is Cancer in General and of the Cervix in Specific?

Cancer occurs when cervical cells become abnormal and, over time, grow out of control. The cancer cells invade deeper into the cervical tissue. In advanced cases, cancer cells can spread to other organs of the body. In the case of cervical cancer, it usually takes 3–7 years for high-grade changes in cervical cells to become cancer.

Screening for Cervical Cancer

Prevention is better than cure and is very suitable in preventing cancer. Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer. Cervical cancer screening may detect these changes before they become cancer. Women with low-grade changes can be tested more frequently to see if their cells go back to normal. Women with high-grade changes can get treatment to have the cells removed.

Cervical cancer screening includes the Pap test and, for some women, an HPV test. Both tests use cells taken from the cervix. The screening process is simple and fast. The cells are removed from the cervix with a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing: For a Pap test, the sample is examined to see if abnormal cells are present. For an HPV test, the sample is tested for the presence of 13–14 of the most common high-risk HPV types. The recommendations for Pap and HPV tests are as follows:

1. Women aged 21–29 years should have a Pap test alone every 3 years. HPV testing is not recommended.

2. Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred). It also is acceptable to have a Pap test alone every 3 years.

3. Women above the age of 65 need not have a Pap test if they do not have history of moderate or severe abnormal cervical cells or cervical cancer, and have had either three negative Pap test results in a row within the past10 years.

4. Woman who have had hysterectomy [surgical procedure whereby the uterus (womb) is removed], may still need screening. This depends on whether the cervix was also removed along with the uterus, why hysterectomy was performed, and whether the woman had a history of moderate or severe cervical cell changes or cervical cancer. This is because even if the cervix was removed at the time of hysterectomy, cervical cells can still be present at the top of the vagina and can develop in to advanced cancer if undetected.

5. If a woman has had a history of cervical cancer or cervical cell changes she will have to continue screening for 20 years after the time of the surgery.

Treatment and Cure Rate of Cervical Cancer

Cervical cancer can be cured if detected early and treated adequately. From treatment perspective either surgery or radiation combined with chemotherapy may be used for early stages of cervical cancer, while radiation combined with chemo is usually the main form of treatment for later stages. For the most advanced stage when the cancer has spread to other parts of the body, chemotherapy (by itself) is often used. When detected at an early stage, the 5-year survival rate for women with invasive cervical cancer is 91%. About 46% of women with cervical cancer are diagnosed at an early stage. If cervical cancer has spread to the surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 57%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 17%.

Dr Suresh Rao

Cervical Cancer in Greater Mangaluru region

Dr Suresh Rao, director of Mangalore Institute of Oncology (MIO) stated that cervical cancer is common in this region and that almost 30% of people are from urban areas while the remaining 70% are from rural areas. Most of the afflicted women are from the middle-aged (between 40 and 55 years). The incidence is greater among women of lower classes, less educated, and those with a more number of children. The screening levels are low in the general population and the cancer education and awareness cell (CEAC) of MIO is actively involved in educating the general public on the importance of regular check up for early detection of cancer. 

Daijiworld Media Network - Health
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Comment on this article

  • Monty Dotor, Mangalore

    Fri, Jan 26 2018

    Dear Mr. Ray,
    Colorectal cancer can be treated successfully with surgery or a combination of surgery, chemotherapy and radiation.
    The doctor decides the type of treatment depending on the stage.
    Herbs like turmeric and simarouba can be taken alongside as long as they are not harmful. Even natural products have to be taken in a correct dose, which the naturopath or treating doctor advises. One should not be under the impression that natural products have no side effects. After all, all medicines are primarily derived from nature. Eg. sudarshan churna of Ayurveda, quinine thymol pills of Homeopathy and Quinine of Allopathy are all obtained from the same plant, cinchona and have the same side effects.

  • Ray, Mangalore/ Dubai

    Thu, Jan 25 2018

    Dear Mr. Monty Dotor,

    Thanks for your kind information...would you please clarify about colorectal cancer..can it be cured with turmeric and simarouba!!

  • Dev, Mangalore

    Thu, Jan 25 2018

    One correction-
    Intravenous Vitamin C in high dose can cure most of the cancers without the side effects of chemo & radiation as they do not kill healthy cells but stop cancerous cells from multiplying & helping the body to kill cancerous cells which our bodies do continuously without our knowledge but with ageing, stress & pollution in any form prevents it from functioning which helps cancers to grow in any part of our body.

  • cliffy, Mangalore

    Wed, Jan 24 2018

    Thanks Daiji for this article. Please publish more articles which gives knowledge and awareness.

  • Dev, Mangalore

    Wed, Jan 24 2018

    Article with right information, but having HPV vaccines is another scam of prevention as per the data available.
    More teenage women in US get them & are maimed, disabled or dead after they got vaccinated.
    As this type of cancer is more likely among women with many partners & who have unprotected relationships, they should get screened more for this.
    Cancers of any type are preventable by having organic food, no exposure to radiation, smoking or alcoholism.
    Having lot of antioxidants to prevent free radical damage can prevent life style diseases like Cancer, diabetes, cardiovascular ailments, high blood pressure.
    As per some naturopaths high dose of IV Vitamin fluid can cure most of the cancers without the side effects of Chemo or Radiation which triggers future cancers in other organs but are labelled as migrating cells of first cancer to cover up one more scam.

  • uday, Bangalore

    Wed, Jan 24 2018

    Daijiworld should publish more and more these types of articles .

  • Monty Dotor, Mangalore

    Wed, Jan 24 2018

    Cervical cancer cannot be cured by Turmeric or any herb. It cannot be cured with any Allopathic, Homeopathic, Unani , Siddhi, Tibetian or any traditional medicines.
    The good part is that it can be cured by surgery and is preventable also.
    Prevention is better than cure. The Human Papilloma Virus (HPV) which is the main cause (not the only cause) of cervical cancer is spread by sexual contact. One should not have multiple sexual partners, this should be taught in schools before children attain puberty. if this is done it can prevent many other deadly diseases as well.
    Viral diseases in the next decade will kill more people than nuclear war, road accidents etc

  • Rocks, Mangalore

    Wed, Jan 24 2018

    May god cure all women who suffer from these disease . . .. .

  • Ray, Mangalore/ Dubai

    Wed, Jan 24 2018

    i have come across people around india say that spice such such as turmeric is very effective on cancer cells and even kills cancer and herb tree like simarouba can cure the cancer disease from the root..if anyone know about it kindly comment!!!

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