How to prevent cervical cancer and symptoms

Though knowledge and awareness are the first steps towards prevention, taking precautionary measures and following these steps can help you prevent the disease.

Knowing that cervical cancer is the most common cancer affecting women in India and accepting that everyone is at risk is the first step towards effective prevention. Human Papilloma Virus (HPV), a sexually transmitted infection, is present in 99.7% of cervical cancer cases, and thus prevention includes:

Having safe sex with a single partner. Using condoms though not fool proof, is a good practice.
Avoiding smoking
Having a healthy lifestyle:

Diet rich in antioxidants, vegetables, fruits, fiber and whole wheat products

Physical activity & exercise, maintaining healthy weight, controlling stress levels

Getting screened regularly and knowing about pap smear & HPV DNA tests

It is appropriate that women above 30 have both HPV DNA test and a pap test at the time of screening, as this helps in early diagnosis

For women above 30, if both the HPV DNA test and the pap test are negative, pre-cancerous changes or cancer is highly unlikely and testing does not need to be repeated for three years. If the pap test is negative and the HR-HPV test is positive, both should be repeated in 6-12 months.

Discussing vaccination with your gynecologist

Vaccination against specific types of HPV is another way to reduce infection rates and thereby reducing the incidence of cervical cancer. Vaccines provide protection against two low-risk and two high-risk types and is expected to provide protection against 90 percent of genital warts and 70 percent of cervical cancers. There are, however no conclusive reports that the vaccine may offer some protection against the other HPVs causing cervical cancer. In addition, the vaccine does not have effectiveness against preexisting infections and thus to be most effective, need to be given before a person is sexually active. Thus, protection is incomplete and screening is a must using a pap and (once 30 or over) the HPV test.


Early cervical cancers are easily missed as they affect an area of the body not visible externally and don’t usually cause express symptoms.

Cancer is a disease in which cells in the body grow out of control. Cervical cancer starts in the cervix, which is the lower, narrow end of the uterus (the womb) and connects the upper part of the uterus to the vagina (the birth canal).

Who gets it?

All women are at risk. Approximately 80% of the new cases occur in developing countries like India, which reports approximately one fourth of the world’s cases of cervical cancer each year. The human papillomavirus (HPV), one of the most common sexually transmitted infections is the main cause of cervical cancer and is associated with 99.7% of all cervical cancer cases.

What puts a woman at risk?

Starting sexual activity at a young age (before 18 years) Having multiple sexual partners Having Human Papillomavirus (HPV) infection Having had any sexually transmitted infection Smoking Having more than 3 children (multiple deliveries) Having the first pregnancy at a young age (before 18 years) Having a weakened immune system

How does a woman know she has cervical cancer?

Early cervical cancers are easily missed as they affect an area of the body not visible externally and don't usually cause express symptoms. When the cancer grows larger, or spreads, women may notice: Increased vaginal discharge Abnormal vaginal bleeding Bleeding that occurs between regular menstrual periods

Bleeding after sexual intercourse, douching, or a pelvic exam Bleeding or spotting after attaining menopause Pelvic pain Pain during sex Menstrual periods that last longer and are heavier than before These must not be ignored and women should seek immediate medical attention. With regular screening tests, cervical cancer is the easiest female cancer to prevent and also highly curable when found and treated early.

What is pap smear examination?

It detects the earliest signs of cervical cancer as well as infections, inflammations, and abnormal changes in cervical cells.

Pap smear examination is the most important tool for the screening and early detection of cervical cancer.

What is pap smear?

Detects the earliest signs of cervical cancer as well as infections, inflammations, and abnormal changes in cervical cells
The doctor puts an instrument called speculum into your vagina, sees the cervix, and then takes a few cells for testing from inside and around the cervix using a special stick, brush, or swab

Who needs it and when?

Once a year, for women at age of 21 or 3 years after becoming sexually active till age 30

Once every 2-3 years for women over 30 (Who have 3 normal tests in a row)
Another option for women over 30 (With normal immune systems and no abnormal pap results) is to get tested every 3 years with pap smear plus HPV DNA test

Once a year for women with weak immune system (organ transplant, chemotherapy, steroid use, or HIV infection)

Women above 70 with no abnormal pap results in the last 10 years, and no history of cervical cancer, HIV infection, or a weak immune system, may choose to not get tested. Women with total hysterectomy (removal of the uterus and cervix) unless the surgery was done for cervical cancer or pre-cancer, may choose to not get tested. Women with hysterectomy without cervix removal need to get tested

Get ready for the test

Schedule it when you do not have your periods
Avoid having sex or using tampons, vaginal creams, or suppositories, about 2 days before the test

What will it tell your doctor?

The test gives a picture about whether there is a suspicion, clear evidence, or absence of cervical cancer. The evidence picked up for infection or inflammation or any other changes would help in further management

In recent times, LBC (Liquid Based Cytology) method of testing has gained recognition over the standard technique due to its higher sensitivity and specificity as well as the early identification of precancerous lesions.

WHAT IS HPV?
HPV stands for human papillomavirus. There are 100 types of HPV but only 13 of them are known to cause cancer. The others are harmless or cause conditions such as genital warts. HPV is the underlying cause for cervical cancer, a sexually transmitted and largely symptomless infection. Many young women contract HPV, but the infection may remain stable for a long time. In some cases, HPV leads to abnormal cell changes that can progress to cancer, but only over many years. This cancer is most common among women 35 years and older around the world.

HOW DO YOU GET HPV?
HPV is transmitted through intimate sexual contact including, but not limited to, sexual intercourse.

IS HPV COMMON?
Infection by HPV is common and at least half of all sexually active women are infected by a strain of genital HPV in their lifetimes. In India it is the most common form of cancer in women. Known to affect a large number of women in rural areas, it is becoming rampant in metros too, since occurrences of unprotected sex are high. In Mumbai, it is the most common form of cancer after breast cancer.

HOW CAN HPV LEAD TO CERVICAL CANCER?
Two particular strains of HPV, types 16 and 18, cause a majority of all cervical cancers in the world. Although HPV infection is usually symptom free, it can damage the lining of the cervix. Persistent infection can cause abnormalities of the cervix, which, if left undetected and untreated, can cause cervical cancer.

AT WHAT AGE DO WOMEN GET CERVICAL CANCER?
Cervical cancer is very rare for women aged under 25. Most women get cervical cancer in their 30s, or when they're older. But with recurring occurrences of unprotected sex with city women and teenagers, local gynaecs are calling the 18-30 age group as a high risk one. Being sexually active with multiple partners too increases their risk of contracting cervical cancer.

WHAT IS THE HPV VACCINATION?
The HPV vaccine protects against two strains of the virus (types 16 and 18) which cause over 70 per cent of cervical cancers. It is estimated to save the lives of hundreds of women each year. Although not available in India as yet, the vaccine is well on its way and will be available by the end of this year, doctors say. Major multinational pharma companies are in talks with experts and gynaecs to execute the same. Vaccination programmes in the west are common and compulsary. Trials of the HPV vaccine show that protection lasts for at least six years, but it is expected to be much longer lasting.

THE PAP SMEAR TEST AND TREATMENT
This test is the simplest and cheapest way to detect cervical cancer. It involves inserting a specialised brush or a cotton swab into the cervix and sending it for narco-analysis. If the patient is a victim of cervical cancer, the slide is likely to pick up the discarded cells and indicate a positive result thereafter. Ideally, the test is supposed to be carried out on all sexually active women at least once a year. But since this isn't being enforced in India, most gynaecologists and radiologists insist on getting the PAP SMEAR test or the HPV test done before any medical procedure. Though western countries have achieved success in early detection of cervical cancer with the 'Pap smear' test, India on the other hand has not reached majority of the women in need, mostly because of high costs involved and a lack of trained experts, especially in the rural areas.

THE GOOD NEWS
A positive way to look at this situation is that this type of cancer is one of the slowest to spread through the body and one of the quickest to be detected. If you detect it at an early stage, you can almost completely recover with treatment. Now, with advanced surgery, complete removal of the affected cells is also possible.

THE FACTS
• By July 2011 over 2 million girls will have been given the HPV vaccine

• This routine vaccine protects against two strains of the HPV virus — which cause over 70 per cent of cases of cervical cancer

• Cervical cancer is the second most common cancer amongst women worldwide. Around 3,000 new cases of cervical cancer are diagnosed

• The vaccine, given as a course of three doses over around six months, is estimated to save lives of hundreds of women each year.