Cervical cancer is the second most common cancer among Indian women. The name was updated a few years ago to include & recognize the care that needs to be given to women diagnosed with non-cancerous cervical diseases that still require follow-up and treatment. According to the American Cancer Society, Cervical cancer can often be found early, and sometimes even prevented entirely, by having regular Pap tests. If detected early, cervical cancer is one of the most successfully treatable cancers. Women should start getting Pap tests regularly at age 21. If your Pap test results are normal, your doctor may say you can wait three years until your next Pap test. Cervical cancer is almost always caused by human papillomavirus (HPV). Vaccines are available to protect against the types of HPV that most often cause cervical cancer. Girls and boys should get all three doses of HPV vaccine when they are 11 or 12 years old. However, if a teen or young adult (through age 26) has not started or finished the series of three HPV vaccine shots, it’s not too late.

Symptoms of Cervical Cancer:

• Bleeding between periods
• Bleeding after sexual intercourse
• Bleeding in post-menopausal women
• Discomfort during sexual intercourse
• Smelly vaginal discharge
• Vaginal discharge tinged with blood
• Pelvic pain

Risk Factors of Cervical Cancer:

Almost all cases of cervical cancers are caused by HPV; persistent HPV infection is the biggest risk factor for cervical cancer. For women, additional factors may contribute to:

• Smoking
• Sexual partners: the more sexual partners a person has, the higher their risk of contracting different and more types of HPV
• Not having regular Pap tests: this means that abnormal cells caused by persistent HPV infection may remain undetected and untreated, and develop into cervical cancer – usually over many years
• Early age of childbirth
• Weakened immune systems

Screening:

There are 2 types of tests used for cervical cancer screening.

• The PAP Smear test can find early cell changes and treat them before they become cancer
• The HPV DNA test detects certain types that can lead to cervical cancer.

New cervical cancer screening guidelines released separately this March by the United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommendations are mentioned below:

• Women ages 21 to 65 - Screen with cytology (Pap smear) every 3 years
• Women ages 30 to 65 - Screen with cytology every 3 years or co-testing (cytology/HPV testing) every 5 years.
• Women younger than age 21 - Do not screen
• Women older than age 65 who have had adequate prior screening and are not high risk - Do not screen
• Women after hysterectomy with removal of the cervix and with no history of high-grade pre-cancer or cervical cancer - Do not screen
• Women younger than age 30 - Do not screen with HPV testing (alone or with cytology)

Challenges in detection & Treatment:

Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until cancer becomes invasive and grows into nearby tissue. So, don’t wait for symptoms to appear. Get regular screenings and pelvic exams. There is also an emergence of HPV DNA tests as a standard of care for women 30 and older; and even political tussling over policy and practice in the field. There is much progress, but an equal number of challenges remain. The best way to prevent cervical cancer is to “start early screening”. Please consult your physician or gynecologist for more information.

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