Author: Dr. Sapna Nangia |
Cervical
cancer is the commonest cancer in Indian women and a quarter of the
world’s cervical cancer patients live in India! It is indeed
ironical that a cancer that can be prevented by a vaccine and
detected in a pre malignant state receives such little attention from
the media.
Caused
by infection with the Human Papilloma Virus( HPV), cervical cancer
involves the opening of the uterus into the vagina. It occurs more
commonly in women who start sexual activity at a young age and is
also more common in women with many childbirths and partners. Given
that girls in rural India marry at a younger age and have more
children than their urban counterparts, it is not surprising that the
incidence of cervical cancer is more in rural India. Other risk
factors are poor personal hygiene and, of late, HIV infection.
The
process of transformation of a precancerous state to cervical cancer
takes approximately 10 years or more. During this period, a simple
test called Pap smear can detect this precancerous state. The
affected area of the cervix can be effectively treated by a
gynecologist using simple treatment methods such as laser,
cryosurgery and LEEP. Pap smears are recommended for all sexually
active women, the test being repeated at three yearly intervals if
normal and at 5 yearly intervals if both Pap smear and testing for
high risk strains of HPV are negative.
Organist
ions looking to make a contribution towards improving the health
status of Indian women would do well to think of mass screening of
women using a technique called VIA. This simple test, which basically
consists of applying vinegar to the cervix and then inspecting it,
can be easily administered by health workers. In a landmark study by
Tata Memorial Centre, Mumbai, mass screening of women was found to
reduce the risk of dying due to cervical cancer by a whopping 30 %.
It is known that mass screening for cervical cancer once in 10 years
can reduce the incidence of this disease by 60 %!
Vaccines
are now available against some strains of HPV. Gardasil from Merck
and Co. protects against 4 strains, 2 of which cause cervical cancer
and 2, genital warts. Cervarix, from Glaxo Smith Kline
Beecham, protects against 2 cancer causing HPV strains. The HPV
strains that these vaccines act against are responsible for about 70
% of all cervical cancers; women who have been vaccinated
should therefor still undergo Pap smears for early
detection of cervical cancer.
The
ideal time for vaccination is prior to initiation of sexual activity.
It is usually administered to at the age of 12
– 13 years to girls, but can be administered between the ages of 9
– 45 years. When administered after
initiation of sexual activity, the vaccine does not protect against
pre- exiting infection.
A
course of three injections is recommended, the second and
third injections being administered one and six months, respectively,
after the first. The cost of the vaccine is approximately Rs. 2500
per dose.
HPV
is responsible for other cancers besides cervical cancer; anal
cancer, vulval cancer and that of the throat are also caused by
strains of this virus. Vaccination is likely to reduce the risk of
these cancers too.
HPV
vaccination is a part of the National Immunization Program in
Australia, United Kingdom and Canada. Besides girls, immunization
of boys to prevent the above mentioned cancers
as well as the transmission of cervical cancer is also being
considered and is already a part of the national Immunization program
of some countries.
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