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    Cervical cancer screening and early detection

    Oct 21, 2012, 06.01AM IST

    Dr. Surendra S. Shastri
    Cervical cancer is the second most common cancer among women worldwide and is most common among women living in developing countries. An estimated 1,82,027 new cases and 77,096 deaths due to cervical cancer occurred in India in 2010, contributing to 29per cent and 30per cent of the global burden of cervical cancer incidence and mortality. A recently published study confirmed that cervical cancer continues to be the leading cause of cancer death among Indian women. Currently, there is no national cervical cancer screening program in India.

    The uterine cervix is the lower part of the uterus (womb). The cervix connects the body of the uterus to the vagina. Cancer of the uterine cervix is due to HPV (Human Papilloma Virus) infection and is compounded by other factors such as poor genital hygiene (among both women and their spouses), frequent deliveries and tobacco use. The cervical cells do not suddenly change into cancer. The normal cells of the cervix first develop pre-cancerous changes that gradually transform into invasive cancer.

    The pre-cancerous changes are called cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL) or dysplasia. The transformation from pre-cancerous changes to invasive cancer takes several years and can be detected by the Pap test, the HPV DNA test and even a simpler low cost test like VIA (visual inspection with acetic acid). Early detection and treatment of cervical pre-cancers can stop their progression to invasive cancer. All cervical precancers do not transform into invasive cancers, only a small proportion will develop into cancer. In most women the pre-cancerous changes will go away without any treatment. However, we do not have any test currently that can tell us which pre-cancers would progress to cancer and hence screening and treatment of all pre-cancers becomes an important preventive measure.

    Warning signs of cervical cancer

    Women with early invasive cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until the cancer becomes invasive and starts growing into adjacent tissues. When this happens, the most common symptoms are: Abnormal vaginal bleeding, such as bleeding after sex ( vaginal intercourse), bleeding after menopause, bleeding and spotting between periods, heavier and longer menstrual periods.
    An unusual discharge from the vagina which may be bloodstained and may occur between the periods or after menopause.

    Pain during intercourse

    These signs and symptoms can also be caused by other conditions e.g. pelvic infections and non-cancerous growths. However, if you have any of these signs or symptoms, you should consult your doctor urgently to rule out cervical cancer. Ignoring symptoms may allow the cancer to progress to a more advanced stage and lower your chance for effective treatment.

    A better option is to have regular screening by any of the available cervical cancer screening tests listed above. Although we do not have a population based cervical cancer screening programme like the western countries, these tests are usually available at most government centres, labs and private practitioners. Your GP can definitely guide you to the nearest centre that offers these tests. These tests are very simple involving an internal pelvic examination and collection of a cervical smear. They are painless and take just a few minutes.

    Treatment of pre-cancers

    If you are detected with a pre-cancerous condition do not panic. The condition is easily treatable and results in almost complete cure. The treatment is again available at most government centres and private gynecologists. It consists of a procedure called colposcopy and removal of the abnormal cells/tissue by either cryotherapy (freezing ), or by small/large biopsy like procedures called LEEP and Conization. All these procedures are simple, can be done under local anesthesia and do not require the women to get admitted to the hospital . Following treatment of the pre-cancers the women will require check-ups as advised by the doctor (usually at three months, six months and one year) to confirm that the cure is complete. All women should however continue to screen themselves for cervical cancer between the ages 30-65 at 3-5 year intervals or as often as advised by their doctor.

    (The writer is a professor of Preventive Oncology in Tata Memorial Centre.)