Worldwide, cervical cancer comes in the top four cancers affecting women. An estimated 6,04,000 new cases were reported in 2020 alone. Of the 3,42,000 deaths from cervical cancer in 2020, about 90% occurred in low- and middle-income countries.
In India, 1.25 lakh women are diagnosed with cervical cancer annually and 75,000 die from it. However, surprisingly more than 95% of these cases are associated with Human Papillomavirus (HPV) infections. Of the 200-odd HPVs, 14 are associated with an increased risk of cervical cancer.
Infection with HPV is common, and in most people, the body can clear the infection by itself. Sometimes, however, the infection becomes chronic. Chronic infection, especially when caused by certain high-risk HPVs, can eventually cause cancers such as cervical ones. HPV types 16 and 18 are the most common subtypes noted in India. All women, who have ever been sexually active are at risk for developing cervical cancer since sexual activity potentially exposes you to HPV.
What is HPV?
HPV can infect cells on the surface of the skin and those lining the genitals, anus, mouth, and throat but does not affect the blood or internal organs. It can spread from one person to another during skin-to-skin contact.
One way HPV spreads is through sexual activity, including vaginal, anal, or even oral. Different types of HPV cause warts on various parts of the body. Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue. Certain types of HPV may cause warts on or around the female and male genital organs and in the anal area. These are called low-risk types.
Becoming sexually active at a young age can increase the risk of cervical cancer as the changes in the cervix during puberty.
Certain types of sexual behaviour augment the risk of infection with HPV. Having intercourse with many partners can increase exposure to HPV, which is transmitted by sexual contact. That is why having many sexual partners is linked with a higher risk of cervical cancer.
But a woman can have HPV even when she has had only one sexual partner. Women also seem to be at a higher risk if their male partners have had many sexual partners or female partners with cervical cancer.
Solution
Major studies show a significant positive effect on sexual risk reduction with the use of protective devices like condoms. The most effective prevention strategy is systematic screening along with treatment and HPV vaccination. Educational interventions targeting socially and economically disadvantaged women, with information complemented by negotiation skills, can encourage behaviour that reduces short-term sexual risk.
Screening
Several screening methods, such as pap smear, visual inspection with acetic acid, and HPV DNA testing are used for the early detection and prevention of cervical cancer. DNA-based testing for HPV is considered to be more effective than other commonly used screening methods.
Another important thing to keep in mind is that vaccination does not replace cancer screening. Even if you get the HPV vaccine, you need to get screened for cervical cancer. All women between 21 and 65 years should get a pap smear every three years. If HPV DNA is detected, the screening interval can be increased to five years.
Treatment
If treatment is needed and eligibility criteria are met, ablative treatment with cryotherapy or thermal ablation is recommended. Both treatments are equally effective and safe.
If not eligible for ablative treatment or where there is suspicion of cervical cancer, women need to be referred to the right level of health services, where proper evaluation can be done with colposcopy and biopsies. When appropriate, the doctor will offer excision treatment. In the case of cancer, an individual treatment plan is designed depending on the stage of the disease, the patient’s medical condition and preferences, and the availability of resources.