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Battling cervical cancer: Early diagnosis is the key

Cervical cancer is a silent killer in India, claiming about 70,000 women every year. But prevention is easy and cheap through regular screening by tests such as pap smear and LBC, says Dr SK Das, Sr Consultant, Gynae Oncology, Action Cancer Centre

Dr S K Das

As a young, healthy woman chasing the dreams of the modern world, it is often easy to forget about the most important person in your life – you. In the full flush of youth, you can be forgiven for thinking that disease is something that happens only in old age, but you cannot be more wrong.

Cervical cancer, which is the cancer of the cervix (the lower portion of the uterus that opens into the vagina), is a threat to women of all ages. It can hit below the belt even in the 30s and 40s when a woman is leading an active lifestyle and least expecting any health problem. It is therefore essential to take proactive steps to safeguard one’s health and get regular check-ups done to catch diseases early when they are creeping up stealthly.

Cervical cancer is the third most commonly diagnosed cancer in women, with over five lakh cases every year worldwide, most of which occur in developing countries. There is very low level of awareness of cervical cancer in India, but the disease is nothing to scoff at. It kills a staggering 70,000 women every year in the country. This figure is much lower than the actual figures because many cases do not get diagnosed or reported at all, especially among the poor and in the rural areas.

According to one estimate, about 45-80 per cent women can be carrying the cervical-infection caused by human papilloma virus (HPV) at any point of time. There are many strains of this virus, ­­some of which are high risk and can change the cells of the cervix, creating abnormalities and triggering the cancer. Women may carry the HPV for years and not be aware of it, developing the disease much later. Most of the time, the body’s immune system manages to kill the virus, but it is the rest of the time that may prove to be dangerous. 80 per cent of the infection contracted at adolescent age will spontaneously disappear so the first requirement is persistence of HPV infection. Later other factors also contribute in production of disease.

Early detection of cervical cancer can save thousands of lives every year because, thankfully, it is one of those rare types of cancer which are detected in pre-cancerous stage and if treated can be completely curable. Its symptoms include abnormal vaginal bleeding, post coital bleeding, inter menstrual bleeding or post menopausal bleeding, excessive vaginal discharge not cured in two to three weeks treatment. 25 per cent of patients remain asymptomatic and can be picked up by routine PAP test.

Often, by the time the symptoms of cervical cancer occur and a diagnosis gets done, it may be too late to save the patient. In the US, the five-year relative survival rate of patients with cervical cancer is 91 per cent. If detected at a late stage, the rate drops to just 17 per cent. This shows how crucial it is for this disease to be detected as soon as possible.

In early stages, cervical cancer can actually be cured in a single sitting of just one hour and at a fraction of the cost that otherwise would be spent to treat it later using surgery, chemotherapy and radiation therapy. This can save many families from an easily preventable tragedy.

A simple pap smear test, costing a mere Rs 350, can diagnose the disease even in the pre-cancer stage by detecting minute changes in cells. It is recommended that every woman above 21 years. should get herself screened every two years as a matter of routine, especially if she is sexually active, even if she is young and has no symptoms or discomfort. The effect of regular screening on cervical cancer deaths is illustrated by the example of the UK where the disease used to claim 150,000 women every year in the 1970s. After the government got aggressive with testing women for cervical cancer, the death toll has now crashed to just 2,000 annually.

To detect cervical cancer even better, a new technology called liquid-based cytology (LBC) has been developed. It has a better prediction value than a pap test and it is worth while the effort to get yourself screened using this because of its many benefits. HPV DNA test can be done from the same sample.

In LBC, the sample from the patient is taken in the same way as the pap smear test by collecting cells from the cervix using a spatula/cyto brush-like device. The sample is however not smeared on a microscopic slide (hence the name ‘pap smear’) but put in a glass vial containing preservative fluid. It is then sent to the lab where it is cleaned of pus, mucus and other obstructing material. Once done, a thin layer of cells is deposited on a slide and examined under a microscope to detect the cancer.

LBC has resulted in considerable reduction in inadequate rates of cervical samples. It has saved women from a lot of anxiety and the need to go for repeated tests because the sample was found inadequate, which is often the case with the pap smear test. In inadequate cervical samples, obstructing material such as blood and pus do not allow cytologists to see the cells properly and no results can be arrived upon. As a result, the patient has to be called for a re-test.

LBC is a major advance in screening for cervical cancer and has proved hugely successful worldwide since its introduction. It today accounts for over 90 per cent of all screening tests done in the US for cervical cancer.

Preventive HPV vaccination and screening every alternate year through LBC or pap smear can keep you safe from the scourge of cervical cancer. It is a small price to pay for your health.

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