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"The right test, on the right specimen, collected at the right time, is essential for reliable diagnosis" Dr Prashant Goyal

Can Cervical Cancer Be Prevented?


Yes, cervical cancer is one of the most preventable types of cancer. 

Cervical cancer is cancer of the cervix, that is the narrow opening into the uterus from the vagina. Cervical cancer is the fourth most common cancer in women in worldwide and second most common in India. The current estimates indicate approximately 1,00,000 new cases diagnosed and 60,000 deaths annually in India.  

Cervical cancer is mainly caused by Human Papillomavirus (HPV) infection, a sexually transmitted infection. There are more than 100 types of HPV and of these about 15 high-risk types cause most of the cases of cervical cancer, two of these types (16 and 18) are responsible for more than 70% of cervical cancer in India. 

Because of slow develops, cervical cancer is also one of the most preventable types of cancer.  Cervical cancer can often be prevented by having regular screenings (Pap smear or/ and HPV detection) to find any pre-cancers and treat them, as well as receiving the HPV vaccine.

Cervical screening Test: 

Vaccines are not 100% protective against cervical cancer and not a replacement for periodic screening. Hence, screening programs should continue as per recommendations. There are 3 different types of screening tests that are currently recommended by WHO:

1. Pap (conventional) Smear or Liquid-based Cytology (LBC): 
The main advantage of Pap Smear (or LBC or Pap test) is detection of early changes (pre-cancerous lesion) in cervical cells which can easily be treated and cancer can be avoided. It also aids in diagnosing Cancer, infections and inflammation of the lower reproductive tract. Because pre-cancerous lesions take many years to develop, screening is recommended for every woman from aged 25 and regularly afterwards. Women who are 25 years and above should undergo a Pap test once in every 3 years until the age of 65 years. If this test is combined with HPV test, then the duration of screening can be increased to 5 years. women over 65 years of age with previous adequate negative screening and no history of CIN2+ within the last 20 years need not be screened. In our country due to low resources for screening, national recommendations are to start screening at 30 years of age.

Liquid-based Cytology (LBC) can be a better alternative to conventional smear because of lower rate of unsatisfactory smears. Furthermore, residual LBC sample is available to perform HPV DNA testing.

2. HPV Test:
This HPV Test is screening test and detects the presence of the human papillomavirus (HPV), a virus that can lead to the development of cervical cancer as well as genital wart. But this test doesn't tell you whether you have cancer. Presently preferred method of cervical screening for women aged 30-65 years, is co-testing with combined HPV testing with their Pap test every five years. 

3. Visual inspection with acetic acid (VIA)
VIA is a visual examination of the uterine cervix after application of 3-5% acetic acid which makes precancerous spots turn white. VIA is an attractive alternative to cytology-based screening in low-resource settings.

HPV Vaccination: 
The WHO recommends the HPV vaccine for all girls between 9 and 14 years (with 2 doses given over a 6-month period), when most have not started sexual activity and the vaccine is highly immunogenic at this age. HPV vaccination is also recommended for 15 to 26 years with 3 doses, if not vaccinated already. Vaccine is not too effective after age 26 years, as they might have been already exposed to the virus, even though vaccine is licensed to be given till 45 years. 


Recommendations for HPV vaccination, according to the Centers for Disease Control and Prevention (CDC) and  WHO
Age Group
Recommendation
Doses
9-14
Highly recommended
Two doses
15-26
Recommended, if not vaccinated previously 
Three doses
27-45
Safe, but generally not recommended
Three doses

The Indian Academy of Pediatrics Committee on Immunization (IAPCOI) recommends offering HPV vaccine to all females who can afford the vaccine. Some countries have started to vaccinate boys as the vaccination prevents genital cancers and genital warts in males as well as females. The vaccines cannot treat HPV infection or HPV-associated disease, such as cancer.



Author: Dr Prashant Goyal

source: WHO, CDC

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