Carcinoma of the uterine cervix is the commonest cancer amongst Indian women. Out of 10 women dying of cervical cancer every hour in South Asia, 8 of them are in India. Cervix cancer occupies the top rank among cancers in women in most developing countries, constituting 34% of all women’s cancers. On a global scale, India carries one fifth of the world burden: the estimated annual global incidence is 500,000, India contributes 100,000. The magnitude of the problem is thus more than evident. Here’s all you need to know to protect yourself.

A complete guide on how to reduce the risks and get the best cure for cervical cancer

What is cervical cancer?
No, it has nothing to do with your neck or your spinal column. Cervical cancer is a disease in which cancer cells are found in the tissues of the cervix. The cervix, the lower part of the uterus, connects the body of the uterus to the vagina. The normal cervix is a healthy pink in colour. It is covered with scale-like cells called squamous cells. The cervical canal is lined with another kind of cell called columnar cells. The area where the two cells meet-the squamocolumnar junction and transformation zone (Tone)- is the likeliest spot for abnormal cell growth. The T-zone is more exposed in the case of young women (teens and those in their 20s), making them more susceptible to cervical infections.

How do I find out if I have it?
In its earliest stages, cervical cancer is difficult to detect because there are no obvious symptoms. Irregular bleeding, bleeding or pain during sex, or vaginal discharge, chronic low backache -symptoms associated with cervical cancer-appear when the disease is in an advanced stage. If you have any of these symptoms, do not ignore it. See a doctor immediately to rule out cancer.

Who is at risk? How can I minimise it?
All women are suceptible, but certain factors increase the risk:

An HPV infection: Most sexually active women are exposed to the HPV virus which spreads through skin-toskin contact with an HPV-infected area. Sex at an early age, multiple sex partners and unprotected sex increases a woman’s risk of an HPV infection. Unprotected sex is a major risk factor, though recent studies show that condoms cannot completely protect against HPV because the virus can be passed through skin contact in the genital area not covered by the condom. However, proper condom use is also important, to protect oneself against AIDS and other sexually transmitted diseases.

Smoking also exposes the body to cancer-causing chemicals absorbed by the lungs and carried into the bloodstream. Chemicals produced by tobacco smoke can damage the DNA of the cervix cells and make them susceptible to cancer.

Chlamydia infection (a bacterial infection), contracted through sexual contact can also increase the risk. A diet low in fruits and vegetables increases the risk. Women who don’t eat enough fruits and vegetables miss out on the protective phytochemicals such as vitamins A, C, E and beta-carotene, which have all been shown to help prevent cervical cancer.

A compromised immune system related to certain illnesses such as Human Immunodeficiency Virus (HIV) infection. A family history of cervical cancer. If your mother or sister had cervical cancer you are at greater risk than other women. This is because you are genetically less able to fight off HPV infection than other women.

Long-term oral contraceptive (OC) use (five or more years) may slightly increase a woman’s risk of cancer of the cervix, according to some statistical evidence from some studies.

Women of all ages are at risk, but half of those diagnosed are between 35 and 55, with the average age being 47 years.

How is cervical cancer diagnosed?
Irregular bleeding, bleeding or pain during sex, vaginal discharge are some signs but don’t necessarily mean you have cancer. Consult your doctor. He might ask you to go in for a Pap test.

What exactly is a pap test?
It’s a simple procedure: A speculum (the standard device used to examine the cervix) is placed in the vagina. Cells are skimmed from the surface of the cervix with a cotton swab then smeared onto a glass slide. Another sample is taken from the T-zone (transformation-zone), with a tiny wooden or plastic spatula, or a tin brand X pictures brush. Newer techniques called ‘liquid-based’ Pap tests provide for greater accuracy and reliability. The slide is sent to a lab where a cytotechnologist (a lab professional who reviews the slides) and a pathologist examine the sample for any abnormalities. Performed properly, the Pap test is fairly accurate and is able to detect a significant majority of cervical cancers-even in the early stages.

How can I ensure its accuracy?
To help improve the reliability of your Pap test, schedule your appointment two weeks after your last menstrual period and avoid the following for at least 48 hours before the test:

● Having sex
● Douching
● Using tampons
● Using vaginal creams, suppositories, medicines, sprays or powders

What if my report shows a problem?
An abnormal Pap smear result does not mean you have cervical cancer. It indicates some degree of cellular change in the cells that cover the surface (lining or epithelium) of the cervix. A Pap test is a screening tool; other procedures are necessary to confirm Pap test abnormalities and diagnose the condition. All abnormal Pap test reports should have some form of follow-up. This may include a ‘watch-and-wait’ approach with retesting after some months. Depending on the degree of abnormality, your doctor may recommend other tests, including colposcopy (a magnified view of the vagina and cervix) biopsy or curettage.

How often should I get the pap test done?
Screening should begin about three years after a woman begins having intercourse, but no later than age 21.

Women should have a regular Pap test every year or a liquid-based Pap test every two or three years. After age 30, women who have had three normal test results in a row may be screened every two to three years.

The combination of HPV testing with a Pap test should be considered as an alternative for routine screening in women 30 and older.

Is cervical cancer treatable?
Yes, it is treatable, even curable in its early stages. The best treatment plans take into account the location of abnormal cells, the results of colposcopy and the age of the patient. The treatment basically involves destroying or removing the abnormal cells. Three basic approaches are used alone or in various combinations:

Radiation therapy (use of high-dose X-rays or other high-energy rays to kill cancer cells) is used to treat both early and advanced-stage cancer. In most stages of cervical cancer, radiation is used with chemotherapy.

Chemotherapy is the use of chemical drugs to kill cancer cells. Chemotherapy is a systemic treatment because the drugs enter the bloodstream, travel through the body and kill cancer cells outside the cervix. Chemotherapy with platinum can also make radiation more effective, depending on the stage of the cancer.

Surgery is used to remove the cancer affected area.

What’s the best way to protect myself?
Detecting pre-cancerous changes in their earliest stages through regular Pap tests is the best way to prevent cervical cancer. Most women who develop invasive cervical cancer have not had regular Pap tests. Reducing or eliminating risk factors is the best protection. And for God’s sake go for the vaccine. It’s now available in India.

The Food and Drug Administration approved a vaccine for HPV in the summer of 2006. Gardasil is approved for women ages 13 to 26 to prevent infection with HPV. Years of clinical trials found the vaccine is safe and 100% effective in preventing HPV strains 16 and 18, which cause 70% of cervical cancers. Gardasil, given in three injections over six months, is also 99% effective in preventing HPV strains 6 and 11, which cause about 90% of genital wart cases. Although Gardasil prevents the bulk of HPV strains, it doesn’t protect against all of them so the FDA recommends it as a complement to safe sex practices and regular Pap tests. Also keep in mind that the vaccine will not get rid of an existing HPV infection.