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The fourth most common cancer in women, cervical cancer develops in the cells lining the cervix, the lower end of the uterus that forms a canal between the uterus and vagina. Cervical cancer is mainly caused by the high-risk human papillomaviruses (HPV), a common virus transmitted through sexual contact.
Most HPV infections clear up on their own over time and cause no symptoms, but persistent infection can cause cervical cancer. Cervical cancer also takes a long time to develop, about 15-30 years in women with normal immune systems and about 5-10 years in women with weakened immune systems (like those with HIV/AIDS). Health agencies and gynaecologists recommend regular screening to help in prevention and early detection.
“Cervical cancer is a slow-growing cancer. If someone has an HPV infection, which starts making changes in the cervix, it could later develop into cancer. These changes occur in a precancerous condition or early cancer. This doesn’t usually cause any symptoms but it can be detected in screening,” says oncologist Dr. Sunitha Daniel, advisor, cancer screening and early cancer detection, Karkinos Healthcare.
According to the World Health Organisation (WHO), more than half a million women around the world are diagnosed with cervical cancer every year.
“Cervical cancer is a slow-growing cancer. If someone has an HPV infection, which starts making changes in the cervix, it could later develop into cancer. These changes occur in a precancerous condition or early cancer. This doesn’t usually cause any symptoms but it can be detected in screening,” says oncologist Dr. Sunitha Daniel, Karkinos Healthcare.
Here are the most important facts about cervical cancer that all women should be aware of:
HPV is behind most cervical cancer cases
The Human papillomavirus (HPV) is an extremely common group of viruses, which is associated with several cancers such as cancer in the cervix, vagina, and vulva. It can also cause penile cancer, anal cancer, and oropharyngeal cancer (in the back of the throat). HPV is not the same as the human immunodeficiency virus (HIV), which causes AIDS.
HPV is spread mainly by direct skin-to-skin contact during vaginal, anal, or oral sex with someone who has the virus. It can spread even when an infected person has no signs or symptoms. Anyone who is sexually active can get HPV, even if you have had sex with only one person. Most people are infected with HPV shortly after the onset of sexual activity.
Sexually-transmitted HPV are divided into two groups:
Low-risk HPVs
These mostly cause no disease, but they can cause warts around the genitals, anus, mouth, or throat.
High-risk HPVs
These can cause several types of cancer. There are about 14 high-risk HPV types and two of these, HPV16 and HPV18, are responsible for most HPV-related cancers like cervical cancer.
HPV is spread mainly by direct skin-to-skin contact during vaginal, anal, or oral sex with someone who has the virus. It can spread even when an infected person has no signs or symptoms. Anyone who is sexually active can get HPV, even if you have had sex with only one person. Most people are infected with HPV shortly after the onset of sexual activity.
There is a vaccine for cervical cancer
Yes, you read that right; there is a vaccine for cervical cancer. The HPV vaccine prevents more than 90% of cancers caused by HPV, like anal, vaginal, and cervical. It also prevents vulvar precancers. Research shows that HPV vaccines are highly effective when they are administered before first exposure to the virus or before people start to engage in sexual activity.
Karkinos’ Dr. Daniel says the latest guidance is to offer cervical cancer vaccines to girls in the age group 9-26 years. Before the age of 15, girls need two doses; the second dose should be administered between 6-12 months after the first one. After the age of 15, three doses are recommended.
The HPV vaccine is also recommended to women between the age of 27-45 years; the vaccine can provide protection against the strains of HPV that they have not been exposed to.
The vaccine has shown remarkable results. A new study conducted by Cancer Research UK found the HPV vaccine reduces cervical cancer rates by as much as 90% in women in their 20s who were vaccinated between the age of 12 to 13. “The vaccine is most effective when given between the ages of 11 and 13 when someone is less likely to have been exposed to HPV,” says Cancer Research UK. Researchers say a combination of HPV vaccination and cervical cancer screening can reduce cervical cancer incidence to a point where almost no one develops it.
Screening is essential
Cervical cancer may have no symptoms in its early stage. To diagnose cervical cancer early and in it’s precancerous condition, women should be screened periodically, says Dr. Rama Joshi, gynae oncologist and director – gynaecology oncology, Fortis Memorial Research Institute, Gurugram. It is essential to continue screening even if someone is vaccinated.
Cervical cancer may have no symptoms in its early stage. To diagnose cervical cancer early and in it’s precancerous condition, women should be screened periodically, says Dr. Rama Joshi, gynae oncologist and director – gynaecology oncology, Fortis Memorial Research Institute, Gurugram. It is essential to continue screening even if someone is vaccinated.
The aim of cervical cancer screening is to find any changes in the cells of the cervix that could lead to cancer. The screening includes a pap smear/pap test or a cervical cytology, HPV testing, or both (co-testing). The screening process involves collecting cells from the cervix with a sampling instrument or a brush and sending them for testing.
A Pap smear looks for changes in the cells on the cervix or precancers, which may lead to cancer if left untreated.
The HPV test looks for the HPV virus, which can cause changes in the cells.
Gynaecologists recommend a pap smear every three years, and an HPV test every five years for all women. According to the American College of Obstetricians and Gynecologists (ACOG), women in the age group of 21 to 29 are recommended a pap test every three years. Women in the age group of 30-65 can have a Pap smear and an HPV test(co-testing) every five years, a Pap test alone every 3 years, or HPV testing alone every 5 years.
Look out for signs and symptoms
Precancer is usually asymptomatic, but some symptoms may appear in the early stage; symptoms may be more severe in advanced stages or when the cancer has spread to other organs.
According to Dr. Joshi, the most common symptom is spotting or bleeding after sexual intercourse. “This is an early sign. The patient might not have discomfort but it is very important that if you see any signs, you must take notice of it and take it seriously,” says Dr Joshi.
Here are some important symptoms of cervical cancer that demand attention:
- Spotting or light bleeding between periods
- Longer or heavier menstrual bleeding
- Painful sexual intercourse
- Bleeding post intercourse
- Abnormal vaginal discharge
- Bleeding post douching
- Postmenopausal bleeding
- Unexplained pelvic or back pain
The risk factors for cervical cancer
HPV infection is the most important risk factor for cervical cancer. Besides that, there are several risk factors which may raise a woman’s odds of having cervical cancer. Some of these are:
- Smoking: Various studies show that both active and passive smoking are associated with an increased risk of cervical cancer.
- Family history: In rare cases, family history is a risk factor. Usually, if a relative has cervical cancer, it does not increase someone’s risk.
- Sexual history: Health agencies and gynaecologists say that becoming sexually active at a very young age, having multiple sexual partners and engaging in sexual activity with someone who is at high risk, can increase a person’s chances of cervical cancer.
- Weakened immune system: The immune system protects people from HPV infection and can stop the spread of cancer cells. Women who have HIV, which weakens the immune system, are at a higher risk.
Women who are on medication to suppress their immune response, may be at higher risk too. This includes women with autoimmune disorders or have had an organ transplant.
Sources:
- Health topic: Cervical Cancer, World Health Organisation (WHO)
- Burden of cervical cancer and role of screening in India
- “The power of science”: HPV vaccine proven to dramatically reduce cervical cancer, Cancer Research UK, 2021
- Effect of smoking on high-grade cervical cancer in women on the basis of human papillomavirus infection studies, Journal of Cancer Research and Therapeutics, 2018
- The relation of passive smoking with cervical cancer, Medicine Journal, 2018
- Huntsman Cancer Institute, The University of Utah, 2021
- Cervical cancer, Centres for Disease Control and Prevention (CDC)
- Cervical Cancer, American Cancer Society
Disclaimer
Information on this website is provided for general informational purposes only, even when it features the advice of a physician or healthcare professional. It is not intended to be and should not be used as a substitute for direct medical advice from your physician or other qualified healthcare professional. As always, you should consult your physician.
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