Understanding Facts And Myths Around Cervical Cancer - Dr Thangarajan Rajkumar

In India, cervical cancer contributes to approximately 6–29% of all cancers in women. Understanding the crucial distinction between facts and myths surrounding this prevalent yet preventable disease is the key to empower individuals and take proactive steps toward prevention and early detection.

FACTS

1. Prevalence in India:

Cervical cancer stands as the second most common cancer among Indian women, with breast cancer surpassing it. This underscores the need for increased awareness and preventive measures.

2. HPV Infection and Vaccination:

Over 99% of cervical cancer cases are linked to persistent Human Papilloma Virus (HPV) infection, specifically with "High Risk" subtypes such as HPV 16 and HPV 18. Vaccines like Cervavac are now available in India, offering effective prevention. It is imperative that both girls (aged 9 to 14) and boys receive these vaccinations.

3. Comprehensive Protection:

Preventing HPV infection not only reduces the risk of cervical cancer but also lowers the chances of other cancers such as vaginal, vulvar, anal, and oropharyngeal cancers. In boys, prevention of HPV infection reduces the risk for penile cancer, anal cancer, and Oro-pharyngeal cancer and genital warts. While most Western countries have advocated vaccinating boys, it is yet to gain widespread acceptance in India.

4. Early Detection and Treatment:

Simple tests like HPV testing and PAP smear can detect pre-cancerous stages, enabling early intervention. Treatment for pre-cancerous conditions is cost-effective and accessible, either for free at government centres or at a nominal cost.

5. WHO Recommendations:

WHO recommends HPV testing at 30 years of age, if the result comes negative, it should be repeated every five years. If the result is positive, the health worker will look for precancers and if found can be treated at the same time.

If no lesion is found, the HPV testing needs to be repeated after 1–2 years, to look for persistence of the same high-risk subtype. Timely detection allows for prompt treatment, ensuring better outcomes. In regions where HPV testing is unavailable, PAP smear or visual inspection after acetic acid application can be viable alternatives.

Symptoms of Cervical Cancer

Recognizing symptoms in the early stages is crucial. Once the cervical lesion becomes cancerous, the symptoms include bleeding through the vagina between menstrual cycles or after menopause, bleeding after intercourse, pain during intercourse, and altered vaginal discharge, either in quantum, colour, or smell.

Curability with Early Detection

Cervical cancer detected in early stage (Stage 1) is completely curable in over 95 out of 100 women at the same stage. This drops to 50 out of 100 patients if detected in stage 3. Once the cancer spreads to other organs, it rarely becomes curable, highlighting the critical need for timely identification in sexually active women.

MYTHS

1. Safety Concerns Regarding HPV Vaccine -

Myth: The HPV vaccine is not safe.

Answer: HPV vaccine has been shown to be safe in large populations studied and followed up for years.

2. Pain as a Sole Indicator -

Myth: I have no pain, so I don’t have cancer.

Answer: While pain during sexual intercourse or pelvic pain can occur, by and large, pain is usually seen in a more advanced stage. Hence, one should not depend on the symptom of pain to rule out cancer.

3. Reliance on Vaccination Alone -

Myth: I've completed my HPV vaccine doses, so I don’t need cervical cancer screening.

Answer: Most of the vaccines protect against the two common “high risk” HPV subtypes – 16 and 18. However, there are other subtypes which can cause cancer. Therefore, regular screenings are essential.

4. Positive HPV Test -

Myth: A positive HPV test means I have cervical cancer.

Answer: A positive result indicates the need for further examination to identify pre-cancerous lesions. It is therefore necessary to repeat the HPV testing after 1 – 2 years to assess for persistence. In most women [over 95%], the immune system clears the HPV high risk infection.

Again, if there is a persistent same high-risk subtype, examination of the cervix using special equipment called colposcopy is done. If any precancer lesions are seen, it will be treated at the same time.  

Understanding the facts and dispelling myths is crucial in the fight against cervical cancer. Through awareness, vaccination, and regular screenings, we can significantly reduce the burden of this preventable disease and save lives.