Cervical cancer, a type of cancer that affects the cervix – the lower part of the uterus – is a silent killer that affects women all over the world. Despite being a preventable disease, it continues to claim the lives of thousands of women each year. In recent years, the prevalence of cervical cancer has been on the rise in India.
According to a Globocan 2020 report, cervical cancer accounted for 9.4% of all cancers and 18.3% (123,907) of new cases in 2020 in India. Yet, screening processes remain scant. A 2021 ICMR report states that only 0.2% of the women in Assam between the ages 30 and 49 have ever undergone screening for cervical cancer.
Despite vaccines available to reduce the risk of cervical cancer, there is a lack of awareness. There are challenges in implementing these measures, including the lack of awareness and access to healthcare, and the stigma associated with sexual health. This is a concerning trend that needs urgent attention.
Dr Rani Bhat, a gynaecologic oncologist, and Head and Senior consultant of the Gynecological Oncology division at Apollo Hospitals, Bengaluru, spoke with EastMojo about Human Papillomavirus Infection (HPV) – the virus responsible for causing cervical cancer; the importance of vaccination, and prioritising gynaecological health.
Can you provide some information about HPV and its underlying causes?
HPV is the most common sexually transmitted infection (STI), but it is not like herpes or HIV. It is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex. It also spreads through close skin-to-skin intimate contact. Sexually transmitted HPV types fall into two groups, low-risk and high-risk.
The virus is present in the external genitalia of both men and women. A person with HPV can pass the infection to someone even when they have no signs or symptoms. If you are sexually active, you can get HPV, even if you have had sex with only one person.
Both men and women are susceptible to HPV infections. In women, HPV can lead to cervical, head and neck, vaginal, and anal cancer; while in men, it can lead to penile, head and neck, and rectal or anal cancer.
Most HPV infections don’t cause cancer, and a robust immune system can clear the virus on its own. But high-risk HPV infections that persist can cause cancer. If the immune system fails to clear a high-risk HPV infection and it persists for many years, it can lead to cell changes that may become cancer, if it is left untreated.
What are some of the symptoms of being infected by HPV?
If your immune system is compromised due to factors such as stress, smoking, or other reasons, the virus may persist in your body for an extended period without showing any symptoms. But the virus gradually affects the cervix. These symptoms can show up after almost a decade.
I always advise my patients to be vigilant of any abnormal symptoms such as bleeding after sexual intercourse, bleeding between periods, and unusual-smelling white discharge, as these could indicate a health issue. One should never ignore these symptoms.
To detect any underlying issue, the Papanicolaou test (Pap test or Pap smear) and HPV DNA (Deoxyribose Nucleic Acid) should be done. The traditional one can be done every two to three years, and the liquid-based HPV DNA test can be done once every five years.
If someone receives a positive HPV test result, what steps should they take and what is the recommended follow-up?
When someone gets HPV-positive results they are advised for colposcopy, which means examining the cervix under magnifying lenses. Colposcopies primarily check for signs of cancerous cells or precancerous cells that could become cancer if not treated.
Why is there such a rise in cervical cancer despite the availability of the vaccine?
Lack of awareness, lack of availability and accessibility to HPV vaccine and pap smear test are the main challenges in controlling cervical cancer in women. A lot of patients tell me they were not aware of the vaccine. We need to organise more health awareness programmes to address the stigma associated with discussing sexual health and encourage women to prioritise their gynaecological health. Cervical cancer is only cancer which can be prevented with vaccination and screening. Women should utilise these measures and safeguard their health.
What is the recommended frequency for gynaecological check-ups and screenings?
Pap smear test and HPV DNA test should be done once in 3-5 years. Early detection and appropriate management can lead to better outcomes. And women have to do it until the age of 65. Women should ideally opt for the HPV DNA test, which is a combination of a pap smear and an HPV test.
What are the different HPV vaccines available for preventing cervical cancer?
We have three types of HPV vaccine – Cervarix, Gardasil and Gardasil 9. Cervarix is designed to prevent infection from HPV types 16 and 18, which are the only high-risk strains of the virus.
Gardasil is designed to prevent infection from low and high-risk types 6, 11, 16 and 18. Gardasil 9 is designed to prevent infection from 16, 18, 31, 33, 45, 52, and 58. Vaccines have been shown to provide cross-protection against other types of HPV viruses as well.
The vaccine can be administered to both boys and girls from the age of nine and above. If administered before the age of 15, two doses of the vaccine are sufficient, but after that age, three doses are required. It is advisable to receive the vaccine before becoming sexually active, as the virus might already be present in the body by then. The vaccine is safe for administration up to the age of 45 for both males and females.
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Although the HPV vaccine cannot clear the virus, it can effectively prevent future infections.
Every sexually active woman is at risk of developing cervical cancer. The best way to prevent this would be to get vaccinated, practise safe sex, and go for regular pap smear tests until the age of 65.
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