Cervical Cancer

In India, every year 1,32,082 women are diagnosed with cervical cancer and 74,118 die from the disease. It is the commonest cancer in India and all sexually active women are at a risk of contracting this disease. But it's mostly seen in woman aged between 50 to 55 years. If detected at a pre-cancerous stage (when the cells are not normal, but are not yet cancerous), this cancer is 100 per cent curable. The unconscionably high mortality in the developing wo rld reflects mainly the lack of timely detection. Early diagnosis usually means an excellent prognosis. This is evident from the fact that the typical latency of 25 to 30 years for the infection to become an invasive cancer provides an excellent window for detecting and treating the problem. Unfortunately, the opportunity is missed in most developing countries where women, especially in rural areas, are rarely screened. The absence of symptoms and of screening often means women become aware of the cervical cancer only after it reaches a fairly advanced stage when treatment is extremely difficult.

The risk factors of cervical cancer are infection with a virus called HPV (human papillomavirus), multiple sexual relationships, conditions that weaken one’s immune system include HIV infection, having had an organ transplantation and Hodgkin's disease, smoking, etc. In the early stages, no symptoms of cervical cancer appear. So, it is important to do Pap tests for screening. In its growing stage of tumor, the following symptoms occur.

abnormal bleeding (including bleeding after sexual intercourse, in between periods, heavier/longer lasting menstrual bleeding, or bleeding after menopause)

abnormal vaginal discharge (may be foul smelling)

pelvic or back pain

pain on urination

blood in the stool or urine.

Pap test: Cells are collected from the surface of the cervix and checked on a slide. This test is available at most hospitals and clinics and its cost varies from Rs 250 to Rs 500.

HPV test: Doctors take DNA cells by swabbing the cervix. The HPV test is ideal for the detection of cervical cancer. It is slightly more accurate than the pap test, but is not recommended for woman below 30 years of age. This test is available at all major hospitals and costs around Rs 1,500.

Colposcopy test: It enlarges the image of the cervic and the cells can be then seen clearly. This test is available at Tata Memorial Hospital, Mumbai.

The three main treatments available today are surgery, radiotherapy and chemotherapy. In case of a surgery, the chances of a woman conceiving a child later in her life are as good as nil. In surgery, lymph nodes, uterus, some tissues and sometimes even some parts of the vagina are removed.

In Western countries, the cases of cervical cancer have come down due to the active awareness, vaccine and pap screenings which detect the cancer at a very early stage. But in India, which accounts for a shocking one in eight cervical cancer deaths in the world, there is little or no awareness about the disease.

Delay sex: Waiting to have sex until you are older can help you avoid HPV. It also helps to limit your number of sexual partners and to avoid having sex with someone who has had many other sexual partners.

Use condoms: Condoms when used correctly can lower the HPV infection rate by about 70%. They can't protect one completely because they don't cover every possible HPV-infected area of the body, such as the skin of the genital or the anal area.

GlaxoSmithKline (GSK) has launched cervical cancer vaccine, Cerverix, in India. The vaccine, which is proved to be effective and safe without any alarming side effects, is targeted towards the 132000 Indian women diagnosed with human papillomavirus (HPV) that causes cervical cancer. GSK is in talks with the government to make HPV vaccine easily accessible in India. At present, only two HPV vaccines are available in the market - GSK's Cerverix and Merck's Gardasil.

Cerverix is available in India for Rs 3300 per dose. The vaccine has to be taken thrice between the age of 10 to 45 years. The duration between the dosages is two months after the first dosage and six months after the second dose. Dr Shailesh Mehta, medical director, Clinical R&D, GSK said, "The prices of the vaccine may be costlier at the initial stage but the prices will come down once the marketing of the vaccine improves. In India, the market will improve once the awareness about the cancer and the importance of vaccination for it is understood. We are in discussions with government to make vaccines accessible."

The vaccine has been successful in around 100 other countries. Annually, 270,000 women die of cervical cancer around the world, which equates to one every two minutes. There are currently over 1.4 million women diagnosed with cervical cancer worldwide. Globally, 500000 cases are reported in women each year. So, there could be over one million new cases each year by 2050.

Researchers are doing work that could give a life-saving purpose to a plant best known for causing cancer. The aim of the work is to coax from tobacco plants a drug that could be used to prevent cervical cancer in India. The vaccine would be somewhat similar to Merck & Co.'s Gardasil, approved by the U.S. government last year to prevent strains of a sexually transmitted disease that causes most cervical cancer. In fact, the same University of Louisville researchers who helped invent Gardasil, Dr. A. Bennett Jenson and Shin-je Ghim, are also working on this new vaccine.

One big difference between the two vaccines is cost.

The tobacco-based vaccine still in the works would cost an estimated $3 for three doses, compared with $360 for three doses of Gardasil. This would make it affordable for developing countries like India, where the disease is the most common malignancy among women.

In India, government does not have proper screening programme for HPV. Presently the government has lots of other priorities, so cancer is not felt as the priority right now. But it will be too late if it is not controlled at this stage.

P.S. :  Several Religious and conservative groups in the U.S. have publicly opposed the concept of making HPV vaccination mandatory for pre-adolescent girls, asserting that making the vaccine mandatory is a violation of parental rights. If this is the situation in US, then it will take atleast another five decades for an average Indian woman to get vaccinated againt HPV.