Dr.Maninder Ahuja
VP FOGSI 2013-2014
EVERY SEVEN MINUTE ONE WOMAN IS DYING OF CERIVICAL CANCER IN INDIA
This mortality is almost equal to maternal mortality. In FOGSI we still have to make a policy decision that every effort should be made to prevent these deaths, This is one step forward by starting these series of articles on cervical cancer prevention and management of precancerous cervical lesions.
Article -1 cervical cancer control Introduction
Cervical cancer is one of those cancers where actual cause is identified and it is caused by HPV. This virus has about 120 types but about 13 are highly oncogenic It is infection with this virus , leading onto persistence of infection which leads onto precancerous lesions and those precancerous lesions if not treated can lead onto invasive cancer. We are starting a series on cervical cancer screening and management and this is first of those series.
WHY IS SCREENING APPROPRIATE FOR CERVICAL CANCER?
Cervical cancer is a suitable disease to screen for as per the following criteria:
- Cervical cancer can be considered a public health priority worldwide.
- It is known fact that it is caused by HPV (Human Papilloma Virus)
- Cervical cancer is mostly preventable.
- Cervical cancer has recognizable precancerous lesions that can be treated in a safe, effective, and acceptable way for the affected women.
- Treatment of these precancerous lesions prevents the occurrence of invasive cervical cancer.
- The time between the appearance of precancerous lesions and the occurrence of invasive cervical cancer is long (10 years), leaving time for detection and treatment.
- Treatment of precancerous lesions is less expensive and more successful in avoiding death, as compared to the management of invasive cervical cancer.
MOST IMPORTANT EVEN WITH VACCINATION SCREENING HAS TO CONTINUE.
- As women who are infected have to be treated.
- Vaccination does not cover all strains causing cervical cancer though most oncogenic no 16 and 18 are covered.
- Vaccination take up would never be 100% even in ideal situations.
- Primary prevention means prevention of HPV infection and cofactors known to increase the risk of cervical cancer, and includes:
- Education and awareness-raising to reduce high-risk sexual behaviour
- Implementation of locally appropriate strategies to change behaviour
- The development and introduction of an effective and affordable HPV vaccine
- Efforts to discourage tobacco use, including smoking (which is a known risk factor for cervical and other cancers),
- Treat co infections like Chlamydia which are risk factors
- Family planning to reduce high parity as risk factor.
Early detection includes:
- Organized screening programmes targeting the appropriate age group, and with effective links between all levels of care
- Education for health care providers and women in the target group, stressing the benefits of screening, the age at which cervical cancer most commonly occurs, and its signs and symptoms
Diagnosis and treatment includes:
- Follow-up of patients who are positive on screening, to ensure that a diagnosis is made and the disease appropriately managed
- Treatment of precancer, using relatively simple procedures, to prevent the development of cancer
- Treatment of invasive cancer, including surgery, radiotherapy and chemotherapy
Palliative care includes:
- Symptomatic relief for bleeding, pain and other symptoms of advanced cervical cancer and for the side-effects caused by some treatments
- Compassionate general care for women whose cancer cannot be cured
- Involvement of the family and the community in caring for cancer patients
Next issue we cover Screening By PAP AND LBC