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• Around 70% of cervical cancer cases globally are attributed to high-risk HPV types 16 and 18.7
How common is cervical cancer?
• Worldwide, cervical cancer is the second-most common cancer affecting women8 and the second-leading cause of cancer death in women.9
· Almost 80 percent of all cervical cancer cases occur in the developing world.10
• Globally, 529,825 women are diagnosed each year and about 275,128 die from the disease.30
• Cervical cancer ranks the 1st most frequent cancer in women in India.30
• India has a population of 366.58 million women aged 15 years and older who are at risk of developing cervical cancer.30
• In India, every year 134,420 women are diagnosed with cervical cancer, accounting for 25.4% of the worldwide incidence30 and 72,825 deaths occur due to cervical cancer, accounting for 26.5% of deaths worldwide.30
• In India, every 8 min, a woman is dying due to cervical cancer.30
Who gets cervical cancer?
• Cervical cancer tends to occur in women in their 40s and 50s,11 when many are still raising children and contributing to their families’ livelihoods and security.12
• Women in underserved communities are less likely to undergo recommended cervical cancer screening, which could account for the greater risk for cervical cancer among these groups.13
What test can help detect cervical cancer?
The Papanicolaou test (also called Pap test) is a simple test – usually conducted in a doctor’s office or clinic – that detects abnormal or cancerous cervical cells.14 In India effective coverage (defined as the proportion of eligible women who report that they have had a pelvic exam and Pap smear in the past three years) for cervical cancer screening is uniformly low, 6% and 4% for rich and poor women, 31
o Because the Pap test can detect cervical changes before they progress to cancer,15 it is credited with significantly reducing cervical cancer deaths since its widespread use began in the 1950s.
§ Every year in the U.S., 3.5 million Pap tests find cervical abnormalities that require medical follow-up.16
o Like other medical tests, however, Pap tests aren’t perfect.17 Sometimes they do not find cervical abnormalities that actually exist – but regular screening can help women and their healthcare providers overcome these “false-negative” screenings.18
o In addition, Pap tests can sometimes show minor cervical abnormalities18 that are due to infection with low-risk HPV types such as types 6 and 11.19 These results can be costly for the health system20, but more importantly, may cause unnecessary anxiety for the patient.221
What are the symptoms of cervical cancer?
• Precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms;22 therefore, it is important to get regular Pap screenings to detect cervical pre-cancers or cancers at a stage when they can be treated most effectively.23
• As the disease progresses, women may notice one or more of the following symptoms:
· o Abnormal vaginal bleeding24:
·
§ Bleeding that occurs between regular menstrual periods
o Bleeding after sexual intercourse, douching or a pelvic exam
o Menstrual periods that last longer and are heavier than before
o Bleeding after menopause
· o Increased vaginal discharge
· o Pelvic pain
· o Pain during sexual intercourse
How are cervical cancer and pre-cancer treated?
• There are a number of treatment options available for cancerous and pre-cancerous cervical lesions. In each case, a woman and her healthcare provider determine the most appropriate treatment.
o Pre-invasive stage (Stage 0 – Carcinoma in Situ) - When the cancer has affected only the outer layer of the lining of the cervix,25 treatment may include:
§ Laser surgery uses a laser beam to destroy abnormal cells.26
§ Cryosurgery destroys cancerous and pre-cancerous lesions by freezing them.276
§ Loop electrosurgical excision procedure (LEEP) uses a thin wire loop (through which an electrical current is passed) to cut away an area of abnormal cells from the cervix.27
§ Conization surgically removes a cone-shaped piece of tissue from the cervix.
o Invasive stage (Stages 1-4 )- When the cancer has penetrated into the cervix and possibly to other tissues and organs,22 treatment may include:
o Radiation uses high-energy rays to shrink tumors by destroying the cancer cells’ ability to reproduce.28
o Chemotherapy uses anticancer drugs which reach all areas of the body to kill cancer cells, including those that have spread to distant organs.276
o Hysterectomy can be performed two ways, depending on the extent of the cancer: 1) Simple hysterectomy is the removal of the cancer, the cervix and the uterus.26 2) Radical hysterectomy involves the removal of the cervix, the uterus, part of the vagina and lymph nodes in the area.26
How can cervical cancer be prevented?
o Cervical cancer can usually be prevented if women are screened regularly with Pap tests.23Women should talk to their healthcare providers about having regular Pap screening tests and discuss results with them.
o Most Cervical Cancers are preventable with a comprehensive approach of education, screening and vaccination.
Are most Cervical Cancers preventable?
· Effective interventions against cervical cancer exist, including screening for, and treatment of, pre-cancer and invasive cancer.
o Over 80% of women newly diagnosed with cervical cancer live in developing countries; most are diagnosed when they have advanced disease. 31
o Most Cervical Cancers are preventable with a comprehensive programme of education / awareness, screening, treatment and vaccination.
· Role of Vaccines
o HPV vaccines that prevent against HPV 6, 11, 16 & 18 infections are now available and have the potential to reduce the incidence of cervical and other anogenital cancers. 31
· The development of vaccines for prevention of cervical cancer holds tremendous promise for developing countries like India where cervical cancer ranks as the 1st most frequent cancer among women in India, and the 1st most frequent cancer among women between 15 and 44 years of age.
· WHO recognizes the importance of cervical cancer and other HPV-related diseases as global public health problems and recommends that routine HPV vaccination should be included in national immunization programmes, provided that: prevention of cervical cancer or other HPV-related diseases, or both, constitutes a public health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured; and the cost effectiveness of vaccination strategies in the country or region is considered.31
References
1. Mayo Clinic, Rochester, Minnesota, Department of Oncology Overview. Available at http://www.mayoclinic.org/oncology-rst/.
2. National Institutes of Health. NIAID. Available at: www.nichd.nih.gov/about/womenhealth/cervix.htm. Accessed July 2005.
3. Cancer Research & Prevention Foundation. Healthy Living: Cancer Information, Cervical Cancer. Alexandra, VA. Available at http://www.preventcancer.org/healthyliving/cancerinfo/cervical_a.cfm. Accessed June 2005.
4. National Institutes of Health. Consensus Development Statement on Cervical Cancer. Bethesda, Maryland, April 1-3, 1996.
5. Stevens LM, Lynm C, Glass RM. Papillomavirus. JAMA. May 8, 2002. 287(18):2452.
6. Centers for Disease Control and Prevention. CDC Fact Sheet. Genital HPV Infection. Content Reviewed: May 2004. Technical Update: December 2, 2004. Centers for Disease Control Web site. Available at: http://www.cdc.gov/std/HPV/hpv.pdf. Accessed January 2005
7. Muñoz N, Bosch FX, de Sanjosé S, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518–527.
8. Bosch FX, de Sanjose S. Chapter 1: Human Papillomavirus and Cervical Cancer-Burden and Assessment of Causality. J Natl Cancer Inst Monogr. 2003;31:3-13.
9. World Health Organization. State of the art new vaccines research and development: Initiative for Vaccine Research. Geneva, Switzerland: World Health Organization; 2003:1-74.
10. World Health Organization, Initiative for Vaccine Research. Available at http://www.who.int/vaccine_research/diseases/hpv/en/index.html
11. Centers for Disease Control & Prevention, Cervical Cancer Health Awareness, Cervical Cancer & Pap Test Information. Available at http://www.cdc.gov/cancer/nbccedp/info-cc.htm.
12. Centers for Disease Control and Prevention. National Vital Statistics Reports: Births: Final data for 2002. 2003; 52 (10): 1-116. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_10.pdf. [CDC, National Vital Statistics Reports, vol 52, 2003.
13. National Cancer Institute. Cervical Cancer Report. Available at: http://women.cancer.gov/planning/whr0001/cervical.shtml. Accessed August 2005.
14. Centers for Disease Control and Prevention. Highlights in Minority Health, January 2005. Last updated January 2005. Available at http://www.cdc.gov/omh/Highlights/2005/HJan05.htm. Accessed June 2005.
15. US Food and Drug Administration. New Devices Aimed at Improving Pap Accuracy. October 1996. FDA Consumer. Publication No. (FDA) 97-4264. Available at http://www.fda.gov/fdac/features/896_pap.html. Accessed June 2005.
16. American Cancer Society. Pap Test. December 2003. Available at http://www.cancer.org/docroot/PED/content/PED_2_3X_Pap_Test.asp. Accessed July 2005.
17. Association of Reproductive Health Professionals. Health & Sexuality, January 2005; 10(1). Available at: http://www.arhp.org/files/h&scervicalcancer.pdf. Accessed July 2005.
18. Liaw KL, et al. Detection of Human Papillomavirus DNA in Cytologically Normal Women and Subsequent Cervical Squamous Intraepithelial Lesions. J Natl Cancer Inst 1999;91:954-960.
19. Chesson HW, et al. The Estimated Direct Medical Cost of Sexually Transmitted Diseases Among American Youth, 2000. Perspectives on Sexual and Reproductive Health. 2004;36:11-19.
20. Association of Reproductive Health Professionals, Health & Sexuality, Volume 10, Number 1, January 2005.
21. National Cancer Institute, US National Institutes of Health, What You Need To Know About Cancer of the Cervix. http://www.nci.nih.gov/cancertopics/wyntk/cervix/page7 , posted 3/18/2005
22. American Cancer Society. Cancer Facts and Figures 2005. Atlanta: American Cancer Society’ 2005. Available at http://www.cancer.org/downloads/STT/CAFF2005f4PWSecured.pds. Accessed March 2005.
23. National Cancer Institute, US National Institutes of Health, What You Need To Know About Cancer of the Cervix. http://www.nci.nih.gov/cancertopics/wyntk/cervix/page7 , posted 3/18/2005
24. National Cancer Institute, US National Institutes of Health, Cervical Cancer Treatment: Stages of Cervical Cancer. Available at http://www.nci.nih.gov/cancertopics/pdq/treatment/cervical/Patient/
25. American Cancer Society, Cancer Reference Information, Detailed Guide: Cervical Cancer, Surgery. Available at http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Surgery_8.asp?rnav=cri.
26. American College of Obstetrics and Gynecology, Medical Library, Loop Electrosurgical Excision Procedure. Available at http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZD6NJ687C&sub_cat=2006.
27. Mayo Clinic, Department of Oncology, Cancer Center, Cervical Cancer Treatment. Available at http://www.mayoclinic.com/invoke.cfm?objectid=F1F8872C-7558-46CC-A5CA75040FFBC974&dsection=5.
28
. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Human Papillomavirus and Related Cancers in World. Summary Report 2010.
29. Gakidou E*, Nordhagen S, Obermeyer Z. Coverage of Cervical Cancer Screening in 57 Countries: Low Average Levels and Large Inequalities. PLoS Medicine 2008; (5): e132: 0863-0868
30. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Human Papillomavirus and Related Cancers in India. Summary Report 2010.
31
. Weekly epidemiological record, 10 APRIL 2009, 84th YEAR, No. 15, 2009, 84, 117–132 available on http://www.who.int/wer accessed on 24th April 2009
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