January marks Cervical Cancer Awareness Month, a time to raise awareness about a disease that is often preventable but can have serious consequences if untreated. To help promote awareness, Dr. Preet Kaur, – Vice President of Lab Operations and Quality at Thyrocare (Ex-Fortis, Ex-SRL, Ex- Dr.Lal), and MD Pathologist from Seth GS Medical College & KEM Hospital, Mumbai is addressing some of the common concerns and questions about cervical cancer along with sharing key insights about findings from the laboratory tests done at Thyrocare to detect this disease.
Q1: How does cervical cancer start and develop over time?
Dr. Preet Kaur: First let’s understand what a cervix is. It is a part of the female reproductive system and is located in the pelvic cavity, towards the base of the uterus. It plays a vital role in menstruation, fertility, pregnancy, and childbirth. Cervical cancer begins when the cells on the surface of the cervix undergo abnormal changes. Most commonly, these changes are triggered by a persistent infection with high-risk types of human papillomavirus (HPV). Initially, these changes are precancerous and can take years to develop into invasive cancer if left untreated.
Q2: What is the primary cause of cervical cancer?
Dr. Preet Kaur: The primary cause of cervical cancer is a persistent infection with high-risk HPV types, particularly HPV-16 and HPV-18. These are the main culprits behind most cervical cancer cases.
Q3: Could you elaborate on the risk factors associated with cervical cancer?
Dr. Preet Kaur: Certainly. The key risk factors include:
- Persistent HPV infection, particularly with high-risk types like HPV-16 and HPV-18
- Early onset of sexual activity or having multiple sexual partners
- Regular smoking and alcohol consumption
- A compromised immune system, such as from HIV or long-term immunosuppressive therapy
- Long-term use of oral contraceptives
- Having multiple full-term pregnancies or giving birth at a very young age
Q4: Is cervical cancer more prevalent in specific age groups?
Dr. Preet Kaur: Yes, cervical cancer is most common in women aged 30 to 50 years, with the highest incidence typically seen in their 40s and 50s. However, younger women, particularly those exposed to risk factors early in life, are also vulnerable.
Q5: What symptoms should women watch out for?
Dr. Preet Kaur: There are common symptoms of cervical cancer that women should vigilantly address. These are:
- Abnormal vaginal bleeding, whether between periods, after intercourse, or post-menopause
- Unusual vaginal discharge that may be watery, bloody, or foul-smelling
- Pelvic pain or discomfort, especially during intercourse
- Pain during urination or frequent urinary issues in advanced stages
- Fatigue, unexplained weight loss, or swollen legs in later stages
Q6: How does the HPV vaccine contribute to preventing cervical cancer?
Dr. Preet Kaur: The HPV vaccine is a game-changer in cervical cancer prevention. It protects against high-risk HPV types, particularly HPV-16 and HPV-18. The vaccine is most effective when administered before exposure to the virus, typically during adolescence. However, it also benefits adults. By significantly reducing the risk of HPV infection, the vaccine helps lower the chances of developing cervical cancer and precancerous conditions.
Q7: How common is cervical cancer in women, both globally and in India?
Dr. Preet Kaur: Cervical cancer remains a significant health concern worldwide. Globally, it is the fourth most common cancer among women, with approximately 660,000 new cases and around 350,000 deaths annually. According to a study published in The Lancet Global Health, the global age-standardized incidence rate is about 13.3 cases per 100,000 women-years, with a mortality rate of approximately 7.2 deaths per 100,000 women-years.
In India, the statistics are equally concerning. India ranks second globally in cervical cancer incidence, with an estimated 127,356 new cases annually. This accounts for an age-standardized incidence rate of 17.7 per 100,000 women. The age-standardized mortality rate in India is 7.38 per 100,000 women. These numbers emphasize the urgent need for effective prevention, early detection, and treatment strategies to address cervical cancer, particularly in regions with higher incidence and mortality rates.
Q8: What diagnostic tests are available for cervical cancer?
Dr. Preet Kaur: There are 3 important tests needed for routine testing of cervical cancer, which we provide at Thyrocare. These are:
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- Pap Smear: A Pap smear is a procedure that involves collecting cells from the cervix for testing. It also is called the Papanicolaou test or a Pap test
- Liquid-Based Cytology (LBC): Liquid Based Cytology (LBC) is a new technique for collecting cytological samples in order to detect cervical cancer. It is a screening test that involves collecting cells in a liquid and preparing a slide for microscopic examination
- HPV PCR – It is a molecular biology test used to detect the Human Papilloma Virus (HPV) DNA. This test is generally more expensive than Pap smear or LBC and may miss other conditions in the cervix such as bacterial/ fungal infections. It is ideally a confirmatory test after a positive Pap smear/ LBC test
Q9: What insights have you gathered from the diagnostic tests performed at your lab?
Dr. Preet Kaur: We analysed data of a total of 15698 samples processed in Thyrocare Technologies Ltd laboratories over the last two years using both conventional Pap smear and LBCC test. The samples were collected from health check camps or as a part of preventive health check of patients presenting none or mild symptoms.
- Patients of all ages were tested – from early 20s to more than 70 years old.
- We found that a positive Pap/ LBC test was reported in 0.08% (12 nos) cases while 1.55% (244 nos) of the samples were unsatisfactory for processing or reporting due to inadequacy or quality of the sample.
- 77.73% (12003) of the total cases were reported as NILM, along with 1.38% with atrophy, 1.24% with bacterial vaginosis, 4.32% with fungal infections and 15.40% with inflammation. These clinical findings about the cervical microenvironment indicate early symptoms that may possibly lead to cervical cancer later in life.
The positivity rate observed in our laboratory is similar to the rate reported in other studies.
Q10: What steps can women take to protect themselves from cervical cancer?
Dr. Preet Kaur: Prevention is key. I strongly recommend the following steps than women can take:
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- HPV Vaccination:. Every year, in India, 24th January is celebrated as National Girl Child Day, to raise awareness and to encourage them to lead a healthy and promising life. Today, on this occasion, I urge every woman and girl to get vaccinated against HPV that can protect them against the most common high-risk HPV types.
- Regular Screening & Early Treatment: Early detection is crucial, and at Thyrocare, we provide all necessary testing for timely diagnosis of cervical cancer.
- Practice Safe Sex to reduce HPV transmission.
- Avoid Smoking.
- Maintain a healthy lifestyle.
