By Dr Niraj Krishnamurthy Yanamandra

Gynecological cancers are amongst the most common cancers in women and hence an important public health issue. Lack of cancer awareness and organised screening facilities in developing countries such as India result in most women being diagnosed at advanced stages, thus compromising on quality of life as well as life expectancy.

India launched its National Cancer Control Program in 1975-1976 in response to the incidence of various cancers affecting women and men. The program goals include the primary prevention of cancers through health education, secondary prevention through early detection and diagnosis, strengthening of cancer treatment facilities and patient care for patients with advanced cancer.

Cancers of the female reproductive tract and breast has a high incidence amongst Indian women. Cancer registries have highlighted that more than 70% of cancers in females occur in the age group of 35-64.

Cervical Cancer

Cervical cancer is on a declining trend, but it remains the second most common cancer in women after breast cancer. In 2020, an estimated 604 000 women were diagnosed with cervical cancer worldwide and about 342 000 women died from the disease.

Cervical cancer develops in a woman’s cervix (the entrance to the uterus from the vagina).  

Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact. Most HPV infections clear on their own, but in some cases the infection will persist and can develop into cervical cancer or other HPV related cancer. 

Can cervical cancer be detected early?

Yes. A simple test called Pap smear that is done in outpatient setting can detect changes in cervix prior to developing cancer. It has long been used in developed countries to screen for cervical cancers, accounting for their low-incidence rates. Unfortunately, in developing nations such as India, due to lack of awareness programs and no formal screening programs, most women present in advanced stages of cervical cancer.

The HPV vaccine, screening and treatment of precancerous lesions are essential interventions to reduce the incidence of cervical cancer.

Is cancer in the cervix preventable?

Yes. Cervical cancer is a preventable disease. Effective primary (HPV vaccination) and secondary prevention approaches (screening for, and treating precancerous lesions) will prevent most cervical cancer cases.

Is the prognosis always bad with cervical cancer?

Cervical cancer is one of the most successfully treatable forms of cancer, if detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care. With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation.

What are HPV vaccines?

HPV is a group of more than 200 related viruses, of which more than 40 are spread through direct sexual contact. Among these, two HPV types cause genital warts, and about a dozen HPV types can cause certain types of cancer—cervical, anal, oropharyngeal, penile, vulvar, and vaginal. HPV vaccines protect against infection with human papillomaviruses (HPV).

Dr Niraj Krishnamurthy Yanamandra, Consultant Obstetrician & Gynaecologist, Laparoscopic and Hysteroscopy Surgeon, Rainbow Hospitals, Hyderabad, Telangana

Who should get HPV vaccination?

The current recommendations for HPV vaccination are:

Children and adults ages 9 through 26 years

HPV vaccination is routinely recommended at age 11 or 12 years; vaccination can be started at age 9 years. HPV vaccination is recommended for all persons through age 26 years who were not adequately vaccinated earlier. Children who start the vaccine series before their 15th birthday need only two doses to be fully protected. People who start the series at age 15 or older and people who have certain conditions that weaken the immune system need three doses to be fully protected.

Adults ages 27 through 45 years

Although the HPV can be given through age 45 years, HPV vaccination is not recommended for all adults ages 27 through 45 years. Clinicians should discuss with their patients in this age group who were not adequately vaccinated earlier whether HPV vaccination is right for them. HPV vaccination in this age range provides less benefit because more people have already been exposed to the virus.

Pregnant women

HPV vaccination should be delayed until after pregnancy, but pregnancy testing is not required before vaccination. There is no evidence that vaccination will affect pregnancy or harm fetus.

Do women who have been vaccinated against HPV still need to be screened for cervical cancer?

Yes. Because HPV vaccines do not protect against all HPV types that can cause cancer, women who have been vaccinated are advised to follow the same screening recommended for those non-vaccinated.

Information on other gynaecological cancers will be dealt with in next edition.

This article was written by Dr Niraj Krishnamurthy Yanamandra, Consultant Obstetrician & Gynaecologist Laparoscopic and Hysteroscopy Surgeon, Gynaecology, Rainbow Hospitals, Hyderabad, Telangana and published in partnership with Rainbow Hospitals.