Express News Service

KOCHI: Kerala is well known for its significant strides in literacy and health care. Improvement in health care while promising a longer life expectancy brings challenges in the form of epidemiologic transition. As a result, cancer has emerged as the second most common cause of death following cardiovascular diseases. There are many regional government and private healthcare institutes in the state, who are implementing strategies for risk reduction and early detection of cancer. Cancer of the cervix in women is one of the life-threatening diseases being focused on. To its credit, Kerala was the first state in India to formulate a state-wide cancer control programme in 1988. However, the incidence of Cervical cancer is still high whether global or national, including Kerala.

Globally, one woman dies of cervical cancer every two minutes. This suffering is unacceptable, particularly since cervical cancer is largely preventable. Hence, recently in August 2020, the World Health Assembly adopted a global strategy for cervical cancer elimination and by 2030, all countries should achieve these goals.

The Federation of Gynecologists and Obstetrics is driving these goals across the nation with state bodies as per international guidelines. American College of Obstetricians & Gynecologists (ACOG), ASCCP, Society of Gynecologic Oncology (SGO) are endorsing the US Preventive Services Task Force (USPSTF) cervical cancer screening recommendations.

The USPSTF recommendations apply to patients with a cervix who do not show any signs or symptoms of cervical cancer. For the patients, at high risk of disease (like those who have previously received a diagnosis of a high-grade precancerous cervical lesion) the recommendations do not apply.

Early detection is the key to preventing cervical cancers from spreading. Also, it is very important that the community is familiar with the ways and tests to monitor any possibility of cervical cancers as well. 
The author is the Chief Scientific Officer, Sr Consultant Oncopathologist at PDCC Metropolis Healthcare Ltd

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Global strategy 

• 90% of girls should be fully vaccinated against HPV by the age of 15
• 70% of women should be screened using a high-performance test by the age of 35, and again by 45
• 90% of women with pre-cancer should be treated; 90% of those with invasive cancer should be managed

USPSTF recommendations 

• No screening is required for the patient population aged less than 21 years
• Cytology needs to be done every three years in patients aged 21-29 years
• Three options for cervical cancer screening in age 30-65 years: 
• primary hrHPV test every 5 years
• cervical cytology alone every 3 years 
• co-testing with cytology & hrHPV testing (in order to identify the cervical infection) every 5 years
• In patients  > 65 years, screening is not required after adequate negative prior screening results
• Those who underwent hysterectomy need not be screened in case they do not have a history of high-grade cervical precancerous lesions.