New Delhi, May 13, 2011 : Cancer cervix is the commonest cancer among Indian women, every hour it kills almost eight Indian women. It is caused by HPV infection, a common sexually transmitted viral infection. The high risk cofactors in its carcinogenesis are multiple sex partners, early age of marriage and intercourse, low socio-economic status, herpes simplex virus and human immunodeficiency virus (HIV) infection, smoking, dietary deficiency and use of oral contraceptives etc.
Dr. Suversha Khanna, the Director of premier cancer hospital in Delhi and NCR; commented that, cancer cervix is the commonest cancer among women cancer patients being registered for cancer treatment in Dharamshila hospital every year. Around 100,000 new cases of cancer cervix are diagnosed, and 74000 die due to it, every year in our country. India is home for more than 20% of total new cases diagnosed in world. Though it progresses at a very slow speed and preceded by an well established and easily identifiable precancerous stage; called Cervical Intraepithelial Neoplasia( CIN), > 2/3rd ladies with cancer cervix present in advanced stages (stage 2 or more), when its prognosis is not so good.
Dr (Mrs) Kamlesh Mishra, Senior Consulant Gynecolgoy Oncology and Gynecological ; comments that it takes about two or three decades before an HPV infection gets transformed into frank cancer. Hence, it can be diagnosed in easily treatable precancerous stages( CIN 1/2/3) with Pap’s smear. The abnormal Pap’s smear reports need colposcopy and directed biopsy for further confirmation of diagnosis before exact treatment planning. While its incidence has been brought down in developed countries with population based cervical cancer screening, but in India due to lack of resources this could not happen and scourge of cancer cervix continues. The cancer patients seen in cancer hospitals may be just tip of iceberg, as many women in rural areas don’t avail any kind of treatment for their illness or go for alternative treatments, which are absolutely ineffective in cancer treatment. VIA, VILI, Naked eye examination, low cost HPV DNA testing etc are some other modalities of screening methods, which are under evaluation to find most appropriate one in low resource setting countries.
As a social responsibility, Dharamshila Hospital & Research Center, Delhi runs a free cancer screening program , in which free Pap’s smear for cancer cervix , mammography for breast cancer and pelvic UUG and examination by gynecologist is done free of cost. If any abnormality is detected free consultation is given to poor patients by cancer experts.
Dr Ramesh Dawar, head of the department of pathology feels that if women are aware about their health needs and rights, besides other priorities, many of our children could be saved of being orphaned. If women undergoes Pap’s smear even once at age of 35 years, the cervical cancer mortality can be halved. Ideal is annual Pap’s smear after she starts sexual activity and it should continue till the age of 60 years.
Dr Kamlesh Mishra further added that any women with irregular bleeding per vagina (post menopausal, post coital or irregular menses) or persistent white discharge should urgently need to be examined by Gynecologist to rule out any abnormality in cervix and get Pap’s smear done. If abnormality is found, an expert opinion should be taken with Gynecology oncologist and further evaluation with colposcopy may be needed. Doing not so, one may miss chance of cancer being detected in curable stage.
LEEP, Cold Knife conization, Cryo and hysterectomy are the available and effective modalities of treatment for patients, who are diagnosed in precancerous stage (CIN) in Pap’s and colposcopy. But those women, who develop frank cancer, Early stages (stage I & IIA) are cured with radical surgeries, though advanced stages (IIB and beyond) are best managed with radiotherapy.
