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Cervical Cancer: Screening, Prevention & HPV Vaccination | Max Hospital

Cervical Cancer & Its Prevention by Vaccination

By Dr. Alka Dahiya in Gynecologic Oncology , Cancer Care / Oncology

Jan 11 , 2024 | 6 min read

Cervical cancer stands as a formidable health challenge for women worldwide especially in India where it is the second most prevalent cancer after breast cancer. However, the silver lining is that cervical cancer is largely preventable. With the right blend of awareness, regular screenings, and early intervention, the risk can be significantly reduced.

Cervical Cancer Causes

The primary culprit behind cervical cancer is the Human Papillomavirus virus especially 16, 18 HPV infection, specifically the Genital Human Papillomavirus. This virus can instigate normal cervical cells to become abnormal. If these abnormal cells are left unchecked and untreated, they can eventually morph into cancer. It's crucial to understand that the Human papillomavirus is a high-risk infection, transmitted predominantly through sexual contact, including non-penetrative acts. The silver lining is that a whopping 90% of new infections are naturally resolved within two years.

Factors that contribute to persistent infection include:

  • Early initiation of sexual activity, especially before 25 years of age.
  • Engaging with multiple sexual partners.
  • A high number of childbirths.
  • Not using protective measures like condoms during intercourse.
  • Genetic predisposition.
  • Smoking habits.
  • Prolonged use of oral contraceptives.
  • Absence of circumcision in the partner.

HPV and Cervical Cancer

Cervical cancer owes over 95% of its cases to the human papillomavirus (HPV). This virus is notorious for being the most common viral infection targeting the reproductive tract. Most sexually active individuals will encounter HPV at some juncture in their lives, with some facing recurrent bouts. The comforting fact is that over 90% of those infected will naturally eliminate the virus.

Cervical cancer remains the most significant health concern linked to HPV. Almost every cervical cancer case can trace its origins back to an HPV infection. While many HPV infections are self-resolving and numerous pre-cancerous lesions spontaneously regress, a lingering risk persists for women. In certain scenarios, HPV infections can lead to pre-cancerous lesions which  can escalate into full-blown invasive cervical cancer overtime

It's pivotal to note that cervical cancer's evolution is a protracted journey, often spanning 15 to 20 years in women boasting robust immune systems. However, for those with compromised immunity, like untreated HIV patients, this timeline can shrink to a mere 5 to 10 years.

Check out Cervical Cancer Treatment here.

Cervical Cancer Staging and Symptoms

In its nascent stages, cervical cancer might slowly progress without manifesting noticeable symptoms. This stealth mode underscores the paramount importance of regular screenings, such as Pap smears and HPV tests, for early detection. As the malignancy advances, symptoms become more obvious:

  1. Abnormal vaginal bleeding: This can manifest as irregular, heavy, or postmenopausal bleeding, or even bleeding between periods or post-coitus.
  2. Pelvic pain or discomfort: This includes persistent pain in the pelvic region or lower abdomen and discomfort during sexual activities.
  3. Unusual vaginal discharge: This might be foul-smelling, watery, or even bloody.
  4. Painful urination: Some women might experience pain or discomfort during urination.
  5. Changes in menstrual cycle: This pertains to alterations in the regularity and flow of menstrual cycles.
  6. Weight loss and fatigue: Unexplained weight reduction accompanied by persistent fatigue.
  7. Swelling in the legs: This symptom might arise if the cancer metastasizes, impacting lymph nodes or obstructing blood circulation.

Read more - Know the Symptoms of Cervical Cancer

Cervical Cancer Prognosis

The prognosis for cervical cancer depends on  its stage at diagnosis. Early detection, especially at stage 0 or I, promises an encouraging five-year survival rate, often above 90%. However, as the disease progresses to stages II to IV, survival rates decrease and treatment becomes different, with stage IV showing the most dismal figures.

Advances in Cancer Care have helped improve cancer treatment outcomes. Regular screenings, HPV vaccination, and early interventions are the cornerstones in enhancing cervical cancer's prognosis by facilitating the detection of the ailment in its most treatable phase

Screening Recommendations for Cervical Cancer

Cervical cancer screening in India adheres to stringent guidelines to enable early detection and prevention. Here's the blueprint:

  1. Pap Smear Test: Women are advised to commence regular Pap smear screenings from the age of 21, done 3 yearly. After a trilogy of consecutive regular Pap smears, women can elongate the screening intervals to every five years, and can be discontinued at 65 years after 3 tests are negative. 
  2. HPV Testing: Human papillomavirus (HPV) testing is advocated for women aged 30 and above, either with the Pap smear or as a standalone test. If both the Pap smear and HPV test yield positive results, the screening interval can be stretched to every five years.
  3. Visual Inspection with Acetic Acid (VIA) or Visual Inspection with Lugol's Iodine (VILI): VIA and VILI are viable alternatives, especially in settings with limited resources. These tests involve applying acetic acid or Lugol's iodine to the cervix to detect anomalies.
  4. Vaccination: HPV vaccine administration is fervently recommended for both girls and boys aged 9-14. This vaccine is a bulwark against HPV infections, the primary instigator of cervical cancer.

Read more - What women should know about cervical cancer?

Cervical Cancer Preventive Methods

  • HPV Vaccination: The most formidable risk factor for cervical cancer is an infection with high-risk HPV strains. HPV vaccines, like Gardasil and Cervarix, are potent weapons against these infections. The vaccination is typically administered to boys and girls aged 9-14, but can be extended to age 45 in specific scenarios.
  • Regular Screening: Regular screenings, encompassing Pap smears and HPV tests, are the first line of defense. Adhering to your healthcare provider's screening recommendations based on your age and risk profile is paramount.
  • Safe Sexual Practices: Curtail the risk of HPV and other STIs that might escalate to cervical cancer by practicing safe sex, like using condoms.
  • Limiting Sexual Partners: Minimize HPV exposure by curtailing the number of sexual partners.
  • Cervical Cancer Awareness: Vigilance is key. If any unusual symptoms surface, seek medical advice immediately. 
  • Healthy Lifestyle: A holistic lifestyle, replete with a balanced diet, regular exercise, and stress mitigation, fortifies the immune system, to combat HPV infections.
  • HPV Testing and Treatment: If an HPV test returns positive, adhere to your healthcare provider's monitoring or treatment recommendations.
  • Cervical Cancer Prevention in High-Risk Groups: Some women might be predisposed to a higher risk due to familial cervical cancer history or a compromised immune system. Such individuals might require more frequent screenings or other preventive interventions.

What Are HPV Vaccines?

HPV vaccines are engineered to shield against specific HPV types. Certain HPV strains can lead to a plethora of health complications, including genital warts and various cancers like cervical, anal, and oropharyngeal cancers.

Types of HPV Vaccine or Cervical Vaccine

Two vaccines are in the fray:

  • Quadravalent Vaccine (GARDASIL) - Administered intramuscularly in the upper arm.
  • Bivalent Vaccine Cervarix - Injected intramuscularly into the deltoid region of the upper arm.

Being a prophylactic vaccine, it's imperative to administer it before sexual initiation. It's powerless against existing HPV infections or diseases stemming from them. The ideal age bracket for vaccination is 9 to 14 years. However, catch-up vaccination can be extended to females aged between 13 & 26 who either haven't been vaccinated or haven't completed the full course. It's pivotal to remember that even vaccinated women should continue with Pap smear screenings. Moreover, women who were sexually active pre-vaccination might already harbor the infection, making Pap screenings indispensable.

Read more - Cervical Cancer and HPV Vaccines, How Far Have We Come?

Why is vaccination the best form of Prevention?

Vaccination targets the root cause: HPV infections.

Here's why the cervical cancer vaccine is the gold standard in prevention:

 
  1. High Efficacy: HPV vaccines have showcased high efficacy in warding off the most notorious HPV strains that cause cancer. They offer maximum protection when administered pre-HPV exposure, ideally during adolescence.
  2. Herd Immunity: Mass vaccination fosters herd immunity, plummeting HPV's overall prevalence in the community. This domino effect offers a protective shield even to the unvaccinated populace.
  3. Long-lasting Protection: HPV vaccines promise enduring protection, potentially for a lifetime, against the targeted HPV strains.
  4. Early Intervention: Offers the best shot at infection prevention and subsequent cancer development.
  5. Cancer Prevention: The cervical cancer vaccine can potentially stave off HPV-induced cancers and diseases.