There is a real significant burden of cervical disease in India: think about it- for every 100 women we see in the clinic, we should be seeing at least 2-3 women with cervical cancer. The cumulative risk of incidence of cervical cancer in women in India ( aged 0-74 years) is 2.8%. Compared this to the world wide average of 1.6%. If each one of us is not seeing this rate- we should ask ourselves- are we missing these cancers because we are not offering pap smears and therefore missing the early, not-so-obvious clinical lesions? On the other hand, if you are offering pap smears to all your patients, pat yourself on the back, because you may have prevented one more cervical cancer death by early detection of CIN or cervical cancer. Unfortunately, no medal for that!
Take home message- screen every patients of yours for cervical cancer.
Cervical cancer is caused by the Human Papilloma Virus( HPV): Cervical cancer in a sense is an infectious, sexually transmitted disease, caused by some of the HPV virus strain that are transmitted during intercourse. In the females, it can cause cervical, vaginal, vulvae and anal cancers and pre cancers. In the males, it can cause penile and anal cancers. The commonest types responsible , in over 80% of cases are the HPV 16 and 18.
Take home message – educate your patients and their families about the HPV etiology of cervical cancer, the sexual lifestyle association and the preventive measures available.
Cervical cancer is a deadly killer: of all deaths in women, the death from cervical cancer ( per 1 lac women) is 12.8 as compared to 8.2 in the world( crude mortality rate). Alarming fact is that out of a southern Asia incidence of 10 women dying of cervical cancer every hour, 8 of them are in India. Over 80% of women newly diagnosed with cervical cancer live in developing countries; most are diagnosed when they have advance disease. In 2008, almost 274,883 women died of the disease, nearly 86% of them in developing countries. In India, every year 134,420 women are diagnosed with cervical cancer, accounting for 225.4% of the worldwide incidence.
In India every year 74,825death occur due to cervical cancer, accounting for 26.5% of deaths worldwide. The cumulative risk of mortality due to cervical cancer is 1.7% and 0.9% in India and world respectively.
Cervical cancer is a preventable disease- Take primary and secondary preventive measure: Every women’s ultimately death from cervical cancer could have been prevented by her gynaecologist, if only the women had been screened for a pap smear and given HPV vaccination. In addition, females in the 13-45 years age group be offered HPV vaccination to protect against cervical cancer.
Take home message: every women who is currently sexually active or has been in the past, should be offered a pap smear and advised HPV vaccination.
Vaccination against HPV is safe and effective: the WHO’S Global advisory committee on vaccine safety ( GACVS), the Vaccine adverse event reporting system (VAERS), the Food and drug administration ( FDA) and the Centre for disease control and preventive ( CDC) have all confirmed and declared that the HPV vaccination is safe and effective proving protection against HPV 16, 18, 6 and 11 associated cervical, vulvar and vaginal cancer, genital warts and other HPV- related genital disease in females.
Take home message: Proactively prescribe HPV vaccination knowing its safely and efficacy to the sexually native young girls as well as sexually active women to age 45 years.
