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Cervical Cancer! All you need to know

by Dr Shelly Singh

By By Dr. Shelly Singh, Senior Consultant, Obstetrics and Gynaecology
Rosewalk hospital, New Delhi

Why Cancer Cervix has increased in women in their early 30’s?
Cancer cervix is the fourth most common cancer globally and the fourth cause of cancer related mortality. As we all know Cancer cervix is diagnosed most commonly between the ages of 35-44 . It is very rare in patients younger than 20 years of age . However since the 1950’s and now since 2014 , statistics have shown an increase in the rates of this cancer in patients less than 30 years. There has been an annual increase by 10.3 % in girls between the ages of 20-29 years between the years 2000-2009 .

What are the risk factors for Cervical Cancer ?
Infection with the Human Papilloma Virus ( HPV) is the most important reason for Cancer Cervix . There are numerous subtypes of these viruses which can cause not only Cancer cervix but also Cancer Vulva, Vagina, Penis and Anal cancers . They are also known to cause viral warts . Some subtypes are called high risk subtypes like HPV 16, 18,33,35 etc .
These viruses are fairly common and are acquired through vaginal , oral and anal sex . They are also acquired through skin to skin contact in skin around the genital area; that is why using a condom is definitely preventive but does not eliminate the chances of getting HPV infection as condoms only cover the penis and not the genital skin .

Smoking is a known risk factor and the incidence increases two fold in women who smoke . Smoking contains many carcinogens and various cancer causing by products have been found in the cervical mucous . Smoking also reduces immunity and so increases the chances of HPV in causing this cancer , amongst many other cancers. Carcinogens in cigarette smoke change the DNA of cells of the cervix making them more susceptible to cancer.

Sexual history
Starting to have sex at a young age and having multiple sexual partners are also known to increase the chance of HPV infections , other sexually transmitted infections and even HIV which causes a total collapse of the immune system . One of the common STDs are caused by Chlamydia which aid the growth of HPV in the cervix , enabling their multiplication .

Long term use of Oral Contraceptive pills
Using hormonal combined contraceptive pills for many years is known to increase the risk of Cancer cervix though stopping them reduces the risk . However this does not mean we stop effective methods of contraception including the pills as unwanted pregnancies also come with their own problems . Using them judiciously and not indefinitely ,weighing risks and benefits with the advice of your doctor are warranted .

Early age of pregnancy and deliveries and multiple deliveries starting at a young age are also risk factors for Cancer Cervix . Rural India sees numerous girls getting married at a young age with subsequent pregnancies and inadequately spaced pregnancies too. Women who had their first delivery at less than 20 years of age are more likely to have Cancer cervix than those at 25 years or more .

It’s now easy to see why rates of Cancer Cervix are rising in women less than 30 years .
Increased promiscuity , beginning sexual activity at a younger age , multiple sexual partners or intercourse with a partner who has multiple partners , increasing STD prevalence including HPV infection and also HIV are some of the reasons . Using Oral Contraceptives for prolonged periods of time and also the reverse; not using barrier methods of contraception like condoms also lead to more chances of HPV . There is an increased incidence of smoking in the younger population as well which adds to the mayhem.

We do not have a robust system of vaccinating our girls from the ages of 9-26 years against HPV infection . Also it is important to know that all girls from the ages of 21 years must undergo screening for cervical cancer by Pap’s smears . A lot of people are unaware that screening is still an integral part of Cervical cancer prevention even after vaccination against HPV . This must be continued till the age of 65 years once every 3 years or with an HPV testing either alone or in combination with cytology once every 5 years . Screening itself has saved many a life by diagnosing precancerous lesions and also Cancer in early stages .

Is Cancer Cervix in younger girls any different from that in the older population ?
Yes. The type of cancer on biopsy is mostly adenocarcinoma or adenosquamous carcinoma or sarcoma in direct contrast to squamous carcinoma . This has ,in some studies ,been found to be a more aggressive cancer with a faster spread .

These are ominous figures indeed but this is a preventable form of cancer . The WHO initiative of 90-70-90 which means vaccinating 90 % of girls by the age of 15, Screening 70 % of women by the age of 35 and then again at 45 by a robust screening test and treating 90 % of women diagnosed with precancerous lesions or invasive cancer by the year 2030 will go a long way in eliminating Cancer Cervix in this century .

Awareness , safe sexual practices , vaccination , screening and early treatment , giving up smoking and a healthy lifestyle are the cornerstones of fighting against this largely preventable menace . The youth must indeed be educated ; an educated and empowered youth is half the battle won !

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