Cervical Cancer Awareness Month 2021

Cervical Cancer Awareness Month 2021: Cervical cancer is one of the most preventable forms of cancer

Early detection can prevent up to 80% of cervical cancers

Cervical cancer is one of the most preventable and treatable forms of cancer. This is because vaccines exist that protect against high-risk human papillomavirus (HPV) types and screening programmes can detect signs of disease at an early stage, allowing for effective management of the condition. Unfortunately, limited access to prevention and early detection presents a major challenge in low- to middle-income countries like Pakistan and concerted awareness efforts are required to lower the morbidity and mortality rates of cervical cancer in our country.

Throughout January, the International Agency for Research on Cancer (IARC) marks Cervical Cancer Awareness Month by supporting the WHO global strategy of triple intervention, which is prevention, early detection and treatment, to accelerate the elimination of cervical cancer as a public health problem.

What is cervical cancer?

Cervical cancer develops in a woman’s cervix (the entrance to the womb). It mainly affects sexually active women aged between 30 and 45. The vast majority of cervical cancer cases is caused by different types of the human papillomavirus (HPV). These types of viruses are considered to cause the cervical cells to grow uncontrollably and develop into cancerous cells.

An overview of cervical cancer in the world and in Pakistan

According to the World Health Organization (WHO), 600,000 women were diagnosed with cervical cancer in 2020 and 340,000 succumbed to this disease. It was the fourth most common cause of cancer deaths among women in the world in the past year. At the Shaukat Khanum Memorial Cancer Hospital and Research Centres (SKMCH&RC), cervical cancer continues to be among the top five commonest cancers seen among adult females between 1994 and 2019.

According to Dr. Shalla Imdad Ali, Consultant Gynaecologic Oncology at SKMCH&RC, the morbidity and mortality rates for cervical cancer are very high in Pakistan as this type of cancer is ignored in terms of screening, prevention and vaccination. In Pakistan, more than 70% of cervical cancer patients report with very advanced stage of malignancy and this results in high mortality rate in our country.

What are some of the risk factors for developing cervical cancer?

Risk factors for developing cervical cancer include multiple sexual partners that increases the risk of acquiring HPV, early sexual activity, weakened immune system and smoking.

How can women protect themselves against cervical cancer?

Prevention of cervical cancer can be classified as primary and secondary. Primary prevention involves vaccination of young girls while secondary prevention includes cervical screening tests. Additionally, women can reduce their chances of getting cervical cancer by not smoking and practicing safe sex.

Vaccination

In Pakistan two vaccines, Cervarix and Gerdasil, are available as primary prevention against HPV. Vaccination of young women before marriage could be the most effective preventive measure against cervical cancer in Pakistan.

Screening & Early Detection

Cervical screening (a smear test) aims to reduce the mortality and morbidity associated with cervical cancer. Regular screening is the best way to identify abnormal changes in the cells of the cervix at an early stage. This screening can prevent 80% of cervical cancers. Role of HPV testing in screening pathway is important as HPV is detected in 99.7% of cervical cancers.

Cervical cancer screening is advisable in women aged 25 – 44 years after every three years, and for women aged 45 – 60 years after every five years. However, all women, regardless of age, should have a second smear test after three years before going on to age-appropriate interval.

Cervical screening is easy to perform and it is a simple test that can be done with cervical brush in outpatient clinical settings. The best time to have a cervical smear test is between day 10 and day 20  of menstrual cycle (counting 1st day of period as day 1). If a woman has stopped having periods then the screening test can be done at any time.

If abnormal cells are detected, diagnostic colposcopy may be offered, which can also be performed in outpatient settings. It is to assess the nature, severity and extent of the abnormality. During colposcopy, the cervix is visualized to view abnormal cells and colposcopy directed biopsy is possible.

Is cervical cancer treatable?

Cervical cancer is treatable and even curable if diagnosed at an early stage. In the past five years, Shaukat Khanum Memorial Cancer Hospital and Research Centres have seen on average, 150 cervical cancer patients every year. If diagnosed at an early stage, cervical cancer treatment involves surgery and in later stages chemotherapy and radiotherapy. In early stage in selected cases removal of cervix may be an option if child bearing is desired (fertility sparing) in other cases surgery involves hysterectomy.

In conclusion, regular screenings, HPV vaccination, and enhancing access to treatment, a triple intervention strategy as recommended by WHO, should be implemented in Pakistan to fight against cervical cancer.

Source of statistics and facts: www.worldcancerday.org, www.iarc.who.int, www.nhs.uk, and Shaukat Khanum Cancer Registry Reports.