WHAT is cervix ?

Cervix is the lower part of the uterus which connects the body of the uterus to the vagina (birth canal).

WHAT is cervical cancer ?

Cervical Cancer occurs when abnormal cells on the cervix grow out of control. Symptoms include irregular vaginal bleeding, bleeding in between periods or after sexual intercourse or post-menopausal bleeding. Foul smelling vaginal discharge and low back pain or lower abdominal pain may also occur.

WHAT causes cervical cancer ?

Nearly all cases of cervical cancer can be attributed to persistent Human papillomavirus (HPV) infection. Other risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, prolonged use of oral contraceptives, and lack of awareness and screening.

IS cervical cancer common ?

• Cervical cancer is the second most common cancer in Indian women.
• Every year, 122,844 women are diagnosed with cervical cancer in India and 67,477 die from the disease (GLOBOCAN 2012).
• One woman dies of cervical cancer every 8 minutes in India. (WHO Summary report on HPV & cervical cancer statistics in India, 2008).

WHY do I need cervical screening ?

A major cause of high burden of cervical cancer in India is lack of awareness and lack of cervical screening. Because of lack of screening, many cases of cervical cancer are detected in advanced stages leading to high mortality rates. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early – when it has not spread, and is amenable to curative treatment.

It is estimated that cervical cancer will occur in approximately 1 in 53 Indian women during their lifetime compared with 1 in 100 women in more developed regions of the world (GLOBOCAN 2012). The reason for this huge difference is the practice of routine screening in developed countries which is not done in India. In fact, only 3.1% women in India get screened, leaving a large population vulnerable to death from the disease.

WHO should get cervical screening ?

Women aged 21 to 29, should have a Pap test every 3 years. From the age 30, the preferred way to screen is to get tested every 5 years with a Pap test combined with an HPV test, OR every 3 years with a Pap test, till the age of 65.

HOW is the Pap test done ?

The Pap test is a painless outpatient procedure done during gynecological examination.  It is used to collect cells from the cervix so that they can be looked under the microscope to find cancer and pre-cancer.

WHAT should I know before scheduling an appointment for Pap test ?

• Do not schedule an appointment during your menstrual period.
• Do not use tampons, jellies, vaginal creams, moisturizers, lubricants, or vaginal medicines for 2 to 3 days before the Pap test.
• Do not douche for 2 to 3 days before the Pap test.
• Do not have vaginal sex for 2 days before the Pap test.

WHAT is HPV test and how is it done ?

A human papillomavirus (HPV) test is done to check for high-risk HPV (HPV strains associated with cervical cancer) infection in women. This is done by looking for the genetic material (DNA) of HPV on a sample of cells collected from the cervix. It is usually done at the same time as Pap smear in screening women aged 30-65 years (also called co-testing). The HPV DNA test is not recommended in women under 30. That is because HPV infections are common in sexually active women in their 20s, and most of them clear on their own.

One of the benefits of adding HPV testing to Pap smear is that women can get cervical cancer testing less often – 5 yearly with co-testing (Pap smear + HPV test), compared to 3 yearly with Pap smear.

MYTHS about cervical screening

• Cervical cancer mainly affects women from lower socio-economic strata. (While cervical cancer is more common in the lower income group due to various factors like lack of awareness and access to health amenities, malnutrition, poor genital hygiene and early marriages, this cancer can affect women from all social and economic strata).
• Women in monogamous relationship don’t need to be screened. (Not true. All women in the recommended age group should undergo regular screening).
• Women who have received HPV vaccine don’t need screening. (All HPV vaccinated women need to be screened in exactly the same manner and recommended time intervals as non-vaccinated women).

WHAT can I do ?

Consult your gynae-oncologist or gynaecologist, who will inform you all about cervical screening and perform a Pap smear (with an HPV DNA test where indicated). If these tests are normal, you need to undergo Pap + HPV DNA test (co-testing) every 5 years OR Pap smear every 3 years, till the age of 65. If the tests are abnormal, your doctor would advise you further investigations, which may include colposcopy (a procedure to examine an illuminated, magnified view of the cervix) along with a biopsy, followed by management according to the results.