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OBG-Speculum: E-Newsletter by dept of Obstetrics & Gynaecology, AIIMS, Gorakhpur, U.P.
OBG-Speculum: 2024 ISSN no.
Vol -2, Issue -1
Dr. Shristi Jaiswal
January month is defined as Cervical cancer awareness month globally in which healthcare teams raise awareness through various events, about this completely preventable cervical cancer and ways for its prevention, early diagnosis and treatment.
It is the 2nd most common cancer in females in perimenopausal age after breast cancer with high incidence and mortality in developing countries. The alarming fact is that every 8th minute one woman dies of cervical cancer in our country. As per ‘Globcon 2020’ data, the global incidence is approx. 6lakh new cases and 3.4 lakh deaths of which India accounts for one-fourth of cases and nearly one-third of mortality.
It has now been proven that 99% of cases are due to the persistence of sexually transmitted Human Papillomavirus in the genitalia. Among the various species 16, 18 genotypes of HPV are responsible for the 90% cases of cervical cancer.
Having an infective aetiology i.e. HPV and a long latent or precancerous phase (up to 10 years or more) makes it a completely treatable cancer if detected in time. World Health Organization (WHO) initiated the Cervical cancer elimination drive in November 2020 through the 90-70-90 strategy, i.e., 90% Adolescent vaccination with the HPV vaccine preferably in the age of 9-14 years and catchup vaccination up to 26 years.
70% of reproductive-age women be screened either through VIA, pap smear (3 yearly) or HPV Testing (5 yearly)
90% should get the timely treatment of detected precancerous or cancerous lesions.
In the year 2024, the theme of the awareness month is “Learn. Prevent. Screen” It emphasised the importance of educating and motivating the public about the factors of cervical cancer, its risk factors and how adolescent vaccination and reproductive screening can reduce the burden to a great extent.
All healthcare workers need to disseminate the following facts regarding cervical cancer:
1. Learn: It is completely preventable and treatable cancer if detected timely.
2. It has infective etiology so good immunity and genital and menstrual hygiene maintenance is helpful for prevention.
3. HPV is a sexually transmitted infection -so monogamous relations provide safety
4. Prevent: HPV vaccine is available which can prevent the chances of cervical cancer by 80-97%
5. Two doses of 0.5ml I/M only are required for 9-14 years girls while above this age 3 doses are needed in a catch-up up period to 26 years.
6. Indian make quadrivalent vaccine developed by Serum Institute “Cervavac” is available in market which is made from capsid protein. (VLP)
7. Screening: Three major options of screening are there:
a. HPV based screening –from 30 years @ every 5 years till 65 years. WHO says in low-resource countries even two HPV screenings at 35 and 45 years is also a sufficient option for its elimination.
b. Cytology based – Pap test starting from 25 years @ every 3 years till 65 years of age.
c. Clinical VIA: visual inspection under acetic acid @5 yearly intervals (LMIC)
8. Even after vaccination- the screening schedule should continue.
FOGSI has initiated a campaign focusing first on HPV vaccination for cervical cancer. Under this Gynaecologists, Paediatricians (commonly involved in vaccination) and general practitioners are being given training to make them confident in motivating and prescribing this life-saving HPV vaccine.
Reference:
FOGSI GCPR : Gynaecological Oncology committee on the prevention and management of cervical cancer. - https://www.fogsi.org/fogsi-gcpr-on-prevention-and-management-of-cervical-cancer-june-2023/
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