Cervical cancer is the second most common cancer affecting women in India. The cervix is the lower part of the uterus which connects the uterus to the virus. What many people do not know is that the cancer is caused by a virus called the Human Papilloma Virus (known as HPV for short). This virus is sexually transmitted. There are many types of HPV and most do not cause any problems. The ones that do are called High-Risk HPV strains (HPV-16 and HPV-18). 90% of all HPV infections get resolved spontaneously within 2 years. However, in a small percentage of people, the virus can persist and cause cancer – this process can usually take anywhere between 10 to 20 years or more.
Cervical cancer becomes symptomatic only after it has progressed beyond a certain stage. And even then, the symptoms may be ignored because they can mimic common problems that women face. These symptoms include bleeding in between periods or after intercourse. It can also cause pain during urination and vaginal discharge. Because the symptoms are vague and also present late, it is essential to detect cervical cancer early. And the best way to do this by performing regular PAP smears along with testing for HPV at least once every 5 years after the age of 25.
In the PAP smear test, a doctor gently scrapes some cells from the cervix. These cells are then examined microscopically for early signs of cancer. An HPV test can be performed from the same sample and will tell you if an HPV infection is present. As mentioned before, it can take decades before changes can be seen even at a microscopic level. This is where knowing whether you have an HPV infection becomes vital.
Even today, many doctors prescribe only a PAP smear. Those patients who are aware of the need for cervical screening and who do it of their own volition also often ask only for a PAP smear. Detecting an HPV infection can help better monitoring and facilitate early diagnosis of cancer or pre-cancerous conditions. This is one of the reasons that the recent American Cancer Society guidelines also offer HPV testing alone as an option for screening. However, co-testing (i.e. doing a PAP smear and an HPV test simultaneously) still remains the best option to determine the risk as well as current status of the patient’s cervix at a microscopic level.
At Suburban Diagnostics, we recently did a study of all the PAP Smear and HPV testing done over a period of 5 years. What we found was that knowing the results of a PAP smear test alone cannot predict the HPV status or future risk of the patient. In fact, knowing the PAP smear result will lead to only a 2.9% decrease in error in our ability to predict the HPV status of the patient (i.e. whether the patient has an HPV infection or not). So, for all intents and purposes, it is still better to do a PAP smear test as well as HPV test simultaneously. It is also very important that people realize that cervical cancer is preventable. Because it is caused by a virus, there is a vaccine available. It is most effective if given to girls before they become sexually active.
So, in summation - Increased awareness to reduce any stigma/reluctance around the screening tests, timely HPV vaccinations, along with regular and mass screening will be crucial to bring down the burden of cervical cancer in India.