India accounts for 27 per cent of the world cervical cancer population. This essentially means that the highest number of cervical cancer cases from a single country - come from India. According to the International Agency for Research on Cancer (IARC), a part of the World Health Organisation (WHO), it has been estimated that every year approximately 74,000 women in India succumb to this disease. In this two-part series, Dr. Madhu Goel, Senior Consultant, Obst.& Gynecology at Rockland Hospital takes us through the disease in detail and what you can do to prevent it. First, an overview:

Cervical Cancer: The Disease and Its Genesis 

Cervical cancer is the cancer of the area that connects the uterus to the external female genital tract. The malignancy is generally spread through Human Papillomavirus (HPV) during sexual contact and it has been proved that even preventive measures like contraceptives cannot stop it from entering a woman’s body. In this disease, symptoms are visible in later stages. It is however, the intensity of the disease that can be prevented by simple Pap smear test in early stages and precancerous stage. This cancer, which begins with the abnormal change in the cell and is often detected in its last stage, does not show any relevant symptoms.

It has been noted that the precancerous changes of the cervix rarely cause pain and fail to show any evident symptoms. If the abnormal cells become cancerous and invade nearby tissue then there may be some abnormal bleeding. Sometimes bleeding after menopause and increased vaginal discharge may also indicate cancer.

Stats and Studies

Smoking and Cervical Cancer: Researchers at Pennsylvania State University College of Medicine suggested (January 2008 issue, Journal of Virology) a direct link between cigarette smoke carcinogens and the human papillomavirus that may lead to increased risk of cervical cancer. The study proved that cigarette smoke carcinogens are cofactors which synergize with human papillomavirus and increase the risk of cervical cancer progression. Benzo[a]pyrene (BaP), a major carcinogen in cigarette smoke, had been detected in the cervical mucus and may bond well with HPV. This unhealthy exposure of cervical cells to high concentrations of BaP resulted in a 10-fold increase in HPV type 31 (HPV31) viral titers; whereas BaP exposure also increased HPV16 and HPV18 viral titers. Thus, the overall, BaP modulation of the HPV life cycle has potential to enhance viral persistence, host tissue carcinogenesis, and permissiveness for cancer progression.

The HPV Virus: Cervical cancer caused by HPV is the most common cancer among Indian women, with an estimated 132,000 new cases and 74,000 deaths annually. HPV is the causative agent in 90 per cent of cervical cancer cases. Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin and body surface disorders, can lead to many changes in cervical cells that may eventually lead to cancer. 

In the year 2008, researchers at the University of North Carolina at Chapel Hill reported that persistent infection with human papillomavirus (HPV) could be a useful clinical marker for increased risk of cervical cancer. They reviewed 41 existing studies including over 22,500 women to systemically evaluate the association between HPV persistence and high-grade lesion. This persistent HPV infection of six months to one year was consistently associated with a woman’s increased risk to cervical cancer. Among the 14 high-risk types of HPV causing invasive cervical cancer, type 16 and 18 were found most rampant. These two virus types are responsible for 70 per cent of invasive cervical cancer and 50 per cent of high-grade lesions worldwide. 

A study at the All India Institute of Medical Sciences also confirmed that HPV-16 and HPV-18 are the most common types of HPV in India and among 10 women succumbing to the disease every hour in south-east Asia, eight of the cases are from India. 

The problem of the HPV virus is that it has a very long incubation period and it may remain asymptomatic even for 20 years. The virus is generally transmitted through sexual contact and people who are prone to high risk sexual behaviour.

In the second part of this two-series post on Cervical Cancer,  Dr. Madhu Goel helps us understand the Cervical Cancer risks, symptoms, prevention and cure. 

*Image courtesy: © Thinkstock photos/ Getty Images