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Cervical Cancer is Preventable

“Human Papilloma Virus (HPV) is a group of viruses that are very common. There are about 100 types of HPV, of which at least 14
Preventing Cervical Cancer
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Jhumjhumi called me one morning. She wanted to talk to me about an article she has been asked to write for her College souvenir. I asked her to come in the morning, have breakfast, discuss related matters, and also join us for a breakfast of luchi. She is such a bright girl. She beamed when she was served with luchi and aloo dum, her favourite.

— “Aunty, you still remember my favourite dish.” 

— “Yes, she remembers. You have been fond of this dish since your childhood days. Now tell me what the subject of your article is?”

–“We have been asked to write an essay on Cancer of the Cervix for our college souvenir. And you know it has got to be comprehensive for general readers.”

— “I understand. Did you think anything about it?”

— “I have already drafted one, but much has to be added to it.”

— “ O. K. I shall go through your draft and by that time you will continue with your breakfast.”

Her draft read:

‘Cancer is a deadly disease caused by uncontrolled growth of abnormal cells of an organ. Lower part of the womb (uterus), is called Cervix of the uterus. Cancer of the cervix is one of the most common types of cancers, it ranks 4th in the category of all cancers and importantly, it is the leading cause of cancer deaths in women in 42 countries. India contributes about a fifth of the world’s cervix burden.

This disease most commonly occurs in families belonging to low and middle income groups having adverse socio economic conditions, and is said to be due to early marriage, multiple child births and multiple sex partners. In earlier years ladies used to visit a doctor late with complaints like abnormal bleeding in the passage of vagina especially after sexual exposure. In regard to these patients the diseases were in an advanced stage and the tumour, so developed, looked like cauliflower. But, due to increased consciousness in later years such incidences have considerably come down, but still remain as an important cause of death. Presently, one life is lost every 2 minutes due to this disease. In 2020, the global mortality statistics increased to over 340 000 women and these are likely to continue to grow, if proper precautions are not taken to prevent childhood marriage and multiple childbirths.’

Also read: What is PCOS: Addressing Misconceptions

— “Jhumjhumi, you have written well. But …”

–“Now, no more academics for the time being. Let her have some jolbhora sandesh (rosewater filled sweet meat) first. Those delicacies are from Chandannagore.” Chitrita quipped. I have to oblige as all husbands should.

— “O.K., O.K. let her have as many as she can, then we will move on further.”

After consuming a couple of the delicacies, Jhumjhumi uttered, “Uncle, please continue with your discourse.”

— “You see Jhumjhumi, now we know that cancer of the cervix of the uterus is caused due to HPV infection, and that is transmitted mostly through sexual activities (intercourse), as you have mentioned, but the infection may also come through non-sexual skin contact. It’s needless to say that HPV infection is mostly transmitted through sex.”

–“What is HPV?”

–“Human Papilloma Virus (HPV) is a group of viruses that are very common. There are about 100 types of HPV, of which at least 14 are known to cause cancer. HPV Types 16 and 18 are responsible for 70% of all cervical cancers and pre-cancerous cervical conditions.”

–“What do you mean by Pre-cancerous state?”

–“It is that condition which has the potential to become cancerous. If we can detect the pre-cancerous state at an early stage then treatment can also be started early.”

–“How can that detection be done?”

–“We recommend that every woman after the age of 30 years should go for a periodical PAP smear test as a screening procedure. The Papanicolaou test (abbreviated as Pap test, also known as Pap smear ) is a method used to detect potentially precancerous and cancerous processes in the cervix. PAP Test should be done every 3 – 5 years.  It is a procedure, where some cells from the cervix are scraped and tested for detection of abnormal cells.”

— “Is there any other preventable measure than PAP smear screening?”

— “Of course. Now we’re equipped with vaccines to prevent such HPV Infection. There are 3 such vaccines available in the market. One is Gardasil, a quadrivalent vaccine acting against HPV serotypes 16, 18, 6 and 11, Gardasil nonavalent against HPV 6/11/16/18/31/33/45/52/58  and the other is Cervarix which is a bivalent vaccine acting against HPV serotypes 16 and 18.”

We recommend that every woman after the age of 30 years should go for a periodical PAP smear test as a screening procedure. The Papanicolaou test (abbreviated as Pap test, also known as Pap smear ) is a method used to detect potentially precancerous and cancerous processes in the cervix. PAP Test should be done every 3 – 5 years. It is a procedure, where some cells from the cervix are scraped and tested for detection of abnormal cells.

—  “What do you mean by serotypes?”

— “Ah yes! For general people, they can be said to be types, like the types of dogs, say Spitz, Puddle, Labrador, Boxer.”

— “Now I get it. So one can see that Gardasil acts against serotypes other than  16 and 18 also. Uncle, does it have any added advantage?”

— “You are a darling Jhumjhumi. It has protective measures against vulval, vaginal cancers, cancer of the mouth and anal canal. It also acts against ano- genital warts.”

— “What should be the dose schedule of these vaccines?”

— “A total of three doses at 0, 2 and 6 months are recommended with Gardasil or 0, 1 and 6 months with Cervarix. These are to be administered intramuscularly. Vaccines are most effective if those are given before the start of sex life.”

— “At what age should it be initiated?”

— “You see, according to the recommendation of ‘Indian Academy of Pediatrics’, routine vaccination of females should be started from the age 11–12 years with three doses of the HPV vaccine. Vaccination can be given to females at an age as young as 9 years. It can also be administered as well to those aged between 13 and 26 years and have not/ could not complete the vaccination course.”

–“Is this vaccination approved by the World Health Organization (WHO)?”

— “Definitely, WHO has recommendations on HPV vaccination for cervical cancer regarding dose also.” 

— “Uncle, as I was not vaccinated in my childhood, can I take it now?” 

— “Yes, it can be given to ladies in older age groups also, but it should be remembered that it will not serve the role as a curative. It will not cure cervical cancer if it is already present there.”

— “If it is that much necessary, then why is it not included in ‘National Immunisation Programme’?”

— ”Very relevant question. Actually cost of treatment which includes specific medicines counts as a determining factor, but possibly that could also be addressed in near future. A new HPV vaccine has been launched in India by the name of CERAVANAC qHPV.  It is a quadrivalent vaccine against HPV strains of 6,11,16 and 18. The suggested dose schedule is:  A two-dose series (0, 6-12 months) for most persons who initiate vaccination at ages between 9 and 14 years. Also there is a three-dose series (0, 1-2, 6 months) for persons who initiate vaccination at the age of 15  and complete the same by 45 years.  It would be much cheaper and for this our government is planning an immunisation programme for this vaccine.”

— “Let India produce vaccines for Covid and Cervical cancer. Since there are no vaccines as yet for hunger, I intend to cure hunger with Lobster Malaikari ( a delicacy prepared with coconut milk), and Kosha mutton. Those items are waiting in for your consumption. Be rest assured that those won’t cause cancer. Jhumjhumi, write that too in your article. Ha-ha-ha.”

Hereby the discussion was supposed to have ended by virtue of application of ‘veto’ by Chitrita. But it didn’t as there was a sudden entry of gastronomic Amarnathda. His ESP (Extra sensory perception) must be of high quality, we have observed it earlier also. He added, “This year Cervical Cancer Awareness Month was in January 2023 and the theme was “Ending Cervical Cancer within a few generations” with a noble goal of raising awareness for cervical cancer and HPV Vaccination.”  Amarnathda disclosed this information as a rejoinder and we were sure that he must have heard the tail end of our discussion.

— “Wow, that would make a wonderful headline…”  Voice of Jhumjhumi suddenly subsided and her exuberance waned. I followed her stare and bounced upon the wide open eyes of Chitrita, who in a firm admonishing tone uttered, “You shouldn’t talk while eating.”

Amarnathda’s head hung low, apprehending if his quota of Lobster malaikari be curtailed for initiating the last dialogue!

Image courtesy: Wikipedia

Ashok Kr Ghosh is a Gynecologist by profession. He is also a Mountaineer and Traveler and amateur photo artist. He is the recipient of several awards including Honourable Mention, Lalit Kala Academy Award, Excellence Honors from ‘Federation International de la Arte Photograhoque’. Dr Ghosh is also a Naturalist specialising in Ornamental Floriculture and appears as Judge in horticulture exhibitions. His articles are frequently published in leading Bengali periodicals and magazines.

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