Author - Dr. Gitali Bhagwati 

Dr. Gitali Bhagawati. MBBS, MD (Microbiology), PGDHM (NIHFW) Consultant and Head, Department of Microbiology and infection Control. 

Abstract - 

Cervical cancer is making headlines in news and social media platforms with the fake viral news of the death of actor, model Ms. Poonam Pandey.  Without being judgemental, let us know about the disease, not the model. Although cervical cancer is the second most common cancer in females in India, it is one of the preventable cancer with age appropriate vaccination and screening.

Introduction - 

World Cancer Day was celebrated on 4^th February 2024 with the theme ‘Close the Care Gap’. On 2^nd February, 2024, shocking news got viral throughout the social media and in news channels that Indian actress, model Poonam Pandey had died of cervical cancer; subsequently the news was claimed to be a fake publicity stunt. Simultaneously, promotion of Human papilloma virus (HPV) vaccination among girls was taken into consideration in Indian budget 2024. 

With the trending disease, let us go through it’s bullet points.

Causative agents of Cervical Cancer:

Human Papilloma Virus (HPV) (Family: Papovaviridae) is one such DNA virus which can cause Genital warts (Cervical, Vulvar, Penile) which may lead to cervical cancer.

Another DNA virus associated with cervical cancer is Herpes Simplex Virus 1 & 2 (Family: Herpesviridae).

Prevalence of the Disease:

The highest prevalence of cervical HPV among women is in sub-Saharan Africa (24%); prevalence in South-East Asia is 14%. Globally, cervical cancer was the 4th leading cause of cancer and cancer deaths in women in 2020.

Cervical cancer is the 2nd most common female cancer in women aged 15 to 44 years in India.Prevalence in men is highly variable based on sexual trends.

Symptoms of cervical cancer:

1. Bleeding between periods
2. Bleeding after sexual intercourse or
3. Foul-smelling vaginal discharge.

Prevention:

1. Condoms help to prevent spread of HPV from infected to non-infected person but do not offer total protection because they do not cover all the genital skin.
2. Another prevention strategy is Routine Screening for Cervical Cancer:

World Health Organisation (WHO)suggests HPV DNA detection in a screen and treat approach starting at the age of 30 years with regular screening every 5 to 10 years.

1. Vaccine: 2 types of vaccines available in India

Gardasil™ 3 doses scheduled at 0, 2 and 6 months. This vaccine confers protection against both cervical cancer and genital warts.

Cervarix™3 doses scheduled at 0, 1 and 6 months. This vaccine confers protection against cervical cancer.

Recommended age for initiation of vaccination is 9–12 years. Catch-up vaccination is permitted up to the age of 26 years.

Diagnostic methods: Cervical cancer is the only HPV-caused cancer for which screening tests are available.  The goal of screening for cervical cancer is to find precancerous cell changes before they become cancer.

1. Pap smearby Conventional method or Liquid Based Cytology (LBC)
2. Molecular tests for HPV DNA
   1. Cartridge based nucleic acid amplification test (CBNAAT):  A real-time Polymerase Chain Reaction (PCR) is a qualitative in vitro test for the detection of 14 high risk HPV types in a single analysis. It specifically identifies types of HPV 16 and HPV 18/45 in two distinct detection channels, and reports 11 other high-risk types (31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68) in a pooled result.
   2. Chip-based Real Time Polymerase Chain Reaction (PCR) test for the semiquantitative detection of high-risk Human Papillomavirus (HPV) types 16, 18, 31 and 45.

Treatment: Treatment of Cervical cancer varies depending upon staging and spread. Modality of treatment can be surgery, chemotherapy and/or radiation therapy. Kindly consult oncologist for proper 

Narrative - 

In India, female-health has always been neglected. ‘Me time’ hardly comes to luck in females amidst the Chakravyuh of enormous relationships with humongous responsibilities. Awareness regarding menstrual hygiene, breast cancer, cervical cancer are almost negligible among them. Even the highly educated ladies feel the embarrassment for screening diseases related to breast or genital organs.

Discussion -

The article effectively highlights the key points about cervical cancer, from its viral cause (HPV) to prevention and treatment strategies. However, a more in-depth discussion could delve into:

• Socioeconomic barriers to prevention and screening: Discuss the challenges faced by low-income communities in accessing vaccination and screening programs. Mention the importance of affordable healthcare and addressing cultural taboos surrounding female health.
• Vaccination hesitancy: Briefly address concerns regarding HPV vaccination, emphasizing its safety and efficacy. Include information on herd immunity and its role in protecting unvaccinated individuals.
• Early detection and management: Expand on the importance of early detection through regular screening and the different treatment options available depending on the stage of cancer.
• Male involvement: Briefly mention the role of males in HPV transmission and the potential benefits of including them in vaccination programs.

Conclusion -

The article rightly emphasizes awareness,vaccination,and screening as crucial tools to combat cervical cancer.However,the conclusion can be strengthened by:

• Quantifiable goals: Mention specific targets for reducing cervical cancer prevalence in India within a set timeframe.
• Call to action: Encourage readers to get vaccinated, screened, and spread awareness about the disease. Include resources for accessing relevant information and healthcare services.
• Policy recommendations: Briefly advocate for specific government policies that could promote HPV vaccination and improve access to screening programs, particularly for marginalized communities.