by: Dr. Nupur Sharma
Sr.Consultant- Obstetrics and Gynecology – Paras Bliss, Panchkula
We always talk about our wives as our better halves but have we even thought about protecting them from the dreaded disease cancer. So here we go with the list of common gynecological cancers and their prevention. The four common gynecological cancers are those of cervix (mouth of the womb), breast, endometrium, and ovary.
What is Cervical Cancer?
India rank’s no. 1 in cancer cervix, this is largely because we believe that leucorrhoea (white discharge per vagina) is normal to occur. This leucorrhoea is primarily because of a variety of genital infections like candidiasis, trichomoniasis, vaginosis etc. These vaginal infections render the genital tract susceptible to HPV (Human Papilloma Virus) infection. When we come across HPV, usually 80% of HPV infections are cleared off by our immunity. But if our immunity is hampered due to these vaginal infections, promiscuity, early age at intercourse, smoking etc, we tend to harbor this organism in our cervical cells (cells the f mouth of uterus). There HPV causes sequence of changes ranging from ASCOUS, AGOUS, CIN1, CIN2, CIN3, carcinoma in situ to florid Cancer cervix (cancer of mouth of uterus). These changes take about 10-12 years before conversion to florid cancer giving us a window for catching the diseases in its infancy.
How to prevent Cervical Cancer?
- Primary Prevention– In this like other viral vaccines like Polio, Hepatitis B we give two doses of bivalent or quadrivalent vaccine intramuscular in the arm, at an interval of 6 months for all girls between ages 9 to 14 years. Beyond that we can give three doses at 0, 1 and 6 months. It is important to vaccinate before exposure i.e. before the first sexual debut but can be given up to age 45 years. As this virus has multiple strains so partial benefits can still be obtained even if given after the first sexual debut or in later age.
- Secondary Prevention- This can be by PAP test. PAP test is a test which collects cells from the surface of the cervix (the mouth of the womb) to check for any abnormal cells. It is a painless procedure; sample should preferably be taken by a gynecologist in absence of active vaginal infections.(also avoid intercourse and vaginal douching 24 hours before undertaking a PAP Test). An HPV test collection is just like a PAP test collection but here we also check for viral DNA.
Recommendations by The American Congress of Obstetricians and Gynecologists
- Cervical cancerscreening should start at age 21 years.
- Women aged 21-29 years should have a PAP test every 3 years.
- Women aged 30-65 years should have PAP test and an HPV (co-testing) every 5 years (preferred). It is acceptable to have a PAP test alone every 3 years.
- Women should stop having cervical cancer screening after age 65 years if they do not have a history of moderate or severe dysplasia or cancer and they have either had three negative PAP test results in a row or two negative co-test results in a row within past 10 years, with most recent test performed within past 5 years.
- Women who have a history of cervical cancer should not follow these routine guidelines.A woman who has had a total hysterectomy (removal of uterus and cervix) should stop screening unless the hysterectomy was done as a treatment for cervical per-cancer or cancer. A woman who has had a hysterectomy without removal of the cervical should continue cervical cancer screening according to guidelines.
If you have abnormal cervical cancer screening result, you may have additional testing or treatment. Your healthcare provider will recommend when you can resume routine screening.
Cancer is a disease we should pay attention to rather than create tension.The key to protection is prevention, early diagnosis, and treatment. Believe me, cancer is curable provided a diagnosis in early stages and may require just chemotherapy, just radiotherapy or just laparoscopic surgery (i.e. cure without cutting open your abdomen).
So let’s wake up and protect our better halves: our wives, our sisters, and our daughters.