Quarter of world’s cervical cancer patients live in India, says Dr. Sapna Nangia

Cervical caner is the commonest cancer in Indian women. A quarter of the world’s cervical cancer patiants live in India. “It is indeed ironical that a cancer that can be prevented by a vaccine and detected in a pre-malignent state receives such little attention from the media”, laments Dr.Sapna Nangia, Seinor Consultant, Radiation Oncology, Apollo Cancer Institute, Indraprastha Apollo Hospital, New Delhi.
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In an exclusive interaction with Jayashankar Menon, she throws insight on this vexatious problem of rampant cervical cancer among Indian women and how it can be nipped in the bud. Excerpts:

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JM: What is the level of awareness about cervical cancer in India?

SN: Cervical cancer is the commonest cancer in Indian women and a quarter of the world’s cervical cancer patients live in India! It is indeed ironical that a cancer that can be prevented by a vaccine and detected in a pre malignant state receives such little attention from the media.

JM: What are the real causes for this infection of cervical cancer amongst Indian women?

SN: Caused by infection with the Human Papilloma Virus(HPV), cervical cancer involves the opening of the uterus into the vagina. It occurs more commonly in women who start sexual activity at a young age and is also more common in women with many childbirths and partners. Given that girls in rural India marry at a younger age and have more children than their urban counterparts, it is not surprising that the incidence of cervical cancer is more in rural India. Other risk factors are poor personal hygiene and of late, HIV infection.

JM: How long it takes the process of transformation of a pre-cancerous state to cervical cancer?

SN: The process of transformation of a pre-cancerous state to cervical cancer takes around ten years. During this period, a simple test called Pap smear can detect this pre-cancerous state. The affected area of the cervix can be effectively treated by a gynecologist using simple treatment methods such as laser, cryosurgery and LEEP. Pap smears are recommended for all sexually active women, the test being repeated at three yearly intervals if normal and at five yearly intervals if both Pap smear and testing for high risk strains of HPV are negative.

JM What is your take on mass screening of women using VIA?

SN: Organist ions looking to make a contribution towards improving the health status of Indian women would do well to think of mass screening of women using a technique called VIA. This simple test, which basically consists of applying vinegar to the cervix and then inspecting it, can be easily administered by health workers. In a landmark study by Tata Memorial Centre, Mumbai, mass screening of women was found to reduce the risk of dying due to cervical cancer by a whopping 30 percent. It is known that mass screening for cervical cancer once in ten years can reduce the incidence of this disease by 60 percent.

JM: Do we have enough vaccines to stem the rot?

SN: Vaccines are now available against some strains of HPV. Gardasil from Merck protects against four strains, two of which cause cervical cancer and two, genital warts. Cervarix, from  Glaxo Smith Kline Beecham, protects against two cancer causing HPV strains. The HPV strains that these vaccines act against are responsible for about 70 percent of all cervical cancers. Women who have  been vaccinated should therefore still undergo Pap smears for early detection of cervical cancer.

JM: What is the ideal time for vaccination?

SN: The ideal time for vaccination is prior to initiation of sexual activity. It is usually administered to  at the age of 12-13 years to girls, but can be administered between the ages of 9-45 years. When administered, after initiation of sexual activity, the vaccine does not protect against pre-existing infection.

JM: What is the recommended course of injection?

SN: A course of three injections is recommended. However, the second and third injections are being administered one and six months, respectively, after the first. The cost of the vaccine is around Rs. 2,500 per dose.

JM: What other cancers HPV is responsible for?

SN: HPV is responsible for other cancers besides cervical cancer, anal cancer, vulval cancer and that of the throat are also caused by strains of this virus. Vaccination is likely to reduce the risk of these cancers as well.

JM: How about the awareness of HPV vaccination abroad?

SN: HPV vaccination is a part of the National Immunisation Programme in Australia, the United Kingdom and Canada. Besides girls, immunisation of  boys  to prevent the cancers as well as the transmission of cervical cancer is also being considered and is already a part of the national Immunisation programme of some countries.

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