The word cancer delivers terror to our souls. You sit there eyes widened in the doctor’s room, fearing the unknown and fighting for hope. Documented proof of the first cases of cancer dates way back to 1,500 BC, in Egypt¹. As of 2020, centuries later, an estimated 10 million deaths due to cancer were recorded, despite medical and scientific advancement². Cervical cancer is one of the leading causes of cancer death among women. Furthermore, within the past 30 years, cases of cervical cancer have increased by 30%, worldwide³. 

Maybe you clicked on this article for a glimmer of hope while in a place you’re in desperate need to get back to life prior to the disease or you want to find a way to help a loved one get through this chapter of their life. Perhaps instead, you have heard or seen how the disease slowly and painfully devours the life out of someone and are looking to learn more about it. Irrespective of your circumstance, solutions start with thorough learning. This article aims to detail you about cervical cancer and ways of preventing and controlling the disease.

About cervical cancer

Cancer is a condition where uncontrolled cell division takes place in the body, causing neoplasia, which refers to a benign or malignant form of abnormal tissue mass. When uncontrolled development occurs in solid tissue, such as an organ, muscle, or bone, this is referred to as a tumour. Cervical cancer begins at the lower part of the uterus, in the cells lining the cervix. Most women with cervical cancer are acquainted with a long asymptomatic period before the disease. Clinically, patients undergo four stages of the disease as described in figure 1. Human papillomavirus (HPV) is a common sexually transmitted viral disease caused by papillomaviruses. The ubiquitous nature of papillomaviruses allows it to affect both animals and humans alike and comprises over 130 types with 20 being cancer-related. 70% of cervical cancer cases are caused by HPV strains, HPV16 and HPV18. A study among 297 women revealed that HPV18 held a 4.4 times greater risk of death than tumours linked with other strains of HPV⁴. 

Factors that increase risk of cervical cancer ⁵

• Human papillomavirus
• Exposure to cigarette smoke
• Exposure to Diethylstilbestrol (DES), a synthetic form of estrogen that was prescribed to pregnant women to prevent miscarriages and premature labour
• High parity
• Sexual activity at a young age with multiple sexual partners
• Long-term use of oral contraceptives
• A history of sexually transmitted infections
• The immunocompromised 

Common symptoms

• Vaginal bleeding between menstruation
• Heavy and long menstruation
• Pain during intercourse and bleeding after intercourse                                                                                          
• Pelvic pain
• Unusual colour or smell in vaginal discharge 
• Vaginal bleeding after menopause

Prevention strategies

1. Blocking of viral transmission

The most convenient mode of blocking viral transmission is by practicing safe sex. This requires the use of latex condoms and a spermicide may decrease the risk of contracting HPV. However, it is not the most efficient method of prevention since HPV can be contracted through other parts of the body that are not protected by a condom, such as the labia, scrotum and anus⁴.

2. Early screening

Early screening of cervical cancer decreases the mortality rate associated with the disease and allows the removal of lesions which may lead to invasive progression of the disease⁵.  The three main tests promoted for cervical cancer screening are as follows⁶:

1. Conventional pap smear and liquid-based cytology

The inner and outer skin of cervix is slightly scraped in order to obtain a thin layer of cells. The sample is directly observed under a microscope in the conventional method. This method is prone to many false positive and false negative cases. Hence, the sample is prepared by making it a suspension in the liquid-based method⁷.

2. Visual inspection with acetic acid (VIA) or lugol iodine (VILI)

After applying VIA or VILI, the cervix is examined by the naked eye. It is an inexpensive and non-invasive method that is conducted for women over thirty.  Those below thirty do not undergo screening unless they have been diagnosed with HIV⁶. 

3. HPV testing for high-risk HPV subtypes 

Tests for low-risk strains of HPV are unavailable up-to-date. There are two major types of tests among those that identify high-risk HPV strains⁶:

1. Test that detects the presence of any of the 13 high-risk serotypes, non-specifically.
2. Tests that detect the presence of HPV16 or HPV18 using HPV genotyping.

3. Vaccination

Human papillomavirus vaccines are vaccinations that protect against infection with certain strains of the human papillomavirus. HPV vaccinations are available that protect against two, four, or nine different forms of HPV. All HPV vaccinations protect against at least HPV types 16 and 18, which are responsible for the majority of cervical cancer cases. Vaccines are found to reduce the incidence of cancer associated with HPV16 and 18 in vagina, vulva, anus, and head and neck  by approximately 70%¹⁰. According to WHO, South Asia is the home for one-third of the World’s under-immunized children. The reason for vaccination being less prominent in South Asia is said to be due to weak health systems, under-skilled health workers, and gaps in parents’ awareness about its importance¹¹. In Sri Lanka, the 2 doses of HPV vaccines are given through National Immunization Programme to all girls who have reached age 10 in schools and in the MOH office of their respective area. To know more about the available vaccination relevant to your location, you may visit the epidemiological unit of the Ministry of Health in person or through their online website. 

Despite cervical cancer being the most prominent form of cancer among women, it is a preventable disease. Prevention begins with awareness. Make sure you share this article with anyone who may find it useful and watch out for the next part of this series which focuses on control strategies to those who have been diagnosed with cervical cancer. 

References 

1. Di Lonardo, A., Nasi, S., & Pulciani, S. (2015). Cancer: We Should Not Forget The Past. Journal of Cancer, 6(1), 29–39. https://doi.org/10.7150/jca.10336
2. Ferlay, J., Colombet, M., Soerjomataram, I., Parkin, D. M., Piñeros, M., Znaor, A., & Bray, F. (2021). Cancer statistics for the year 2020: An overview. International Journal of Cancer. https://doi.org/10.1002/ijc.33588
3. Zhang, S., Xu, H., Zhang, L., & Qiao, Y. (2020). Cervical cancer: Epidemiology, risk factors and screening. Chinese Journal of Cancer Research, 32(6), 720–728. https://doi.org/10.21147/j.issn.1000-9604.2020.06.05
4. ‌Burd, E. M. (2003). Human Papillomavirus and Cervical Cancer. Clinical Microbiology Reviews, 16(1), 1–17. https://doi.org/10.1128/cmr.16.1.1-17.2003
5. PDQ Screening and Prevention Editorial Board. (2022, February 10). Cervical Cancer Prevention (PDQ®). Retrieved March 10, 2022, from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK65997/
6. Ngoma, M., & Autier, P. (2019). Cancer prevention: cervical cancer. Ecancermedicalscience. https://doi.org/10.3332/ecancer.2019.952
7. Bentz, J. S. (2005). Liquid-based cytology for cervical cancer screening. Expert Review of Molecular Diagnostics, 5(6), 857–871. https://doi.org/10.1586/14737159.5.6.857
8. Mustafa, W. A., Halim, A., Jamlos, M. A., & Idrus, S. Z. S. (2020). A Review: Pap Smear Analysis Based on Image Processing Approach. Journal of Physics: Conference Series, 1529(2), 022080. https://doi.org/10.1088/1742-6596/1529/2/022080
9. Cancer Surgery – Anil Cancer Clinic. (2021, February 3). Retrieved September 1, 2022, from Anil Cancer Clinic website: https://anilcancerclinic.com/cancer-surgery/
10. Cheng, L., Wang, Y., & Du, J. (2020). Human Papillomavirus Vaccines: An Updated Review. Vaccines, 8(3), 391. https://doi.org/10.3390/vaccines8030391