Gynecological cancers: do the right thing

Cancers of the female reproductive system and breast have a high incidence in Indian women.

By Dr Niraj Krishnamurthy Yanamandra

Gynecological cancers are among the most frequent cancers in women and therefore constitute an important public health issue. Lack of cancer awareness and organized screening facilities in developing countries like India results in most women being diagnosed at late stages, compromising quality of life as well as life expectancy.

India launched its National Cancer Control Program in 1975-1976 in response to the incidence of various cancers affecting women and men. The objectives of the program include primary prevention of cancer through health education, secondary prevention through early detection and diagnosis, strengthening of cancer treatment facilities and care of patients with advanced cancer.

Cancers of the female reproductive system and breast have a high incidence in Indian women. Cancer registries have shown that over 70% of cancers in women occur in the 35-64 age group.

Cervical cancer

Cervical cancer is on a downward trend, but it remains the second most common cancer in women after breast cancer. In 2020, approximately 604,000 women were diagnosed with cervical cancer worldwide and approximately 342,000 women died from the disease.

Cervical cancer develops in the cervix (the entrance to the uterus through the vagina).

Almost all cases of cervical cancer (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact. Most HPV infections go away on their own, but in some cases the infection will persist and may progress to cervical cancer or other HPV-related cancer.

Can cervical cancer be detected early?

Yes. A simple test called a Pap smear that is done on an outpatient basis can detect changes in the cervix before you develop cancer. It has long been used in developed countries to screen for cervical cancer, which explains their low incidence rate. Unfortunately, in developing countries like India, due to the lack of awareness programs and the absence of formal screening programs, most women present with advanced stages of cervical cancer.

The HPV vaccine, screening and treatment of precancerous lesions are essential interventions to reduce the incidence of cervical cancer.

Is cervical cancer preventable?

Yes. Cancer of the cervix is ​​preventable. Effective primary (HPV vaccination) and secondary (screening and treatment of precancerous lesions) prevention approaches will prevent most cases of cervical cancer.

Is the prognosis always bad with cervical cancer?

Cervical cancer is one of the most successful forms of cancer that can be treated, if caught early and managed effectively. Cancers diagnosed at an advanced stage can also be controlled with appropriate treatment and palliative care. With a comprehensive approach to prevention, screening and treatment, cervical cancer can be eliminated as a public health problem within a generation.

What are HPV vaccines?

HPV is a group of more than 200 related viruses, more than 40 of which are spread through direct sexual contact. Of these, two types of HPV cause genital warts, and about a dozen types of HPV can cause certain types of cancer: cervical, anal, oropharyngeal, penile, vulvar, and vaginal. HPV vaccines protect against infection with the human papillomavirus (HPV).

Dr Niraj Krishnamurthy Yanamandra, Obstetrician and gynecologist consultant, laparoscopic and hysteroscopic surgeon, Rainbow hospitals, Hyderabad, Telangana

Who should get the HPV vaccine?

The current recommendations for HPV vaccination are:

Children and adults from 9 to 26 years old

Vaccination against HPV is systematically recommended at the age of 11 or 12 years; vaccination can be started at the age of 9 years. HPV vaccination is recommended for all people up to the age of 26 who have not been properly vaccinated before. Children who start the immunization series before their 15th birthday need only two doses to be fully protected. People who start the series at age 15 or older and people with certain conditions that weaken the immune system need three doses to be fully protected.

Adults 27 to 45 years old

Although HPV can be given up to the age of 45, vaccination against HPV is not recommended for all adults between the ages of 27 and 45. Clinicians should talk to their patients in this age group who have not been properly vaccinated earlier to find out if HPV vaccination is right for them. Vaccination against HPV in this age group offers less benefit because more people have already been exposed to the virus.

Pregnant women

HPV vaccination should be delayed until after pregnancy, but a pregnancy test is not required before vaccination. There is no evidence that the vaccination will affect the pregnancy or harm the fetus.

Do women who have been vaccinated against HPV still need to be screened for cervical cancer?

Yes. Since HPV vaccines do not protect against all types of HPV that can cause cancer, women who have been vaccinated are advised to undergo the same screening recommended for unvaccinated people.

Information on other gynecological cancers will be covered in the next edition.

This article was written by Dr Niraj Krishnamurthy Yanamandra, Obstetrician Consultant and Laparoscopic and Hysteroscopic Surgeon Gynecologist, Gynecology, Rainbow Hospitals, Hyderabad, Telangana and published in partnership with Rainbow Hospitals.

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