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Home News and Update Archives India must wake up to Dangers of Cervical Cancer: Experts

India must wake up to Dangers of Cervical Cancer: Experts

Times of India
23 Feb 2009

MUMBAI: As the world came to know that British reality TV star Jade Goody’s cancer is incurable, women across the UK walked into diagnostic clinics in larger numbers than ever before for a pap smear test to detect early stages of cervical cancer if any. But in India, despite the grim reality that eight women die every waking hour to cervical cancer, only 5% to 6% of them, who are more than 35 years, take the diagnostic test.

On Sunday, Goody walked down the aisle and collected a whopping 7,00,000 pounds from a leading magazine in exchange of her exclusive marriage pictures, triggering a debate over her money-for-cancer-bytes transactions. Bollywood actor Shilpa Shetty–Goody's one-time arch rival on the Big Brother show–promised to pray for a miracle for the mother of two.

India's millions need a miracle, too, to rein in the largest cancer killer–74,000 women in the country die every year of it. On an average, 1.2 lakh new cases of cervical cancer are detected annually. The situation calls for a public health miracle all right, say health experts. A mass screening process like that in the US could be the answer, they feel.

Largest Killer
"Early marriages, too many children in quick succession and poor genital hygiene have made cervical cancer a big killer in India,'' said Dr Rekha Daver, who heads the gynecological department of JJ Hospital in Byculla. The medical theory is that while several reasons contribute to cervical cancer, 98% of the cases are caused by the human papillomavirus (HPV), which is transmitted to women from men.

Six months ago, international pharma giant Merck launched the first vaccine in the world to prevent cervical canceraimed at girls aged between nine and 26 years of age. "We did a consumer survey among women in the 18-45 age group and found that only 30% of them were aware of HPV. Only 40% knew about cervical cancer and only 13% thought it was a serious disease,'' said Anjana Narayan, who heads the business unit of MSD India, the Indian branch of Merck.

The vaccine, however, is expensive at Rs 2,800 a shot; the person needs three shots in six months. In the well-to-do quarters, there is a demand for the vaccine, says Dr Kiran Coelho of Lilavati Hospital, Bandra Reclamation. "Women come asking for it for their young daughters. Considering that 98% of cervical cancer cases are caused by the human papilloma virus (HPV), the vaccine gives good protection,'' she said.

Not all doctors are convinced. Says Tata Memorial Hospital director Dr Rajan Badwe, "We still have to see evidence of whether the vaccine protects one from cervical cancer or not.'' He offers a different take on cervical cancer too: "The incidence of cervical cancer is quite low among Jewish and Muslim women, showing that there is a correlation between male circumcisions and cervical cancer,'' he said. Medical research has shown that male circumcision protects men against viruses such as HPV and HIV. The logical corollary is that men who have undergone circumcision hence don't spread the viruses to their wives.

On the Bright Side
Said Dr Badwe, "India has been seeing a drop of 1% every year in the incidence of cervical cancer.'' This is perhaps due to better education among people residing in cities, increased use of condoms as well as awareness about regular diagnostic tests such as pap smear tests, he said.

With better screening programmes, the incidence of the disease can reduce further. "In the past few years, we have developed a visual screening test in which doctors can detect cervical cancer. This method is known to be as efficient as pap smear and costs much lower,'' said Dr Badwe.

Dr Daver said while two decades ago, she would see women coming with stage 3 or 4 of cervical cancer, "now we see more women coming with stage 0 or 1 of the disease, which is easily curable''.

It is because of increasing awarness, but a lot more needs to be done.

Cervical cancer forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer, taking between zero to 20 years after exposure to HPV. Women may not have symptoms but can be detected with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope).

Risk Factors
Infection with HPV (human papillomavirus)
Smoking
Weakened immune system
Sexual history (women who have had many sexual partners or a woman who has had relationship with a man who has had many sexual partners)
Using birth control pills for a long time
Having many children
(Please note that having an HPV infection does not mean that a woman will develop cervical cancer)

Symptoms
Early cervical cancers usually don't cause symptoms. As the deadly cells spread, women may notice one or more of these symptoms:
Abnormal vaginal bleeding.
Bleeding that occurs between regular menstrual cycles.
Bleeding after sexual intercourse, douching or a pelvic exam.
Menstrual cycles that last longer and are heavier than before.
Bleeding after going through menopause.
Increased vaginal discharge.
Pelvic pain.
Pain during sex.

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