Cervical cancer prevention: It's now or never!

By Dr Debjani Mukhopadhyay, Consultant Gynaecologist at Barking, Havering and Redbridge University Hospitals NHS Trust, London.

Dr Debjani MukhopadhyaySun Tzu’s ‘Art of War’ says about laying plans: It is a matter of life and death, a road either to safety or to ruin. Hence it is a subject of inquiry which can on no account be neglected.’ Cervical cancer is a unique cancer that is almost non existent in the developed world and the ‘second biggest killer’ after breast cancer in the developing world. Why this big discrepancy? It is in the plans, right? Which part of the plans? Is it science, is it money or is it our viewpoint? Let us discuss this systematically. 

Twenty-five percent of all deaths due to cervical cancer occur in India. Sixty-eight percent of all women deaths in Africa are due to cervical cancer. Every year more than 56,000 women in Latin America and the Caribbean are diagnosed with cervical cancer and more than 28,000 ie, 50% die from it. However, lifesaving prevention and treatment tools do exist. 

In the western world, cervical cancer has been made extinct by applying science to formulate a screening programme and then yes, spending money to develop an infrastructure to apply it nationally. In theory, if implemented on all eligible women, cervical cancer should be extinct. Yet, it is less than 1% but not zero. One of the main reasons is that some women chose not to take full advantage of this programme and don’t get their smears done regularly. 

The screening programme involves, having a cervical smear done. If the result is normal, to keep doing smears annually or atleast every three years. If the result is abnormal, to see a gynaecologist who can examine the cervix with a microscope called colposcope. If this procedure, called colposcopy identifies any pre cancer cells, the gynaecologist will deal with them appropriately to ensure these pre cancer cells never become a cancer.  

In India, there are many gynaecologists well trained to take a cervical smear and to perform a colposcopy if needed. Many pharmaceutical companies have made it possible to detect the HPV virus that is the main reason for normal cervical cells to become pre-cancerous. The vaccine against cervical cancer is also available in India. This vaccine protects best if taken by girls before they become sexually active but will provide some immunity even if taken after being sexually active.

Yes, there is no national screening programme set up in India. How many women in India go and get their smear tests done regularly… I am yet to find one. Why spend money on a screening programme that women are not interested in or are not ready to participate? Perhaps there is a lack of awareness that there is a vaccine to prevent cervical cancer? Perhaps there is a lack of awareness that cervical cancer can be screened and prevented? Or is it because of sheer laziness to act which we are all guilty of from time to time? Or is it because you doubt the efficacy of the vaccine and the smear? Or is it because the pain of the injection or having a smear done that puts you off? 

Life is precious and if you can prevent something as horrible as cervical cancer, all the above are an excuse if anyone ever succumbs to it. Hail Google! No excuses for not being aware. Come on, own up, we all have been google doctors sometime in our lives. 
Someone very wise has said, ‘prevention is better than cure’. Not convinced? Let’s discuss what happens if a cervical cancer is detected. Following a few scans, if it is found treatable, the plan will be either to have surgery which would be a hysterectomy or chemotherapy and radiation given together. This disease usually affects young women between 25-45, so with either of these treatments, one may find themselves in a position where they may never be able to have children. If not treatable then the pain caused by their spread to the bones are of a different level.

Let me share a personal experience with you. One fine day, I went to work with some bellyache. Thought nothing of it and did my clinic, attended the meetings but when the pain got really worse, and I vomited, my husband took me to the hospital. After a few investigations, I was diagnosed with a 10 cms neuroendocrine tumour of the pancreas. I was shattered! Anyway, to cut the long story short, I underwent a Whipple’s procedure. It was a long eight to nine hours surgery via a cut extending from my xiphisternum to nearly the pubic bone. I had to stay two whole weeks in the hospital and learn how to walk and climb stairs before I was discharged home. I lost seven kgs of weight in two weeks and could not finish a sentence in one go without being breathless. I recovered from this with no complaints as it was a better option than dying. Within six months, it recurred and by the time we noticed it, it was a 17 cms necrotic mass. So, had to have a second surgery via the same cut, now a bit longer! The same thing all over again to recover. After the second surgery, the decision was made by experts that I should have chemotherapy as well.

I had to have it every 3 weeks for 6 such cycles. The chemo would knock me down for a few days with extreme tiredness, lack of sleep when needed, poor appetite, bitter taste in the mouth and occasional nausea. Being an optimist, I would cope with it alright. I have had very good support from my family and friends. After about 10 days, I would start to feel better and smile again. When I absolutely felt my best, it would the day I had the chemo again and it would knock me down again. Being the optimist that I am, I could cope with this for four cycles. Despite all the comforts and love from family and friends, for the last two cycles, I could only sit and cry and think ‘only if there was a screening programme for this sort of tumour too’. I could not cope with the waxing and waning of my physical and mental status. This is in very short of how I felt about chemo. Just a note, that the oncology team felt I have sailed through the chemotherapy regime compared to some other people. 

The risk factors of cervical cancer are smoking, starting sex at a young age, many sexual partners and a partner who has or had many sexual partners. If you can relate to any of these, checking the cervical health via a smear annually would put your mind to rest. The warning signs are abnormal bleeding, bleeding after sex or in between periods. While there are many things in life we cannot control, cervical cancer is one thing we can! Why loose this opportunity? Condoms are not just to prevent an unwanted pregnancy; it also protects you from getting HPV and in turn from cervical cancer. The money you would spend on a cervical smear would be less than a cup of coffee and a sandwich that you have several times a week but may prove to be lifesaving.

To the men I say, there cannot be a better way show that you care by ensuring the women you love have regular smears. Ladies, please do not do the smear for anyone else but yourself, because you are worth it! You are the core of the home. If you are well, the family runs well. Consider the vaccine for your daughters, albeit after understanding it from your local gynaecologist. You and your daughters are worth much more than to suffer in pain. 

I wonder what the women who have been or are being treated for cervical cancer might feel if they knew they could prevent it all. If they could reverse time, would getting a vaccine or annual smear test be that big a deal to them?