Dear Doctor

I am in my late 30s but I am afraid of getting cervical cancer. A few years ago I went for a pap smear test and the doctor discovered I had signs that could lead to cervical cancer. The doctor told me I was lucky it had not developed into cancer and I was given treatment. Are there chances of the cancer signs resurfacing again?

Josiane

Dear Josiane,

World wide cancer of the cervix (lower portion of the uterus) is the fourth most common cancer. It is also the most common cause for deaths due to cancer in women.

The human papilloma virus(HPV) infection is responsible for 90 per cent cases. However, all women infected by this virus will not develop cervical cancer. Of the 150-300 known strains of HPV, 15 are classified as high risk for causing cervical cancer. Other risk factors include a weak immune system as due to HIV infection, malnutrition, having sex from an early age, multiple sex partners , multiple pregnancies and smoking. Oral contraceptive pill use for a long time has been associated with increased risk of cervical cancer.

Vaginal bleeding, bleeding on touch or after intercourse, lower abdominal pain, vaginal discharge, feeling a mass in the pelvic region, are the common symptoms of cervical cancer. If it spreads to other parts like liver, backbone, e.t.c. , there would be other signs depending on the part affected. The cancer develops slowly over a period of 10-20 years. It may go unnoticed in early stages as there may be no signs. However, screening by pap’s smear and a cervical biopsy can help to detect the cancer in early stages due to typical changes in the cervical mucosa known as pre cancerous changes. Currently you are free from cancer, but avoid the risk factors. It is advised to go for regular screening.

Regular screening by the papanicolau test, or pap smear, for cervical cancer has been credited with dramatically reducing the number of cases and mortality from cervical cancer in developed countries. Pap smear screening every 3–5 years with appropriate follow-up can reduce cervical cancer incidence up to 80%. Abnormal results may suggest the presence of pre cancerous lesions allowing examination and possible preventive treatment. Pap’s smear testing is recommended every 3 to 5 years, from the ages of 21 to 65 years for all women. Screening can be combined with cervical cytology and HPV virus testing. Cervical biopsy confirms the diagnosis and also helps in determining the stage of the cancer. Treatment depends on the stage. Surgery, radiotherapy and chemotherapy are modalities that is used either singly or in combination.

Prevention consists of avoiding premature sex and multiple sex partners, keeping good pelvic hygiene avoiding smoking and use of oral birth control pills for a long time. HPV vaccine in 2 doses (6-12 months apart) is recommended from age 9 to 25 years. A booster can be taken if considered necessary by the health professional. However, the vaccine is effective only when infection has not set in.

Vitamins A, B12, C, E and beta carotene help in reducing risk of cervical cancer, hence a balanced diet is also useful

Dr. Rachn Pande is a specialist in internal medicine.

rachna212002@yahoo.co.uk