Cervical cancer: Can it be prevented?

Cervical cancer: Can it be prevented?

Prevention is better than cure. More so, when the disease in question is prevalent and has a high morbidity and mortality. We are talking about cervical cancer, the most common cause of cancer related death in developing countries.

Prevention can be done at several levels and each level is as important as the other. A combination of primary, secondary and tertiary prevention methods is needed to prevent cervical cancer morbidity and mortality.

Primary prevention is the modification of risk factors (where possible) for cervical cancer. This includes prevention of HPV infection by vaccination and following safe sexual practices. HPV vaccines currently available are the prophylactic vaccines, which are most effective in HPV naïve population (before the onset of sexual debut). These have been around for more than a decade, and in countries like Australia, where a nationwide vaccination campaign was followed, resulted in the reduction of pre-invasive cervical disease within just three years of vaccination. The vaccines are administered in 2 or 3 doses (depending on age at vaccination) and provide cross protection from HPV types other than those covered by the vaccine.

HPV infection, though a necessary causal agent for cervical cancer, is not the only one. Other factors like cigarette smoking, early age at first intercourse, multiple sexual partners, multiple pregnancies, low socio-economic status, diet poor in folates and anti-oxidants are modifiable risk factors. These can be impacted on by public education and awareness. Some other factors like older age, immunosuppression, genetic and racial predisposition are non-modifiable risk factors and in such patients, early diagnosis by screening has a more important role to play.

Early diagnosis of precancerous lesions in asymptomatic patients by regular screening constitutes secondary prevention. It also includes carrying out confirmatory tests in screen positive or symptomatic women. Several methods are available for screening, ranging from simplistic and inexpensive to complex and costly. They also vary in their sensitivity and pick-up rates, some can be carried out by trained providers (including non-clinicians), while others require a full setup of laboratory and equipment. The oldest and most well known is the Pap test, which was developed over 60 years ago. Countries who have implemented this test in mass screening, an example being the Nordic countries, have been successful in reducing the deaths from cervical cancer by about half.  However, this method is resource and time intensive and therefore has not taken off as the primary method for screening in resource poor nations. Here, another simple technique, using dilute vinegar has shown equal promise at a fraction of the costs. The advantages and disadvantages of each method are explained in detail in the referenced article. HPV DNA testing also forms part of secondary prevention in detecting women who have persistent HPV infection due to its direct correlation with cervical cancer. Its role is dual, both as the sole method of screening, as well as for triaging screen positive women into treatment or observation arms. Its universal use is limited by the cost of the test, although a low cost alternative may soon be available. Molecular biology techniques detecting HPV related proteins are potential biomarkers for cervical cancer prevention as they indicate progressing or aggressive lesions.

The cycle of testing (using a sensitive test at regular intervals), diagnosis (using a highly specific test), treatment (with effective methods and by trained staff) and follow-up (as a part of an organized program with high population coverage) should be completed to ensure the success of screening.

Tertiary prevention serves to manage the precancerous lesions at an early phase before they turn into cancer. This involves the use of therapeutic approaches to destroy or remove the precancerous lesions before they have a chance to convert into cancer. In the case of cervical cancer, this phase of precancerous disease may last several years and is hence amenable to treatment. There are two ways to deal with the pre-cancer that is detected. The first is destroying the pre-cancerous tissue using extreme heat or extreme cold and preserving the rest of the cervix. The other method is excising a part of the cervix containing the pre-cancerous zone. The method chosen depends on the type and extent of the precancerous lesion. Screen-and-treat approaches are useful in resource-limited settings, where a suspected precancerous lesion is treated at the same time it is detected (single visit). A trained provider is a must for this. Guidelines for management are available from many international bodies.

Only in pregnancy, the situation is different and a precancerous lesion is kept under follow up until after delivery and then treated.

Thus, prevention of cervical cancer involves a multi-pronged approach of education, creating awareness, advocacy, public-private partnerships for HPV vaccination, screening and early treatment of precancerous lesions before they develop into cancer. The extent of focus on each of these measures may vary between communities and countries based on the availability of resources and healthcare commitments. A holistic approach to prevention, involving locally effective measures and treatment protocols and evaluating their adherence and success over time can help tailor programs and policies to maximize the benefits of cervical cancer prevention programs.
Cervical cancer is completely preventable. Cervical cancer can be prevented. However the extent to which we achieve this goal depends on us.

Dr. Pakhee Aggarwal

MS, MRCOG (UK), MIPHA, Fellow Gynae-Oncology – Oxford, Consultant – Obstetrics & Gynaecology.

(http://www.bio-services.org/cervical-cancer-can-prevented-2/)

September 24, 2017

References:

World J Clin Oncol. 2014 Oct 10;5(4):775-80. doi: 10.5306/wjco.v5.i4.775.

Cervical cancer: Can it be prevented?

https://www.ncbi.nlm.nih.gov/pubmed/25302177

 

Please write us  at info@bio-services.org for more information.



He initiated TQM as a management way in SRF and the Company has so far earned the Deming Prize for two of its businesses, for the tyre cord in 2004 and for the Chemicals Business in 2012.

Mr. Bharat Ram was elected President of Confederation of Indian Industry (CII) during 2000-2001 and continued to play important roles as Chair and Member of various council of CII till March 2015. He co-chaired the Indo German Consultative Group (IGCG) which consisted of eminent citizens from both the countries from 2002 till 2014.

Mr. Bharat Ram is actively involved in social development activities. Currently he is Chairman of:

  • SRF Foundation, the social wing of SRF, which manages its own schools and also supports education in villages;
  • The Lady Shri Ram College (LSR) for Women in Delhi which has consistently been rated as one of the two best colleges of India;
  • The Shri Ram Schools; and
  • CAF (India) – Charities Aid Foundation (India); and
  • A governing body member of CAPED– a registered Society for spreading cancer awareness program

He is on the governing body of SPIC Macay, a society for the promotion of the Indian Classical Music. He is himself an accomplished sitar player, having learnt it from Pt. Ravi Shanker.

Mr. Arun Bharat Ram has won many awards and accolades, The Jamshedji Tata Award, which was conferred on him by the Indian Society for Quality (ISQ) for the year 2006 and the Officer’s Cross of the Order of Merit, presented by the Federal Government of Germany in 2008. Mr. Bharat Ram schooled at the Doon School, Dehra Dun and graduated in Industrial Engineering from the University of Michigan, U.S.A.

Prior to his current appointment, Dr. Vaid practiced and coordinated the Department of Medical Oncology at the Rajiv Gandhi Cancer Institute and Research Centre (RGCI) in Rohini, Delhi, India. In addition to his active medical oncology practice, Dr. Vaid has participated in many national and international clinical trials as a principal and sub-investigator. His clinical interests include Hemato-Oncology and Bone Marrow Transplant. He has also taken keen interest in treating breast cancer, lung cancer and genitor-urinary cancers.

Dr. Vaid established the bone marrow transplant services in the private sector in Delhi starting with Rajiv Gandhi Cancer Institute & Research Centre during the last decade and has cumulatively carried out the largest number of bone marrow transplants in the private sector in Delhi. Currently at Medanta, he leads a large team which comprises of hemato-oncologists, pediatric transplant specialists, hemato pathologists specializing in transplant pathology, transfusion specialists, and molecular pathologists required for HLA typing and post transplant chimerism monitoring.

Dr. Vaid lectures nationally and internationally and has contributed to numerous peer-reviewed articles, book chapters and abstracts. His work has appeared in Journal of Clinical Oncology, Journal of Thoracic Oncology, World Journal of Gastroenterology and Hepatobiliary Pancreatic Diseases International. Dr. Vaid currently chairs the Indian Council of Medical Research Subcommittee on formulating guidelines for treatment of Hodgkin’s Disease in India. He is recognized as Teacher and Examiner for superspeciality course of Medical Oncology by National Board of Examinations and the Bombay University and a reviewer of thesis for award of PhD degree in Life Sciences, Chhatrapati Shahu Ji Maharaj University, Kanpur, India. He is an editorial board member for the following journals “Research & Reviews: A Journal of Medicine” and “Research & Reviews: A Journal of Toxicology”, and “South Asian Journal of Cancer”.

He was conferred the prestigious “Padma Shree” Award, one of the highest civilian award in India, by the President of India in 2009 for his contribution to the field of medicine on 14th April, 2009.
Prior to Stellaris, Alok was a Partner at another VC firm, Helion Ventures, where he led enterprise software and services investments. Before his career in venture capital, Alok was the Chief Operating Officer (COO) of SAP India and had been associated with SAP since the year 2004 in various leadership roles in the United States and in India. Before SAP, Alok also worked with Siebel Systems, The McKenna Group, McKinsey & Company and Cadence Design Systems.

Alok has completed his MBA from INSEAD (France), MS in Computer Sciences from University of Texas, Austin and his B.Tech in Computer Science from IIT Delhi.

Alok is interested in cricket, light & classical Indian music, hiking and long distance running. In addition, Alok is passionate about mathematical puzzles and used to run a weekly blog at http://alokgoyal1971.com/.

Alok’s association with cancer started in 2007 when his mother was diagnosed with a late stage Ovarian Cancer. He saw his mother battle with cancer for more than four years, during which time he was the primary care giver.

Committees / Ambassador Radhika is a part of many committees in CII and is also Pinkathon Ambassador. Social Initiatives

  • Radhika has participated in plays as a lead singer to raise funds for NGO’s like Azad Foundation and CAPED.
  • Mamma Mia Again, ABBA songs Musical, was staged at The Shri Ram Center, Delhi in December 2016 to raise funds for Azad Foundation.
  • I have a Dream, ABBA songs Musical, was staged at Apparel House, Gurgaon to raise funds for CAPED in April 2017.
  • I have a Dream, ABBA songs Musical, was staged at The Shri Ram Center, Delhi to raise funds for CAPED in December 2017.
  • She was also instrumental in staging a play, Khushi Ek Ehsaas, by the visually impaired children of JPM School to raise funds for Blind Relief Association at Kamani Auditorium in January 2016.

Hobbies

  • Radhika learns music at Theme.
  • She also loves to run and has completed 3 half Marathons in India in 2017.

Amitav worked for Bristol Myers Squibb based in Princeton for 5 years. He has been involved with his family-run business since 1994.

Amitav was educated at the Doon School and went on to study Economics at St. Stephens College, Delhi University. He has an MBA from UNC Chapel Hill, USA. He sits on the board of Central Square Foundation, AVPN India and several other non/for-profit organisations in India.

In 2010, he became an Aspen Fellow, in 2015 he became an Ashoka Fellow and 2017 he was incubated as an N/Core Fellow.

Organizational Positions
  • Vice President, Fertility Preservation society of India/ 2014 – 2018
  • Coordinator, Deptt of Obstetrics and Gynaecology, Artemis Hospital, Gurgaon, April 2007 – Nov 2009
  • Coordinator, (North India), Clinical Research Committee, Federation of Obstetrics & Gynecology Society of India (FOGSI) 2003-2008
  • Executive Member, Adolescent committee, Association of Obstetrics & Gynaecologists of Delhi (AOGD ) 2006 – 2007
  • Executive Member, Association of Gynaecologic Oncologist of India,2009 -2011
  • Chairperson, Gynaec. Oncology Committee, Gurgaon Obstetrics and Gynaecology Society, 2011
  • Executive Member, Gynaec.Oncology Committee, Association of Obstetrician & Gynaecologists of Delhi (AOGD) 2012 -2014
  • Executive Member, Gurgaon Obstetrics and Gynaecology Society (GOGS), 2012 -2013
  • Coordinator – Young Women Club ( National Project under the aegis of National Adolescent Health Committee, FOGSI) 2012 -2013
  • Treasurer, Asia Oceania Research Organization in Genital infections and Neoplasia ( AOGIN) –India, 2011 -2015
  • Executive member, Gynaec Oncology Committee, Federation of Obstetrics & Gynecology Society of India (FOGSI).2012 -2015
  • Peer Reviewer for the Journal of Federation of Obstetrics & Gynecology Society of India (FOGSI).
  • Peer Reviewer for The Indian Journal of Gynaecologic Oncology.
  • Invited as a trainer by Vattikuti Foundation, Michigan, USA for – Gynaec. Robotic Surgery Training of Gynaecologists at KIMS Vattikuti Institute of Robotic Surgery, Hyderabad
  • Executive member, AOGD(Association of Obsterician and Gynaecologist of Delhi ) 2013 – 2014
  • Executive member, AOGD(Association of Obsterician and Gynaecologist of Delhi ) 2014-2015
  • Executive member,GOGS 2013
  • Executive member, Gynaec.Oncology Committee, Association of Obstetrician & Gynaecologists of Delhi (AOGD) 2013 -2014
  • Executive member, Gynaec.Endoscopy Committee, Association of Obstetrician & Gynaecologists of Delhi (AOGD) 2013 -2014
  • Executive member, International academic exchange committee(FOGSI) 2013 – 2015
  • Executive member, Delhi Society of Gynaec endoscopists.2014- 2015
  • Co-Chairperson, Gynaec.Oncology Committee, Association of Obstetrician & Gynaecologists of Delhi (AOGD) 2015 -2016
  • Executive member, Gynaec Oncology Committee, Federation of Obstetrics & Gynecology Society of India (FOGSI).2015 -2017