Cervical Cancer

75,000 or more of our countrywomen will die from this disease every year. Hence India accounts for 26.7% of the incidence and 27% of deaths due to this disease world-wide. This disease is truly a scourge for our countrywomen. Cervical cancer can be detected in early or pre-invasive stages with the help of screening, thus greatly reducing the morbidity and mortality. In developed countries with an organized Pap’s smear screening program on a national level, the incidence and mortality from cervical cancer has been dramatically reduced. However, screening of all women in India is likely to remain an unrealized goal due to various reasons. So far, screening has not been implemented properly and has had no impact on the incidence or death rates in India. Hence some other preventive intervention must be considered. It has been established that infection with high risk human papillomavirus type is a necessary cause of cervical cancer in almost 100% cases. HPV type 16 & 18 are responsible for 70% of the invasive cervical cancers. Hence a prophylactic vaccine against these HPV types will be able to provide the population wide primary prevention against the disease. This, if implemented properly, could be the more viable and practical option in a country such as ours. However, even for vaccinated persons, screening has to continue. So establishment of screening protocols and facilities for screening have to be organized.

Detection and Management of Pre Cancerous Lesions of the Carvix

1. Detection
There is as yet no organized screening programme for the country. Screening was recommended in 1984 when National Cancer Control Programme (NCCP) was launched. Subsequently programme has been revised, the last one being in 2006. However, it is recommended that women undergo periodic cancer screening based on the following criteriae. 1. Sexually active women above 30 years of age. 2. Sexual life more than 10 years. 3. More than 3 pregnancies and labour. Screening