LETTER TO EDITOR
Year : 2007 | Volume
: 32 | Issue : 3 | Page : 233--234
Prevention and control of uterine cervical cancer: Current strategies
Smita Asthana, L Satyanarayana
Division of Epidemiology and Biostatistics, Institute of Cytology and Preventive Oncology, Indian Council of Medical Research, Noida, India
Division of Epidemiology and Biostatistics, Institute of Cytology and Preventive Oncology, Indian Council of Medical Research, Noida
|How to cite this article:|
Asthana S, Satyanarayana L. Prevention and control of uterine cervical cancer: Current strategies.Indian J Community Med 2007;32:233-234
|How to cite this URL:|
Asthana S, Satyanarayana L. Prevention and control of uterine cervical cancer: Current strategies. Indian J Community Med [serial online] 2007 [cited 2020 Jul 11 ];32:233-234
Available from: http://www.ijcm.org.in/text.asp?2007/32/3/233/36845
Uterine cervix is the second major site to be affected by cancer, next in order to breast, in many registries in India. Although there is a declining trend in the recent years, yet the magnitude of the disease is quite high. The lifetime (0-64 years) chances of developing cervical cancer estimated  from six cancer registries in India are - the highest in Chennai with 1 out of every 38 women, followed by successive declining magnitude in Bhopal with 1 out of every 51, Bangalore with 1 out of every 55, Delhi with 1 out of every 59, Barshi with 1 out of every 62 and Mumbai with 1 out of every 80 women. Thus in India, based on six population-based registries, on an average 1 in every 55 women is likely to develop cervical cancer in their lifetime of up to 64 years. There are studies that demonstrated the established risk factors, the screening modalities for early detection of cancer of cervix and the possibility of vaccine for cervical cancer. Health education on risk factors; screening for early detection of the disease; and vaccination for HPV infection, which is the causative agent for cervical cancer, are preventive approaches.
Achievement of health education demonstrated the early-stage detection of cervical cancer in Barshi cancer registry, in rural area of Maharashtra. This registry adopted a devised strategy to include health education of population of the registry area on symptoms of cancer of cervix and motivation of symptomatic individuals to undergo medical investigations.  It has clearly shown a significant improvement in the stage at diagnosis, which has facilitated the detection of more number of cases in stage I and stage II cancers. Similarly, knowledge of risk factors for cervical cancer among people could help the general population to identify changes in life style in order to reduce their risk for cervical cancer. The definite and established risk factors of cervical cancer that have been documented are early age at first intercourse (2 children) and low socioeconomic status. On the other hand, barrier method as a dominant method of birth control provided protection from cervical cancer. , Signs and symptoms before the development of cancer are not noticeable by women, especially in the precancerous state. The abnormal areas can be found through the examination of cervix. Screening involved testing of target groups who are at risk for the disease. The women between age 30 and 60 years are at the highest risk of cervical cancer and should be screened, for which various screening tests are available.
It is now a clearly established fact that cervical cancer is largely preventable, and screening methods do exist to detect it at a precancerous state. Cytology-based Pap smear screening is one such reliable tool, but it was proved to be not feasible for mass screening due to lack of resources and trained manpower in developing countries, including India. This technique relied on adequately collecting and studying the morphology of both squamous and epithelial cells. Alternative strategies explored in the recent past are aided visual inspection screening and HPV screening methods. Visual methods rely on visualization of the cervix for gross lesions (unaided visual inspection) or for aceto white lesions or for iodine non-uptake areas (aided visual inspection). The aided visual methods  are known as VIA (visual inspection of cervix after application of acetic acid) and VILI (visual inspection of cervix after application of Lugol's Iodine). The other alternative is Human Papilloma Virus (HPV) screening. The HPV status is used to identify women at "high risk for HPV type 16 and 18," which is now considered the main causative agent for developing cancer of uterine cervix. The currently available Hybrid capture II (HCII) method of DNA-based HPV screening is expensive and requires a relatively sophisticated laboratory infrastructure. This may not be feasible for mass screening in low-resource settings. Implementation of vaccine for cervical cancer needs several considerations and a lot of time to assess its impact. Thus in the mean time, aided visual (VIA/ VILI) screening approaches, which have demonstrated acceptable performance in field settings,  should be adopted while educating the public on risk factors to control the disease.
|1||NCRP (2005): Two-year report of the population based cancer registries 1999-2000: Incidence and distribution of cancer. Indian Council Medical Research: New Delhi; 2005.|
|2||Jayant K, Rao RS, Nene BM, Dale PS. Improved stage at diagnosis of cervical cancer with increased cancer awareness in a rural Indian population. Int J Cancer 1995;63:161-3.|
|3||Colditz GA, Atwood KA, Emmons K, Monson RR, Willett WC, Trichopoulos D, et al . Harvard report on cancer prevention Volume 4: Harvard cancer risk index. Cancer Causes Control 2000;11:477-88.|
|4||Juneja A, Sehgal A, Mitra AB, Pandey A. A survey on risk factors associated with cervical cancer. Indian J Cancer 2003;40:15-22.|
|5||Sankaranarayanan R, Basu P, Wesley RS, Mahe C, Keita N, Mbalawa CC, et al . Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Aftrica. Int J Cancer 2004;110:907-13.|