Understanding Cervical Cancer: Top Essential Insights and Prevention Strategies You Need to Know

Cervical cancer refers to the abnormal growth of cells in a woman’s cervix, the narrow passage that connects the uterus and vagina, playing a crucial role in reproductive health.

In the early 1900s, cervical cancer became the leading cause of death among women in the USA, highlighting a significant public health issue.

In response, Congressman Henry Waxman proposed a legislative initiative in 1989 to enhance awareness and screening for cervical cancer nationwide. This marked the beginning of a focused effort to address the impact of cervical cancer on women’s health in the United States.

Is Cervical Cancer A Major Public Health Concern?

Cervical cancer poses a significant public health challenge globally. Here are some key facts underlining its impact:

• Prevalence: Cervical cancer is the fourth most common cancer in women worldwide.
• Global Impact: In 2022, there were about 660,000 new cases and 350,000 deaths from cervical cancer.
• Higher Rates in Lower and Middle-Income Countries (LMIC): Incidence and mortality rates are notably higher in lower and middle-income countries (LMICs), primarily due to limited access to healthcare, including vaccination and regular screenings.

What Are The Major Contributors To Its Development?

Understanding the risk factors associated is crucial for prevention and early detection. Here are the key risk factors:

• Age: Cervical cancer is most frequently diagnosed in women aged 35-44, with an average diagnosis age of around 50. Over 20% of cases occur in women over 65.
• Infections: HPV infection is responsible for over 99.7% of cervical cancer cases, and Chlamydia infections also increase risk.
• Immunity: Weakened immunity due to medical conditions or medications, reducing the ability to combat HPV, and raising cancer risk.
• Smoking: Exposure to tobacco smoke, both direct and indirect, elevates the risk of cervical cancer.
• DES Exposure: Women exposed to diethylstilbestrol (DES) in utero may have a higher risk later in life.
• Early Sexual Activity: Engaging in sexual activity before age 18 is a contributing factor.
• Multiple Sexual Partners: Having multiple partners or partners with multiple partners increases the likelihood of HPV infection.
• Oral Contraceptive Use: Long-term use of oral contraceptives is associated with a higher risk of cervical cancer.
• Pregnancy: Early or multiple full-term pregnancies may increase risk.
• Nutrition: Poor nutrition, particularly diets low in fruits and vegetables, can heighten risk.
• Family History: A family history of cervical cancer, such as a mother or sister diagnosed, can increase risk for other women in the family.

Development and Types of Cervical Cancer

The cervix consists of two main cell types: squamous cells, which cover the exocervix connecting to the vagina, and glandular cells, lining the endocervix that connects to the uterus. 

These cells are separated by a distinct anatomical margin. In cancer, this margin becomes indistinct, and the cells undergo rapid proliferation, resulting in abnormal growth that can lead to a tumor or cancerous development in the cervix.

Cervical cancer primarily consists of two main types, each with distinct characteristics:

• Squamous Cell Carcinoma: Accounts for about 90% of cervical cancers, arising from squamous cells and often linked to HPV-related precancerous changes.
• Adenocarcinoma: Adenocarcinoma is the second most common type of cervical cancer, originating from glandular cells.
• Adenosquamous Carcinoma: A mixed type that combines both squamous and glandular cells.
• Neuroendocrine Neoplasm: The rarest form, characterized by rapid growth and spread, often through lymph nodes.

Key Signs and Symptoms

Cervical cancer can be categorised into different stages based on cellular changes, tumor size, and the areas affected. Cervical cancer often remains asymptomatic in its precancerous and early stages, with symptoms typically emerging in later stages. 

Here are the signs and symptoms that may occur as the cancer progresses:

• Pelvic Discomfort: Feelings of heaviness or uneasiness, possibly with light bleeding.
• Vaginal Bleeding: Abnormal bleeding between periods, after menopause, or post-intercourse.
• Menstrual Changes: Prolonged menstrual bleeding with heavier flow.
• Vaginal Discharge: Bloody, watery discharge that may be heavy and have a foul odor.
• Pain: Discomfort in the lower abdomen, pelvic area, during intercourse, or in the back and legs.
• Urethral or Anal Bleeding: Presence of blood in urine or stool.
• General Symptoms: Loss of appetite, unexplained weight loss, and fatigue.

Why Is Regular Screening Essential?

Regular screening is vital for reducing cervical cancer incidence and prevalence. 

Although precancerous and early stages often show no symptoms, routine tests can detect early cellular changes, enabling prompt treatment and potential full recovery. 

Early detection can lead to survival rates as high as 91%, while delays in diagnosis can drop survival chances to 19%. The average survival rate for cervical cancer cases is around 67%. Therefore, staying proactive with regular screenings is crucial for effective cervical cancer control.

There are several screening tests available to help detect cervical cancer early:

• Pap Test: It is recommended that women start this test at age 25 and repeat it every 3 years.
• HPV Test: Recommended for women over 30 years of age should be conducted every 5 years.
• HPV/Pap Co-Test: This is a combination of both the Pap test and the HPV test, recommended to be performed every 5 years.
• Visual Inspection with Acetic Acid (VIA): Conducted every 3-5 years in settings with limited resources, this test involves examining the cervical area with the naked eye after applying acetic acid.

What Are The Steps To Prevent Cervical Cancer ?

Adopting recommended preventive measures and adopting healthy habits can significantly lower the chances of developing cervical cancer, Here are some key strategies that you should be aware of: 

• HPV Vaccine: The HPV vaccine has been a game-changer in cervical cancer prevention, with the potential to prevent up to 90% of cases. The vaccine is ideally administered to individuals aged 9 to 14 years. However, those above this age, especially sexually active women, should consult a doctor before vaccination to assess its suitability for their circumstances.
• Routine Screening: Early detection through routine tests allows for prompt treatment, preventing cancer progression.
• Healthy Lifestyle Choices: Avoiding and quitting smoking is essential, as it can harm cervical cell DNA and increase the risk of cervical carcinoma. Additionally, using protection during sexual activity can significantly lower the risk of contracting HPV.

Is Cervical Cancer A Public Health Challenge in India?

We are presenting some facts and figures which would help us to assess the present situation and measures taken to combat the situation:

• Public Health Challenge: Cervical cancer is the second most common carcinoma in India and the second leading cause of cancer-related deaths, with India accounting for one-fifth of new cases and one-fourth of global deaths.
• Awareness Issues: A 2020 survey indicated that 55% of participants were unaware of cervical cancer, 41% were unfamiliar with the Pap test, and 22% confused it with neck or spinal cord issues. Additionally, 38% of states lack adequate medical expertise.
• HPV Vaccine: The HPV vaccine has been available since 2008 but was only officially recommended in 2022, resulting in low awareness—52% of participants were unaware of the vaccine. 
• Community Outreach: Initiatives through ASHA programs have been implemented, but their lack of effectiveness is evident.
• Policy Initiatives and Their Current Status: India is facing a significant challenge in tackling the increasing burden of cervical cancer, exacerbated by a lack of awareness about the disease. In response, the Government of India announced initiatives in 2022 to incorporate the HPV vaccine into the universal immunisation program and to conduct a school-level vaccination drive aimed at girls aged 9-14. However, despite the allocation of budget for this initiative in 2024, the actual implementation of the immunisation program has yet to commence, leaving a critical gap in the fight against HPV infection and cervical cancer prevention.

Actionable Recommendations to Improve Vaccine Awareness At Mass Scale To Prevent It In Early Stages

Despite the existence of commendable policy initiatives and announcements, their implementation remains insufficient. To foster meaningful progress, it is essential to adopt targeted strategies that effectively address these gaps and ensure that policies translate into tangible outcomes.

• Leverage Social Media: Launch nationwide campaigns on platforms like Instagram, Facebook, and WhatsApp to educate young girls and parents about the importance of HPV vaccination. Highlight personal stories, statistics, and expert interviews to combat misinformation.
• Community Engagement Programs: Although community health workers such as ASHAs have been introduced to raise community awareness, meaningful results have yet to be achieved. To improve their performance, ASHA workers must receive focused training that is tailored to local culture and traditions.By providing them with tools such as booklets, FAQs, and interactive workshops for parents and educators, we can ensure that they have a thorough understanding of the information they must communicate. This method will enable ASHAs to engage more deeply with their communities and raise awareness about critical health programs.
• Partnerships with Educational Institutions: Conduct school-based vaccination drives for girls aged 9–14, combined with workshops for teachers and parents to address concerns.
• Celebrity endorsements: Use public figures and influencers to advocate for HPV vaccination, normalize the conversation, and increase acceptance across demographics.

To truly combat cervical cancer, efforts must focus on raising awareness about the vaccine, improving distribution networks, and addressing the stigma surrounding HPV-related discussions.

Conclusion: Unite and Take Action  for a Cervical Cancer-Free Future

With cervical cancer posing a significant public health challenge, the need for targeted awareness campaigns and widespread vaccination drives has never been more urgent. Protecting every girl child from this preventable disease must remain a top priority for public health efforts in India.

Understanding cervical cancer is the foundation for prevention. By educating ourselves and those around us, we can empower women to take proactive steps in safeguarding their health and well-being. Together, through awareness and action, we can create a world where cervical cancer is no longer a threat to women’s health.

Empower yourself and your community to take action today. Share this guide, schedule your screenings, and advocate for HPV vaccinations in your local area. Together, let’s pave the way for a cervical cancer-free future.