That cervical cancer can be prevented easily by a simple vaccine (actually three doses of one vaccine) may sound too good to be true, but it is. So what exactly has stopped it from being as good as gone? Well, lack of awareness. The new vaccine by the Serum Institute of India has brought the hidden cervix into the news for all the right reasons.
I do pap smears on a daily basis. The duck beak-shaped speculum in my hand makes my patients break into a sweat. Will it hurt? I reply in the negative and comfort them, but they don’t seem convinced for as long as the speculum gleams in my gloved hand. As I proceed to explain the procedure and that it is done for screening for cervical cancer, the furrow between their brows deepens.“Cancer? Do I have cancer?” echoes from their muted gulp. I reassure them it’s just a routine screening, a part of the master health check-up that they are seeing me for. Patients who have had pap smears earlier are just as confused as the new ones. Who cervix, what cervix?
The cervix is the part of your reproductive tract between the vagina and uterus. The vagina is the reproductive canal through which the baby enters the world. The uterus is where the baby grows. And the barrier between the two is the closed cervix which stretches and opens up at the time of normal delivery. It protects the uterus from infections by producing mucus with infection-fighting properties and staying closed. The word cervix is from the Latin word meaning neck. So to speak, the cervix is the neck of the uterus- a narrow neck-like passage to the outside.
Cervical cancer is one of the top 5 killers in India. It is a silent disease and grows and goes unchecked before it spreads to other parts of the body. One of the first few symptoms are mild bleeding- symptoms which we as women will ignore as irritating irregular periods and spotting. Pain in the lower abdomen, pain during intercourse and a foul-smelling discharge- can often go misdiagnosed as a fungal infection. Still, something many patients do not think is worthy of seeking treatment. One of the very few completely treatable cancers also happens to be a totally preventable cancer. The main culprit in most cases of cervical cancer is a prior Human Papilloma Virus infection (most commonly sexually transmitted). Yet again, a silent infection can go undetected for years owing to not having any overt symptoms. The fact that it causes no symptoms or harmless genital warts in the male partner makes sexual contact tracing pretty much absent.
But hang on. Did I say preventable? Yes, I did.
The Human Papilloma Virus infection has a vaccine against it (phew!). It is advised to be taken before the girl gets sexually active. Due to the taboo around sexual activity in adolescents and tweens, the general advisory now is to vaccinate the pubescent girl irrespective of information about her sexual activity, a seemingly great solution.
But here lies the catch in this approach. Despite 5% of the female population harbouring the virus at any given time, a lack of awareness around this topic and the prohibitively high cost of the available vaccines in India, the vaccination program could not really take off. The two vaccines available in the market thus far have been very costly. The vaccine is given in 3 doses, first and the second doses are a month apart, and the third dose is given six months after the first dose. Both cost around ₹3000 per dose, the total cost of vaccination being close to 9000. A big step forward in the prevention of cervical cancer is the newly launched Indian-origin vaccine – Cervavac, all set to take over the market.
With a tentative pricing of around 200-400 rupees, it takes away the main confounding factor that has prevented public scale vaccination an achievable dream- the cost. Along with a lower cost and a target set for a school-based vaccination program, early protection of girls would be a remarkable step in the right direction. The vaccine has shown promise in mounting a strong immune response to the HPV strains responsible for cervical cancer. Already ahead of its scheduled release date, this made-in-India quadrivalent vaccine is all things hopeful. And before you head to reading your next piece, make sure to get yourself and your loved ones screened with pap smears yearly for early detection of cervical cancers.
Dr Farah Adam Mukadam is a Bengaluru-based family physician and author of Newborns and New Moms. She vlogs on Instagram and YouTube as Dr Farah_Momstein