CERVICAL CANCER AWARENESS MONTH

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Cervical cancer is a type of cancer that develops in the cervix or in any layer of the wall of the cervix.  It is due to the abnormal growth of cells that can invade or spread to other parts of the body.  Early on, typically no symptoms are seen.  Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse.  While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer. 

Virtually all cervical cancer cases (99%) are linked to genital human papillomavirus infection (HPV); most who have had HPV infections, however, do not develop cervical cancer. HPV 16 and 18 strains are responsible for approximately 70% of cervical cancer cases globally and nearly 50% of high-grade cervical pre-cancers. Minor risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners. Genetic factors also contribute to cervical cancer risk. Cervical cancer typically develops from precancerous changes called cervical intraepithelial neoplasia over 10 to 20 years.  About 75% of cervical cancers are squamous cell carcinomas, 20-25% are adenocarcinoma, 3% are adenosquamous carcinomas, and less than 1% are small cell neuroendocrine tumors of the cervix. Diagnosis is typically by cervical screening followed by a biopsy.  Medical imaging is then done to determine whether or not the cancer has spread beyond the cervix.

HPV vaccination is the most cost-effective public health measure against cervical cancer.  There are six licensed HPV vaccines.  They protect against two to seven high-risk strains of this family of viruses. They may prevent up to 90% of cervical cancers.  By the end of 2023, 143 countries (74% of WHO member states) provided the HPV vaccine in their national immunization schedule for girls.  As of 2022, 47 countries (24% of WHO member states) also did it for boys.  As a risk of cancer still exists, guidelines recommend continuing regular Pap tests.  Other methods of prevention include having few or no sexual partners and the use of condoms.  Cervical cancer screening using the Pap test or acetic acid can identify precancerous changes, which when treated, can prevent the development of cancer.  Treatment may consist of some combination of surgery, chemotherapy, and radiation therapy.  Five-year survival rates in the United States are 68%.  Outcomes, however, depend very much on how early the cancer is detected.

Worldwide, cervical cancer is both the fourth-most common type of cancer and the fourth-most common cause of death from cancer in women, with over 660,000 new cases and around 350,000 deaths in 2022.  This is about 8% of the total cases and total deaths from cancer.  88% (2020 figure) of cervical cancers and 90% of deaths occur in low- and middle-income countries and 2% (2020 figure) in high-income countries.  Of the 20 hardest hit countries by cervical cancer, 19 are in Africa.  In low-income countries, it is one of the most common causes of cancer death with an incidence rate of 47.3 per 100,000 women.  In developed countries, the widespread use of cervical screening programs has dramatically reduced rates of cervical cancer. In medical research, the most famous immortalized cell line, known as HeLa, was developed from cervical cancer cells of a woman named Henrietta Lacks.^[40]

17 November is the Cervical Cancer Elimination Day of Action.  The date marks the day in 2020 when WHO launched the Global strategy to accelerate the elimination of cervical cancer as a public health problem, with a resolution passed by 194 countries. To eliminate cervical cancer, all countries must reach and maintain an incidence rate of below 4 per 100 000 women.

The early stages of cervical cancer may be completely free of symptoms.  Vaginal bleeding, contact bleeding (one most common form being bleeding after sexual intercourse), or (rarely) a vaginal mass may indicate the presence of cervical cancer. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. Bleeding after douching or after a pelvic exam is a common symptom of cervical cancer.  In advanced disease, metastases may be present in the abdomen, lungs, or elsewhere.

Symptoms of advanced cervical cancer may include loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen legs, heavy vaginal bleeding, bone fractures, and (rarely) leakage of urine or faeces from the vagina. Other signs of locally advanced disease (as the cancer invades organs in the pelvis) include hydronephrosis with flank pain as the ureters directing urine from the kidneys to bladder are blocked, leg swelling and blood clots in the legs as pelvic veins are blocked, rectal bleeding, and bleeding in the urine.