Of all the cancers that infect women in India, cervical cancer outnumbers its counterparts by a mile. We tell you how you can spot it before it is too late. A few months ago, the newly married Preeti Shastri (29) casually decided to accompany her husband for an medical examination, proffered to them on behalf of his multinational auditing firm. In the prime of their health, the couple breezed through their various tests until Preeti's pap smear test came back with abnormalities. What started out as a routine check-up, soon turned into a horrific ordeal for the new family as they soon discovered that she suffered from stage one cervical cancer. "With no known symptoms and no history of cancer in the family, it came as such a shock. What made it worse was that the doctor said it is an STD. Our ignorance about it was what stunned me the most," says a now-recovering Preeti. Dr Rajendra Akerkar, HOD gynecological oncology at the Tata Memorial Hospital, says that over 1,35,000 women get infected by it in India every year and we contribute to over 25 percent of the global count for cervical cancer. Due to insufficient information, it often goes undetected until fatal. "To put it in perspective, the detection and prevention is so lax that by the time 1,35,000 cases come to light, 73,000 women die," says Akerkar. Get facts right Essentially, it is a cancer that is caused at the neck of the womb and infects the cervix. The virus alters the behaviour of the cells and over the years, can turn them malignant. » Cervical cancer is a sexually transmitted disease. » 80 per cent of all cases are caused due to the Human Papillomavirus (HPV) which transmits through sexual contact (normal, oral and anal), and is prevalent in both heterosexual and homosexual relationships. While males are asymptomatic carriers, they can transmit it to women. » 90 per cent of all HPV infections are virtually preventable. » The gestation period can range from 10-15 years, wherein the cells lie dormant (pre-cancer stage). Catching the virus at this stage is by far the most effective and simplest preventive mechanism. High risk groups Since the vehicle of the disease is sexual transmission, sexual behaviour and attitudes determine the extent of risk. According to Akerkar, a basic behaviour profile is that of women between the age group of 21-40 years, multiple sexual partners, unprotected intercourse, initiating intercourse at a young age, and poor sexual hygiene. Rural areas where early marriages and promiscuity are rampant, cervical cancersare far more common, adds Akerkar. Whle all HPV may not be cervical cancer, the only way to know for sure is if theyare regularly tested. "An interesting trend has been, while until five years ago, the cases were usually 35 years old and above, nowadays it has dropped to late 20s. This is because the average age of Indians losing their virginity has dipped phenomenally," says Akerkar. Preeti says, "Since we weren't always in a monogamous relationship, we had tested for AIDS before we got married. No one told us about this or I would have done it years ago. For over four months, I wasn't prepared to go under the knife. They told me that even though it's stage one, I will need to get a hysterectomy done, since that's the only way to ensure it is eradicated. For a new relationship, nothing can be more traumatic and we attended a few counseling sessions to mentally prepare for it. Now I'm in my postsurgical stage and the reports look good. It just needs to be regularly monitored," she says. Spot and treat In the very early stages, it is virtually undetectable. The most common symptoms are abnormal vaginal bleeding, which could be post-coital, post menopausal or during non-period days. Abnormal vaginal discharge (smelly, copious and blood stained) is also a telling sign. In its advanced stage, it could lead to many ailments such as very heavy bleeding, swollen feet, backaches, severe UTI and incontinence. - The importance of regular screening cannot be emphasised enough - to be started ideally three years after the first intercourse, to be repeated on a yearly basis. If the smear shows abnormalities, a biopsy is taken and a colposcopy looks at the cervix closely. - If detected at stage one, a surgical procedure followed by a course of radiation and chemotherapy assures a 90-95 percent survival rate. Until recently, the surgery involved extracting the uterus, tissues, lymph glands and the vaginal cup (a little more than a normal hysterectomy). Now this can be done with laparoscopy and in some cases and in very young women, advanced surgery can also save the uterus and remove only the cervix which can let them have children. - By stage two, surgery is no longer an option and the survival rate drops to about 60 per cent. - By stage three, it's about 40-45 percent and stage four has a five percent survival rate. For Preeti and her husband, the trauma of never being able to have children cannot be undone. "Our painful experience has strengthened our relationship like little else could. While it will always be unfortunate that we can't have our own, we are looking forward to becoming adoptive parents in the future," says Preeti, optimistically. What is a pap smear? Women between the ages of 21-40 should be annually screened for cervical cancer through a simple test called the pap smear which is virtually painless, if at all, uncomfortable. - With the help of a little lubricant, a speculum is inserted into the vagina which allows access to the cervix. - Small samples are collected from the outer walls, by scraping it gently with a spatula. - A plastic-fronded broom could also be inserted and rotated at the opening of the cervix to collect the sample. The speculum is then gently removed and you are good to go. - The test can be conducted by a general physician or gynecologist.