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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1363-1364
Targeting cervical cancer in low and middle income nations: Necessity of a comprehensive approach


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Click here for correspondence address and email

Date of Web Publication6-Nov-2017
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Targeting cervical cancer in low and middle income nations: Necessity of a comprehensive approach. Ann Trop Med Public Health 2017;10:1363-4

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Targeting cervical cancer in low and middle income nations: Necessity of a comprehensive approach. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Dec 15];10:1363-4. Available from: http://www.atmph.org/text.asp?2017/10/5/1363/196603


Dear Sir,

Human papillomavirus (HPV) has been ranked as the most common viral infection of the genital tract, with a very large proportion of sexually active women and men acquiring the infection at least once or even number of times in their lifetime.[1] Even though, the infection is sexually transmitted; nevertheless, invasive intercourse is not mandatory and skin-to-skin genital contact is a known mode of transmission.[1],[2] Further, 90% of the infections caused by different types of virus tend to subside on their own.[1]

Overall 13 HPV viruses are carcinogenic and depending on the immune status of the women, the precancerous lesions progress to invasive cervical cancer within a span of 5-20 years.[1] In fact, almost all patients of cervical malignancy are linked with HPV infection.[1],[2]

Factors like early first sexual intercourse, multiple sexual partners, tobacco use, and immunocompromised state have favored the persistence of the virus and allowed for the progression of infection to eventually the malignancy.[2],[3]

Cervical cancer is the one of the leading cancers among women, accounting for 0.53 million cases worldwide in 2012, of which 85% cases have been reported from the developing regions of the world.[1] Further, even in terms of malignancy-associated deaths, an estimated 85% of the fatalities were from the low and middle income nations.[1] It has been projected that more than half of the deaths due to the malignancy can be averted through effective screening and treatment programs.[1] As the precancerous lesions take many years to develop, screening has been recommended for all women from 30 years of age at periodic intervals of time.[2],[4]

Screening has a special role in prevention and control as the symptom manifests mostly in the advanced stages of the disease and by means of an organized screening approach, the incidence has been significantly reduced in the developed nations.[4]

In contrast, due to the limited access to screening activities due to various health sectors, infrastructure and community attributes, the disease is detected in late stages only, resulting in poor prognosis and increased death rates.[2],[4] In addition, two safe and effective vaccines have also been introduced to protect against two virus types which together are responsible for 70% of the cancerous lesions.[1],[5] These vaccines have shown efficacy in preventing the development of malignancy and gives best results if they are administered prior to exposure to the disease agent or before first sexual activity (viz. girls in the 9-13 years age group).[1],[5] However, they have no role in treating the viral infection or the malignancy, and in no way it can substitute screening activities.[5]

In order to accomplish effective prevention and control, a comprehensive approach consisting of multidisciplinary strategies like community education, social mobilization, vaccination, screening, treatment, and palliative care has been advocated worldwide.[3],[4],[5] In addition, interventions like educating about safe sexual practices, including delay in initiation of sexual activity, promoting consistent use of condoms among sexually active women, implementing measures to discourage tobacco use, offering periodic screening activities and appropriate treatment interventions based on the stage of the disease, should be targeted in regions with high incidence of malignancy.[1],[4],[5]

To conclude, cervical cancer is an important global public health concern and effective measures are available to minimize its incidence significantly. However, the need of the hour is to implement them in a comprehensive manner to improve the existing scenario.

Acknowledgement

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Human papillomavirus (HPV) and cervical cancer - Fact sheet; 2016. Available from: http://who.int/mediacentre/factsheets/fs380/en/. [LastAccessed 2016 June 4].  Back to cited text no. 1
    
2.
Zhang Q, Xie W, Wang F, Li RH, Cui L, Wang H. et al. Epidemiological investigation and risk factors for cervical lesions: Cervical cancer screening among women in rural areas of Henan province China. Med Sci Monit 2016;22:1858-65.  Back to cited text no. 2
    
3.
Majidi A, Ghiasvand R, Hadji M, Nahvijou A, Mousavi AS, Pakgohar M. et al. Priority setting for improvement of cervical cancer prevention in Iran. Int J Health Policy Manag 2015;5:225-32.  Back to cited text no. 3
    
4.
Shrivastava SR, Shrivastava PS, Ramasamy J. Screening of cervical cancer: barriers and facilitators. Iran J Cancer Prev 2013;6:177-8.  Back to cited text no. 4
[PUBMED]    
5.
World Health Organization. Comprehensive cervical cancer control-A guide to essential practice. 2nd ed. Geneva: WHO press; 2014;p. 1-14.  Back to cited text no. 5
    

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Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur Guduvancherry Main Road, Sembakkam Post, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196603

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