Cervical cancer has been established as one of the most common causes of cancer related deaths among women aged 14-44 years in India. unvailability of population based screening programs in India is one of the major causes for high mortality, since most cases present late in the course of disease. HPV (human papilloma virus) is the only known documented cause of cervical cancer. Sexually active women are more susceptible to contract human papilloma virus (HPV) at any juncture of their life. As per nationwide surveys, about 132,000 new cases of HPV infection are reported each year with more than 74,000 women developing the cancer. An alarming number of 62,416 women died of cervical cancer between 2015 and 2016. This high mortality rate makes it imperative to create awareness about cervical cancer and drive mass screening programs so that this malignancy can be detected early when it is well treatable.

Causes, Signs & Symptoms
The Cervix in the female body is a narrow cylinder-shaped neck-like passage of tissue which connects the vagina and uterus. Also known as the birth canal, cells coating the cervix are called cervical epithelial cells and form a multilayered covering over the cervix. It is these epithelial cells that Human Papilloma Virus (HPV) homes and causes ‘atypical maturation’ a cellular event which eventually turns into cancer. HPV is sexually transmitted and most women are infected by this virus at any stage of their life. However, it is dormant in many cases or the immune system clears it by itself. Only those women who have persistent HPV infection are at a high risk of developing cancer. Several subtypes (Over 40) of the HPV are known, but it is only high risk genotypes of the virus namely, HPV type 16 &18 which cause majority of the cancers.

Other risk factors like smoking, chlamydia infection, oral contraceptives, diethylstil bestrol (DES) exposure (Hormonal drug) and having a family history act as a co-adjuvant factors for causing cervical cancer. Early cervical cancer may be clinically asymptomatic; hence, a regular pap test, pelvic examination & HPV test can help detect the condition early and prevent spread of the cancer. Post coital bleeding is often the first sign of cervical cancer. However, when the disease

advances, symptoms such as abnormal or irregular vaginal bleeding (between menstrual cycles/after menopause), pain during coitus and abdominal pain may be observed. However, such symptoms may be due to other factors as well; hence, it is advisable to consult a gynecologist in case any of these symptoms are observed.

Prevention
Cervical cancer can be prevented by:

• HPV Vaccine: There are two vaccines (Gardasil and Cervarix) available in India which are recommended for females between 9-13 years and may be used as preventive measures, although the vaccine does not guarantee protection from cancer.

• Barrier Protection During Intercourse: As HPV is transmitted sexually, using condom reduces the risk of contracting the infection.

Screening Methods
Cervical cancers may be completely asymptomatic in the early stages and hence, medically established screening tests are reliable means to detect cellular a typiaor cancers early.

• HPV Detection & PAP Test: It is a non-invasive swab test wherein scrapings of cervical epithelium are collected and analyzed microscopically for visible cellular changes that may indicate abnormal maturation. The cellular scrapings are also subjected to molecular tests for detection of high risk HPV. The procedure takes few minutes and is painless. Lab reports are available within few days

• Pelvic Examination, Colposcopy & Radiologic Examination: These are the measures to detect more advanced disease when suspicious clinical evidence is present.

Although cervical cancer is a common cancer and a major cause of cancer related deaths in the country, it can be controlled by early detection and higher awareness about the disease. Doctors generally advise women above 30 years to get Pap/HPV tests at least once a year but greater awareness is required so that young women voluntarily seek medical consultation and sup¬port for cervical cancer screening. An increasing number of NGOs are being seen creating awareness especially amongst the lower literacy strata of the society. Several labs also extend support for cervical cancer screening even in non-metro cities and in remote areas. With rising awareness of cervical cancer and widely available screening test facilities, coming times will see a decrease in incidence of this killer disease.

Treatment
Since there is no national program for screening of cervical cancer in our country, the medical professionals in private practice are often torch bearers for conducting population based surveys and screening for cervical cancers. Various modalities of prevention like vaccines are made available through NGOs. Even surgical intervention is simpler and cheaper if the cancer is detected early. Targeted radiation therapy or brachy therapy may be given for locally advanced cancers with lesser side effects. PET scan & MRI are done to determine the extent of cancer. In early stage of cancer, surgical procedures like hysterectomy/operative removal of cervix and uterus almost guarantees cure from this cancer.

Countries like Norway and Sweden are targeting to eradicate cervical cancer through population based screening programs. Although similar strategies are extremely difficult to implement in India due to its magnanimous population, geographies terrain and literacy rates, spreading awareness is the key to tackle this cancer in India.