|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 160-161
Cervical cancer screening in India
Department of Surgical Oncology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
|Date of Submission||19-Jan-2021|
|Date of Decision||31-Jan-2021|
|Date of Acceptance||07-Feb-2021|
|Date of Web Publication||26-Mar-2021|
Department of Surgical Oncology, Sir HN Reliance Hospital, Rajaram Mohan Roy Road, Parthana Samaj, Girgoan, Mumbai - 400 004, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dessai S. Cervical cancer screening in India. Cancer Res Stat Treat 2021;4:160-1
We read with interest the article by Vidhubala et al. titled, “Loss to follow-up after initial screening for cervical cancer: A qualitative exploration of barriers in Southern India,” the article by Sahadevan Kanthimathy et al. titled, “The spectrum of cytological patterns in cervical smears of a high-risk group: retrospective analysis of a cancer detection camp experience” and the accompanying editorial.
Cervical cancer is an important health-care problem in our country. It is the second most common malignancy among Indian women and the most common among women in rural India. It is well know that most cervical cancers are caused by infection with the human papillomavirus (HPV). Screening tests are available for the detection of this cancer in the precancerous and early stages. The causative agent, HPV, is sexually transmitted and causes epithelial changes in the cervical cells that can be identified by a screening test. HPV DNA testing and cervical smear testing or pap smear are the commonly used screening tests for cervical cancer. However, these tests are expensive and require trained personnel for sample collection, processing, and interpretation of the results. Simple screening tests such as visual inspection by acetic acid (VIA) and visual inspection by Lugol's iodine (VILI) are also effective in detecting precancerous lesions of the cervix. These tests can be performed by community health-care workers and paramedical staff and are inexpensive. Despite the availability of these tests, the screening rate in India is extremely low. This could be due to the lack of awareness among the Indian women and unavailability of an organized screening program.
Sahadevan Kanthimathy et al. in their study have assessed the rate of cytological abnormalities in the high-risk population of female sex workers (FSWs). The study is well conducted, and I would like to congratulate the authors for their commendable work. In this study, conventional cytology and liquid-based cytology were the methods used for screening. These tests could be used in this subgroup of patients most likely because they were part of a research study, and the tests were being offered free of cost. However, the real-life application of these tests remains questionable, especially in this patient subgroup. Moreover, the study methodology does not describe how the FSWs were identified. Vidhubala et al. in their study have tried to identify the barriers to follow-up after initial cervical cancer screening. The lack of understanding about screening, concerns about the screening process, lack of trust in service providers, and lack of financial and family support were identified to be some of the most common barriers. This information is critical and needs to be incorporated in future screening programs. Involving the local community bodies may help improve the attitude of the population toward screening and increase the uptake. Most of the hurdles identified can be overcome by this strategy.
Implementation of compulsory screening in the postpartum period will ensure that most Indian women are tested at least once in a lifetime. Moreover, using the less expensive screening methods such as VIA for non-affording patients could further increase the screening rates in India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Vidhubala E, Shewade HD, Niraimathi K, Dongre AR, Gomathi R, Ramkumar S, et al
. Loss to follow-up after initial screening for cervical cancer: A qualitative exploration of barriers in Southern India. Cancer Res Stat Treat 2020;3:700-7. [Full text]
Sahadevan Kanthimathy SD, Kizhakkebhagam NG, Aravind S, Parambil NA, Therayangalath B, Nayanar SK. The spectrum of cytologic patterns in cervical smears of a high-risk group: Retrospective analysis of a cancer detection camp experience. Cancer Res Stat Treat 2020;3:692-7.
Vora KS, Saiyed S. Cervical cancer screening in India: Need of the hour. Cancer Res Stat Treat 2020;3:796-7. [Full text]
Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol 2016;37:278-85.
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Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev 2003;16:1-7.