Cervical cancer is one of very few cancers we know how to prevent almost entirely. We know the cause, we can vaccinate against it, and we can detect the changes that precede cancer years before they become dangerous.
Despite that, India accounts for a substantial share of global cervical cancer deaths, largely because screening rates remain low.
The Cause Is a Virus
Nearly all cervical cancer is caused by persistent infection with high risk types of human papillomavirus. HPV is extremely common and is transmitted through skin to skin genital contact, meaning most sexually active people are exposed at some point.
In the overwhelming majority, the immune system clears the infection within one to two years with no consequence. In a minority it persists, and over ten to twenty years persistent infection can drive abnormal cell changes that eventually become cancer.
That long interval is precisely what makes screening so effective. There is a wide window in which to find and treat changes that are not yet cancer.
What Screening Actually Looks For
Screening does not primarily look for cancer. It looks for precancerous changes, which are entirely treatable.
- Pap smear: cells are collected from the cervix and examined for abnormality
- HPV DNA test: detects the presence of high risk viral types, and is more sensitive than cytology alone
- Co testing: both together, allowing longer intervals when both are negative
- Visual inspection with acetic acid: a low cost method used in community programmes
The procedure takes a couple of minutes. A speculum is inserted, a small brush collects cells, and the sample goes to the laboratory. It is uncomfortable rather than painful, and reporting takes a few days.
Who Should Be Screened and How Often
Guidance varies slightly between bodies, but the general framework is consistent.
- From age 21 to 29: Pap smear every three years
- From 30 to 65: HPV testing every five years, or Pap every three years, or co testing every five years
- Over 65: screening may stop after adequate normal results and no history of significant abnormality
- After hysterectomy: usually no further screening if the cervix was removed for benign reasons
- With HIV or immunosuppression: more frequent screening
Vaccination does not remove the need for screening, because the vaccine does not cover every high risk type. Vaccinated women follow the same schedule.
An Abnormal Result Does Not Mean Cancer
This causes enormous and usually unnecessary distress. The overwhelming majority of abnormal smears reflect minor changes that resolve on their own.
- ASCUS: borderline changes, often followed by an HPV test to decide next steps
- Low grade changes: commonly regress spontaneously, often managed with repeat testing
- High grade changes: genuinely precancerous, and treated, but still not cancer
- Colposcopy: a magnified examination of the cervix with targeted biopsy where indicated
Treatment of high grade changes is usually a short outpatient procedure removing the affected area, and it is highly effective at preventing progression.
The HPV Vaccine
The vaccine protects against the HPV types responsible for most cervical cancer, and it is most effective when given before any exposure to the virus.
- Ideal age: nine to fourteen years, when two doses are sufficient
- From fifteen onward: three doses
- Catch up: beneficial up to twenty six, and can be considered up to forty five after discussion
- Boys: vaccination protects against genital warts and several other cancers, and reduces transmission
Safety data across many millions of doses is reassuring. Side effects are typically injection site soreness and occasionally fever. Fainting after injection in adolescents is a response to the needle rather than the vaccine, which is why a short observation period is standard.
An Indian made vaccine has substantially reduced the cost barrier that previously limited uptake.
Symptoms That Need Assessment Now
Screening is for women without symptoms. If you have symptoms, you need investigation rather than a routine smear.
- Bleeding after intercourse
- Bleeding between periods
- Any bleeding after menopause
- Persistent watery, blood stained or foul smelling discharge
- Persistent pelvic pain or pain during intercourse
Bleeding after intercourse is the symptom most often dismissed and most worth acting on. It has many benign causes, but it needs examining rather than waiting.
Why Uptake Remains Low, and What Helps
Barriers in India are practical and cultural rather than medical: embarrassment, the assumption that screening is only for the unwell, lack of awareness, and a preference for a female examiner that is not always accommodated.
Those are addressable. Our gynaecology department provides female clinicians for screening, and appointments are short. Screening is included in several of our women's health check packages, which is often the easiest way for it to actually happen.
Reducing Your Risk Beyond Screening
Vaccination and screening are the two interventions that matter most. A few other factors influence risk.
- Not smoking, which impairs the clearance of HPV infection
- Barrier contraception, which reduces though does not eliminate transmission
- Attending follow up after an abnormal result, which is where many preventable cancers are lost
- Treating other genital infections promptly
That third point is critical. A woman who has an abnormal smear and does not return for colposcopy has gained nothing from being screened.
Cervical cancer takes over a decade to develop from a preventable, detectable change. Vaccination before exposure and screening at the recommended intervals together make it one of the most avoidable cancers there is.
To book a Pap smear or discuss HPV vaccination for yourself or your daughter, contact our gynaecology department in T. Nagar, Chennai.
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