Cervical cancer: Can it be prevented?

Abstract

Cervical cancer prevention requires a multipronged approach involving primary, secondary and tertiary prevention. The key element under primary prevention is human papilloma virus (HPV) vaccination. So far, only prophylactic HPV vaccines which prevent HPV infection by one or more subtypes are commercially available. Therapeutic HPV vaccines which aid in clearing established infection are still under trial. Secondary prevention entails early detection of precancerous lesions and its success is determined by the population coverage and the efficacy of the screening technique. A number of techniques are in use, including cytology, visual inspection (using the naked eye, magnivisualizer, acetic acid and Lugol’s iodine), HPV testing and a combination of these methods. Updated screening guidelines have been advocated by the American Cancer Society in light of the role of HPV on cervical carcinogenesis. Recent research has also focussed on novel biomarkers that can predict progression to cancer in screen positive women and help to differentiate those who need treatment from those who can be left for follow-up. Last but not the least, effective treatment of precancerous lesions can help to reduce the incidence of invasive cervical cancer and this constitutes tertiary prevention. A combination of these approaches can help to prevent the burden of cervical cancer and its antecedent morbidity and mortality, but all of these are not feasible in all settings due to resource and allocation constraints. Thus, all countries, especially low and middle income ones, have to determine their own cocktail of approaches that work before we can say with certainty that yes, cervical cancer can be prevented.

Keywords: Cervical cancer, Prevention, Screening, Human papilloma virus, Pap smear

Core tip: While cervical cancer is not new, approaches to prevent the burden of this deadly disease are constantly being re-invented, be it human papilloma virus (HPV) testing or screening strategies. Novel biomarkers than can predict which HPV positive lesions will progress into cancer are the need of the hour. Along with early diagnosis of pre-invasive lesions, the other preventive aspect includes prophylactic vaccines which have flooded the scene, but their true impact remains to be gauged as the precancerous phase of cervical cancer is longer than the vaccine has

been around. Only time can answer the question: can we truly prevent cervical cancer?