Dr RG Wiseman Pinto
Cancer of the cervix is the second or third most common cancer among women. In Goa, its incidence has declined over the last few decades. This is due to Pap tests, screening, public education and awareness.
Advances in cervical screening include the Pap smear, Human Papilloma Virus (HPV) testing, colposcopy, colpomicroscopy and the HPV vaccine. Invasive squamous cell carcinoma of the cervix usually presents between 45 and 50 years of age. This provides at least 20 years in which early dysplastic changes can be detected, treated and prevented from progressing to cancer.
The credit for the Pap test goes to Dr George N. Papanicolaou, a Greek-origin American pathologist. He described a simple technique of collecting cells from the female cervix and vagina, preparing smears on glass slides, staining them and examining them under a microscope. This enables doctors to detect mild dysplasia (CIN I, or Cervical Intraepithelial Neoplasia), moderate dysplasia (CIN II), severe dysplasia (CIN III) and carcinoma in situ. At the same time, Dr Aurel Babes, a Hungarian pathologist, also described the technique of examination.
If these changes are not detected and treated, cancer can later invade and progress to invasive disease. It may spread through the lymphatics to the lymph nodes, through the blood and into the peritoneum.
The common histological types are squamous cell carcinoma (85 per cent) and adenocarcinoma (15 per cent). Adenosquamous carcinoma is rare.
A patient may have no symptoms or may present with bleeding per vagina, vaginal discharge, an ulcer or a growth on the cervix. A few patients present with features of metastases.
Screening is very important. Every woman must undergo a Pap test after her first delivery or at 21 years of age. If the result is normal, it should be repeated every three years. After the age of 30, it can be done every five years if the result remains normal. The Pap test may be accompanied by an HPV DNA test, colposcopy and colpomicroscopy. In community mass-screening programmes, VIA (Visual Inspection of the cervix with Acetic Acid) is also used.
Cervical screening, the Pap test, HPV DNA testing and other tests are essential for women. These measures have reduced cervical cancer incidence worldwide through effective early detection and prevention.
Cervical cancer is seen more often among women who have sexual intercourse at an early age, multiple sexual partners or many children. Other associated factors include poor hygiene, poor socioeconomic status, being a rural woman, cigarette smoking, long-term use of oral contraceptives and sexually transmitted diseases.
The HPV vaccine is given to girls between nine and 14 years of age and helps prevent cervical cancer. However, even after HPV vaccination, Pap tests and HPV testing must continue.
For patients with cervical cancer, further investigations include biopsy with histopathology, immunohistochemistry, HPV DNA testing, MRI and PET-CT.
A 10-year study conducted by Dr Wiseman Pinto and Dr Anjali Naik at Goa Medical College, covering 2010 to 2019, recorded 11,690 cancer cases. Breast cancer was the commonest cancer among women, accounting for 22.75 per cent, while cervical cancer was second, accounting for 8.67 per cent.
Recently, the Government of India introduced free HPV vaccination for girls aged 14 years.
The World Health Organization has marked November 17, 2026 as World Cervical Cancer Elimination Day globally. In India, Cervical Cancer Prevention Day is observed on May 21.
These initiatives aim to create awareness among girls and women about cervical cancer, its prevention and early detection. This responsibility rests with all stakeholders, including the government, NGOs, different government departments and agencies, the media, women’s groups and women’s organisations.
(The writer is a Professor of Pathology, former Head of Department, former Dean of Goa University and President of the South Asian Academy of Cytopathology and Histopathology)
