Cervical cancer is a significant public health concern. Understanding its risk factors and symptoms and the importance of screening and community awareness is crucial for prevention and early detection. January is recognised as the cervical cancer awareness month serving as dedicated time for healthcare organisations and professionals to emphasise the significance of cervical health.

Cervical cancer originates in the cervix, the lower part of the uterus connecting to the vagina. Several factors increase the risk of developing cervical cancer making it crucial for individuals and healthcare professionals to be aware of these influences. The primary risk factor is the presence of high-risk strains of human papilloma virus, particularly Types 16, 18 and 33. Persistent HPV infection can lead to cervical cancer through a series of events, emphasising the importance of regular pap-smears (cervical cancer screening tests) for early detection.

Apart from HPV, various lifestyle and reproductive factors also play a role in the risk of cervical cancer. Having multiple sexual partners, independent of HPV infection, poses a potential risk, as revealed in a meta-analysis study by Liu et al, in 2015. Women who have experienced multiple full-term pregnancies or had an early age at their first full-term pregnancy may face an elevated risk. Additionally, a family history of cervical cancer, weakened immune systems (such as an individual with HIV/ AIDS) and tobacco use have been identified as risk factors.

Long-term oral contraceptive use has been associated with a slightly increased risk of cervical cancer. Socioeconomic factors like limited access to healthcare and preventive services can also contribute to the overall risk profile.

The early stages of cervical cancer often do not present noticeable clinical features, emphasising the critical role of regular screenings in its detection. As the disease progresses specific symptoms may emerge, serving as indicators for further investigation and medical attention. In a review article published in the JPMA, Batool SA noted that in Pakistan over 70 percent women present with advanced cancer stages, contributing to the high mortality rate. It is therefore crucial, that screening tests like pap test or HPV test are offered to women on regular basis.

Women who have experienced multiple full-term pregnancies or had an early age at their first full-term pregnancy may face an elevated risk. Additionally, a family history of cervical cancer, weakened immune systems (such as an individual with HIV/ AIDS) and tobacco use have been identified as risk factors.

In terms of symptoms of cervical cancer, abnormal vaginal bleeding is a common symptom, taking various forms such as bleeding between periods, after sexual intercourse or post-menopause. This irregular bleeding pattern should raise concerns and prompt individuals to seek medical advice. Pelvic pain is another potential symptom causing discomfort during sexual intercourse or between menstrual periods. This discomfort may vary in intensity and could be indicative of advancing cervical cancer. Unusual vaginal discharge is also associated with cervical cancer. The discharge may be watery, bloody or accompanied by a foul odour. Changes in the characteristic of vaginal discharge can be indicative of abnormalities in the cervix and should not be ignored. Pain during urination is a symptom that may manifest in advanced stages of cervical cancer, when the disease affects nearby structures. This discomfort during urination underscore the potential spread and impact of cervical cancer on adjacent tissues.

Given the subtle and or asymptomatic nature of early stage cervical cancer, routine screening such as pap-smear and HPV test play a crucial role in early detection and prevention. A pap- smear involves collecting cells from the cervix to check for abnormalities or pre-cancerous changes. The American Cancer Society recommends initiating pap-smears at age 25 repeating every 3 years or co-testing with HPV test every 5 years for those aged 30 and older.

Community awareness campaigns are instrumental in disseminating information about cervical cancer, its risk factors and the importance of screening and vaccinations. These initiatives aim to:

1) educate individuals through community outreach programs. This education empowers individuals to make informed decision about their cervical health;

2) promote timely and regular screenings for early detection and effective intervention. Such measures encourage individuals to prioritise their health and undergo pap-smears or HPV testing as per latest healthcare guidelines;

3) emphasise that HPV vaccination is a key preventive measure, and community awareness efforts aim to promote vaccination, especially among adolescents and young adults;

Community outreach programmes can address socioeconomic barriers, which may limit access to healthcare services, ensuring that a broader population has the opportunity for screening and vaccinations. Much needs to be done in developing countries of the world. A survey conducted among women of different age groups in neighboring India, showed younger educated women having greater cervical cancer awareness, compared to older illiterate women.

Awareness of clinical features among individuals coupled with regular medical checkups can contribute significantly to timely diagnosis and improved outcomes in the management of cervical cancer. Regular screenings and prompt medical attention are imperative for addressing cervical cancer effectively and enhancing the chance of successful treatment. As we observe the Cervical Cancer Awareness Month, it is a collective responsibility to spread awareness, promote preventive measures and strive for a future where cervical cancer is a rare and manageable condition.

The writer is a family physician