Private bathing can beat cervical cancer

The other day some of us the senior cancer specialists were discussing about ‘prevention of cervical cancer’.

Cervical cancer incidence has decreased in most countries, including those who have not implemented pap smear screening.

What are the likely reasons?

Dr. Anita Borges came with the interesting thought.

“Do you know that most women in India don’t bathe in privacy”, she exclaimed. “Cervical cancer has a lot to do with personal hygiene. Fix that and the incidence will come down.”

A very valid thought coming from a leading pathologist with decades of experience.

It is very unfortunate that women and men in India do not have the privacy of taking a completely bath without clothes as most places are public bathing spaces.

This certainly leads to poor genital hygiene and HPV viral infections which ultimately lead to cervical cancer.

So one of the easy ways to decrease this is by creating private bathing spaces. Swachh Bharat Abhiyan is a great campaign towards constructing toilets. It will be even beneficial to add a private bathing facility which can be a small room with a tap. This can reduce the incidence not only of cervical cancer but many other infections.

This cost effective solution is a lot easier to implement than mass screening/mass vaccination. So it is an appeal to the Swachh Bharat Abhiyan to add bathing spaces in addition to just toilets for the population which can be done with hardly any additional cost.

It is also interesting that Akshay Kumar is following up his film ‘Toilet ki ek premkatha ’ with another social awareness film ‘Padman’ based on Arunachalam Muruganantham’s story.

Influence by Tina must by the inspiration  for taking up these movies.

Hats off Akshay and Tina for creating awareness of a problem, we try to hide ‘ literally under the clothes’.

 

Advertisements

Toilet ki ek aur katha- Personal hygiene and Prevention of Cervical cancer

I am so glad that ‘toilets’ are receiving the importance thanks to the movie ‘toilet ki ek prem katha’. Here ‘s the reason why toilets should be demanded by every lady !

Cervical Cancer incidence and mortality is decreasing steadily.

However most of the reduction happened in the developed countries as this graph shows.(GLOBOCAN)

All this happened even before HPV vaccine was introduced . Even pap smear screening was not total in some countries.

How did this happen?

Its clear that improved personal hygiene due to access to toilets with privacy was an important factor . Personal genital hygiene in both men and women can reduce cervical cancer.

Just compare with the countries with least number of toilets per capita ( WHO/UNICEF)

20150708_Toilets_FoGLOBOCAN_BSC_87648723

All  in the areas with high cervical cancer.

Of course there are other factors like unprotected sexual activity and HPV does spread due to poor habits. There was a nice study way back in 1999 from Kerala, in a survey based in Trivandrum centre,  that highlighted the correlation of cervical dysplasia to  lack of access to hygiene with toilets, sanitary napkins etc .

Expensive vaccines and even more expensive population screening are not suitable for large rural populations like India and Africa.

The fact however is that the rural and urban poor ARE AWARE of the ill effects of poor hygiene but have no access to clean toilets

That’s a preventable tragedy!

Its time for action !! It’s time this basic need is ensured in every household

Conflict of interest:

I know Akshay Kumar but was neither influenced or approached to write. The  thought developed for sometime in discussion with Dr Anita Borges.

International Women’s Day – Warning Signs for Women’s Cancers

 

Wishing all women good health on International Women’s Day!

 To ensure good health, women need to take some precautions. Now let’s examine  important warning signals for women’s cancers.

 Rachel, one of the secretaries of the hospital, came crying to me that both her breasts become extremely painful particularly before menstrual periods.  She was woried that she has cancer as one of her relatives was recently diagnosed.This is quite common and  is due to hormonal changes along with menstrual cycle.  The breasts become heavy,  tender and the pain fully disappears after the periods start.  This is not to be worried about as a sign of malignancy.

A.Breast Cancer

Let me give some practical information on early detection of breast cancer.

Breast Lump :    Classically a painless lump in breast like a buried pea or sometimes larger like a grape, is one of the important signs of breast cancer. It can be irregular. Unfortunately, its painless and hence neglected.  It is  much easier to find such lump  by a good Breast Self Examination – BSE (as I have written earlier).  Mammography has been overrated and the frequency of mammography and the age to  recommended are changing world over. For India and for many developing countries self-examination continues to be the best option.  A careful examination with the pulp of fingers, immediately after the 5th day of periods, is the best way to locate anything abnormal.  It costs nothing and is easiest !

Lumpy breast versus lump in the breast  –  Many times the breast feels lumpy all over and sometimes tender too.  This is particularly true of what is called fibrocystic disease which is hormonally dependent.  Such lumpy breasts are not a cause of great concern but if there is anything which is really hard, say consistency of an olive, then certainly it has to be carefully looked into.  Some of the breast lumps are clearly benign particularly those occurring in young girls less than 20 and which keep moving around in the breast.  They are called fibroadenomas and they are not to be worried about.  Only if they increase in size do we need to be worry.

Skin puckering: Other tell tale sign of breast cancer is the skin starts getting puckered ( adherent) onto the lump which is underneath. Sometimes when you lift the arms, along with the lump a little tag of skin gets pulled up.  These are definitely warning signs and need to be examined by a doctor.

Breast pain – breast pain is  a  distressing symptom. This is not to be worried about as a sign of malignancy.  Unfortunately there is no effective treatment for this, mastodynia , fibrocystic disease, except a paracetamol frequently.  Some people take Vitamin E but mostly these are emperical medication. As the hormonal activity starts reducing the breast pain also starts decreasing. Pain  is not an early sign of cancer.

Nipple discharge – Nipple discharge is also quite common.  If there is a bloody discharge in the nipple, that is something to be worried about.  But bloody discharge from the nipple can also occur in younger women and if it is bright red it can also be due to what is called ‘duct papilloma’ which again needs surgical intervention.  But nipple discharge, bloody discharge particularly, is also a sign of breast cancer. On the other hand greenish discharge or straw coloured discharge are common in a fibrocystic disease which is completely benign.  So one of the ways of checking out is examining or doing a slide test on the discharge and you can differentiate between a serious problem or a benign disease.

Retraction of a nipple – This is another sign which has to be carefully looked in a miror. A lady can easily recognise that an aerola which should be more or less equal on both sides starts becoming smaller and the nipple starts getting buried inside with any ulceration on the top is again an important sign of breast cancer and has to be immediately taken note of.

Image

 

 

 Well these are the common presentations of breast cancer. We do hope that none would  wait till it becomes advanced with infiltration of the skin and with an orange peel appearance and ulceration which is now rarely seen, thanks to awareness of many of the women. 

 

So most of the breast cancers can be detected early and once detected early, a lot of them have a potential for cure and also there is a significant change in the treatment parameters. Now we can conserve the breast and not remove the breast by limiting the removal of the tumor and the adjacent breast and lymph node in the armpits rather than sacrificing the whole breast. This has made a big difference as far as the feminine personality is concerned.

B) Cervical and Uterine Cancer

Cervix is the mouth of the uterus which projects into the vagina.  Uterus is an organ in the pelvis with a cavity which constantly undergoes proliferation and involution as per the menstrual cycles.

Bleeding and discharge– bleeding which I am talking about is not the menstrual blood loss which is physiological for all women.  The bleeding which is serious is the inter menstrual or in between the menstrual period or the post-coital bleeding. These are important indicators which definitely need examination of the cervix by a Gynaecologist.  There is also sometimes Foul smelling discharge. Discharge from the vagina particularly without any itching or any irritation is again a reason for getting examination done. 

Cervical cancer is on the decline thanks to good cervical hygiene, childbirth at older age group and overall number of children being 1 or 2 in the modern times.  We hopefully will see less and less of cervical cancer.  An annual check up by just an examination of the cervix would be a great way to pick up even an early cervical cancer and even cervical infections.

Uterine Cancer – on the other hand normally presents with bleeding in the post menopausal period. Menopause occurs around 50 and after a couple of years when there is no bleeding and suddenly there is spotting of blood, this certainly is an important sign and should be immediately taken note of.  Unexplained backache is sometimes  another way of presentation of endometrial carcinoma.  This again, once detected in early stage, can have high potential for cure.

Last is the Ovarian Cancer and this is perhaps the most difficult cancer to detect early because there are hardly any symptoms of ovarian cancer.  Unexplained backache, fullness of the abdomen and bit of weight loss and pelvic pain, particulaly in 50-70 age group are all signs of ovarian cancer.  It can occur in younger women in 40s too. The symptoms are all  non-specific and many times ovarian cancer is diagnosed in stage III.

 An ultrasound has an ability to pick up ovarian cancer and I think if you are going for any health examination, definitely get an ultrasound of abdomen and pelvis and it is likely that you can pick up ovarian cancer at an early stage.  Yes, there are some blood tests, some marker tests for ovarian cancer but it is not practical and feasible to do all these marker tests on a yearly basis unless one has a family history or one is very concerned of the same, in which case tumor marker tests like Ca 125 would be useful but not always definitive.

So here are the various different ways of detecting cancers in the  women which are specific to women and I do wish and pray that all the readers would  continue to be healthy without any such  problems. You can certainly  guide others by disseminating this information so that many of the women would continue to enjoy a great life.

We are grateful to you ! You are all very precious for your families ! Take good care of your health

 

Should I take HPV vaccine for preventing Cervical Cancer?

Cynthia, my secretary, said that her aunt aged 54 was advised by a gynaecologist to take the HPV vaccine for preventing Cervical Cancer.  It is quite tempting to opt for any technique to prevent cancer and rightly so.

Yes, Cervical Cancer is caused by six strains of the Human Papilloma Virus (HPV). This has won Nobel prize for Prof . Zur Hausen.

zur hausen

The vaccine contains recombinant DNA of 2 or 4 of such virus strains.  The IMPORTANT FACT is  the vaccine is recommended to be given before the sexually active age i.e preteens aged 11-12. Certainly not after 25.  This also created a lot of controversy in India as this was actually tested in rural population where none had knowledge of Cervical Cancer nor did they benefit from the vaccine.

What are the basic facts of Cervical Cancer

Cervical Cancer, worldwide, even before the advent of the vaccine, started falling and this was evident as in most of the developed world.  Cervical Cancer has gone down significantly from No.2-3 position in many countries and is mainly the problem of eastern and northern Africa and parts of developing world. .

Why did this happen when they were not even vaccinated?  Even a pap smear screening was not implemented in many countries like India.  But in the urban population, even in India, Cervical Cancer started coming down.  The simple reason is that Cervical cancer is largely related to a number of children, early marriage and most importantly the personal hygiene of women.  As the lifestyle has changed, personal hygiene improved. Number of children are limited to 1 or 2 and the age at marriage has progressively increased.  So, social dynamics and personal hygiene  reduced the incidence of Cervical Cancer.

More facts on HPV vaccination

  • Some side effects of headache and fever are reported. In Japan more serious effects like persistent body aches, joint pains made the government suspend promotion of vaccine. India also has adopted a cautious approach.
  • The vaccine would not protect once there is infection and so has to be given early.
  • The cost is around 300 USD for 3 doses and in those highrisk populations, it would never be affordable.
  • The risk of cervical cancer is reduced by 43% and screening by pap smear is still recommended.
  • Highrisk individuals include homosexuals, HIV positive and immuno compromised patients

Summary

Readers of this blog are NOT at risk.

They are healthy, mostly over 15 and definitely conscious about hygiene.

So don’t panic if some one advises HPV vaccination for you.

You can carefully consider for young girls.

References:

http://www.cdc.gov/hpv/vaccine.html

http://globocan.iarc.fr/factsheets/cancers/cervix.asp