When Dr Malika Samuel embarked on a long-term study across six centres of Apollo Hospitals in Chennai, to research the incidence of cervical cancer among women in the region, she came upon an interesting finding: Doctors were able to spot possible cases of cervical cancer more if an EVA – an enhanced visual imaging test – was done, and not just the pap smear. As the Senior Obstetrician & Gynecologist at Apollo FirstMed Hospital in Kilpauk, who strongly advocates for awareness to prevent cervical cancer, this was an important finding for her in the study which ended in 2017. Just one more inexpensive test could spot the cancer earlier, in more people.
There has however been one challenge: not many people know about the EVA and the MobileODT Colposcope, which is enabling doctors to spot the cancer. This challenge is rooted in yet another problem, she says, – general lack of awareness about cervical cancer. “The one thing I want women to know is, cervical cancer is preventable. If you catch it early enough, it is treatable. Even now, many women don’t know that,” Dr Malika says.
The cancer which moves slow
Cervical cancer is slow moving, and it announces before it arrives if the cervix is monitored regularly. Cervical screening, through tests like the pap smear, can show any abnormal cells in the area. The various stages of abnormality are categorised as CIN 1, 2 and 3. While it is not necessary that women with abnormal cells will definitely get cancer later, it is certainly a risk category. “If we notice that a woman is at the CIN1, we might not even treat it. But we keep a tab. And from that stage for it to become a cancer, if at all it does, it can take up to four years. So there is a good three-four year window when it can be prevented and treated. All you need to do is regular monitoring,” Dr Mallika points out.
“If we catch it early, we can treat it before it actually invades into the deeper layers of the body, into the deeper layers of the tissue,” she explains, adding that an early diagnosis also means saving a lot of money and trauma, and having a better life.
But, how do you spot it in advance? There are two symptoms a woman can watch out for: One, a very foul smelling discharge from the area; and two, post-coital bleeding. But in many cases, such symptoms do not occur, and that’s where screening comes in.
Say ‘Yes’ to early screening
Not only is cervical cancer slow to move, it is something that can be observed, something we can see with our eyes, says Dr Mallika. “It is important that we utilise this advantage god has given us – we should observe the cervix,” Dr Mallika says. That’s why, enhanced visualisation through EVA colposcopes become an important part of the screening, with equipment like the MobileODT. “Using them, we can actually look at the cervix, it is like using a microscope to examine the area,” the doctor says.
The EVA is called a co-pap, so all the tests are done in one shot along with the pap smear. “We look at the cervix and we spray it with acetic acid. If there is an area which is malignant, or pre-cancerous, it will undergo a colour change. It will blanche and become whitish from the cervix’s normal, pinkish colour. That gives us an indication that it could be cancerous, and we take a biopsy,” Dr Mallika explains. “We then do the pap smear to find out more about the cervix and if there are any problems. According to the pap smear report, we decide on the next steps,” she says. The tests aren’t too expensive either. Along with the pap smear, an EVA test will not cost more than Rs 2,000.
“In India, women should start having pap smears from the age of 30, and we recommend getting it done till they’re 65-70 years old. Ideally, it should be done once every three years if results are normal; but if there are any early signs, it should be once a year or once in six months,” she says.
This article has been produced by TNM Brand Studio in association with Apollo Hospitals and not by TNM Editorial.