Most Common Cancer in Women, Its Symptoms & Prevention Tips

According to GLOBOCAN 2018 data, the top 5 cancers that affect the Indian population are Breast, Oral, Cervical, Gastric and Lung cancers. Breast and cervical cancers are the most common causes of cancer mortality among women in India and these are largely preventable diseases. Awareness and health-seeking practices are poor in many developing countries including India, necessitating the need for proper awareness programs.

In this article, we shall discuss the various things a woman should know about these two cancers and this basic awareness can be very helpful in preventing our women from these most commonly occurring cancers.

Breast Cancer

Breast cancer is the most common cancer in women in India and accounts for 14% of all cancers in women [1, 2]. Overall, 1 in 28 women is likely to develop breast cancer during her lifetime.

Risk Factors Associated with Breast Cancer

Non-modifiable risk factors are age > 45, family history of cancer, genetic factors (BRCA1 and BRCA2 mutations), Younger age at menarche (before age 12) and older age at menopause and past history of breast cancer

Modifiable risk factors (lifestyle-related) are obesity, nulliparity, late pregnancy, no or less lactation, drinking alcohol, hormone intake, and radiation exposure.

Prevention of Breast Cancer

By simple changes in lifestyle [4] like maintaining ideal body weight, exercising regularly, quitting smoking and excessive alcohol consumption, breastfeeding your baby and avoiding unnecessary radiation exposure.

Signs and Symptoms of breast cancer which every female should be aware of are a new mass or lump in the breast, any change in the breast or nipple appearance like unexplained change in shape or size of the breast, unexplained shrinkage of breast, unexplained swelling of the breast especially on one side only, recent unevenness of the breasts (It is normal for women to have one breast slightly smaller than the other, but if this asymmetry is a recent one, then consult your doctor), dimpling anywhere on the breast, sunken or inverted nipple, redness or scaling of the skin of the breast, nipple or areola, uneven areas or pores on the skin that resemble an orange peel, clear or bloody discharge other than breast milk, swelling of lymph nodes/glands in armpits or around collar bone.

Any woman can easily check for these signs of breast cancer by examining her own breast.

Tests for Early Detection of Breast Cancer

• Clinical breast examination (CBE): CBE by a doctor is recommended for all women once a year after 30 years of age.
• Breast self-examination (BSE): BSE is a suggested option for women above age 20 years to look for early signs of breast cancer. It can be done in the comfort of your own home. Women who are menstruating should examine their breasts every month 1 week after the menses have stopped. Post menopausal women can self examine every month. There are Five Steps of Breast Self-Exam which one can learn from your health care provider.
• Mammogram test: A mammogram is an X-ray picture of the breast used to look for early signs of breast cancer. Regular mammograms are the best tests to find breast cancer early, sometimes up to three years before it can be felt. Women between 40 and 44 have the option to start screening with a mammogram every year. Women 45 to 54 should get mammograms every year. Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

Cervical Cancer

Cervical cancer is the second most common cancer among Indian women (As per Globocan 2018). More women in India die from cervical cancer than in any other country. New cases of cervical cancer detected in India: 96,922 every year [1]. Deaths due to cervical cancer in India: 60,078 per year [7].

Cervical cancer is a preventable disease as it has a well defined, long pre-malignant phase which can be detected by regular screening tests and follow up. Unfortunately, awareness about symptoms, early diagnosis, and screening test in Indian women is very poor. Poor awareness lowers the possibility of early diagnosis in spite of the availability of screening test.

Risk factors for cervical cancer are persistent infection of the cervix with Human Papillomavirus (HPV), having many sexual partners, Husband or partner having multiple sexual partners, having first sexual intercourse at a young age, giving birth to many children, smoking, having other diseases which lower immunity such as HIV/AIDS, immuno-suppressive drugs, transplant, etc.

The presence of these risk factors does not imply that you will definitely acquire cancer. However, if you have one or more of these risk factors, it is advisable to consult your doctor. Also, any woman should consult a gynecologist if she has abnormal vaginal bleeding, unusual or excessive vaginal discharge with a foul smell, vaginal bleeding after having sexual intercourse, pain in the lower abdomen or pelvic pain, pain during sexual intercourse. The presence of these signs and symptoms does not imply that you are suffering from cancer. However, if you have one or more of these, it is advisable to consult your doctor.

Prevention of cervical cancer:

Primary Prevention: It is designed to prevent the disease from occurring in the first place.

• This can be done by adopting safe sex practices (avoid multiple sexual partners), using condoms as barrier contraceptives to reduce the risk of HPV infection, timely treatment of reproductive tract infections and HPV vaccination.
•  Prophylactic vaccines for cervical cancer: Currently two vaccines, licensed globally are available in India; a quadrivalent vaccine (against HPV genotypes 6, 11, 16, 18) and a bivalent vaccine (against HPV genotypes 16, 18). Females who have not been exposed to the HPV infection are likely to benefit more from the vaccine.
• Indian Academy of Pediatrics (IAP) recommendations on HPV vaccination [8]: Only 2 doses of either of the two HPV vaccines for girls aged 9-14 years: doses at an interval of 6 months. For girls 15 years and older, and those with HIV/AIDS on chemotherapy or after organ transplant: dose at 0, 1-2 and 6 months.
• However, vaccination is not a replacement for cervical cancer screening.

Secondary Prevention [9-11] Secondary prevention aims at detecting the disease in its early stages (pre-cancers) through screening and to prevent its progression.

Screening tests are done in apparently healthy women to diagnose changes in the cervix which are pre-cancerous and could develop into cervical cancer in the future. If the abnormal tissue or cells are removed, the disease can be prevented from progressing to cancer [12]. Available screening tests for cervical cancer include Pap smear test, VIA (visual inspection with acetic acid), VILI (visual inspection with Lugol’s iodine) and HPV DNA test.

The Pap Smear is a simple test that is done to collect a few cells from the cervix and help to diagnose precancerous and cancerous conditions of the cervix. As per the International recommendations, women above the age of 21 years can get the pap test. If you are 30 years and above Pap test should be done once in every 3 years till you turn 65 years of age. If this test is combined with the HPV test, then the test may be repeated every 5 years. Women aged less than 21 years and above 65 years and women who had their womb removed for non-cancerous conditions do not routinely require Pap test.

The procedure of Pap Smear test involves the introduction of an instrument called a speculum gently into the vagina to visualize the cervix. There may be some discomfort or cramping during the procedure, but it is usually not painful. A small wooden stick or spatula is used to gently scrape the surface of the lower part of the cervix to pick up cells. A special brush called a cytobrush is used to obtain cells from the inner part of the cervix. The cells are placed on a glass slide, immediately fixed in ethanol and sent to the laboratory for further processing and interpretation.

Visual inspection using Acetic acid (VIA): Naked-eye visual inspection of the uterine cervix, after application of 5% acetic acid (VIA) provides a simple tests for the early detection of cervical precancerous lesions and early invasive cancer.

Visual inspection with Lugol’s iodine (VILI) is a visual examination generally performed after the VIA test and requires the application of Lugol’s iodine, a compound that reacts with glycogen resulting in brown or black coloration. 

HPV test identifies the presence of Human Papillomavirus (HPV) DNA in cervical smear which is a causative factor for cervical cancer. Women having an HPV-negative test are not at risk for developing cervical cancer in the next 5-10 years. If this test is combined with Pap Smear test, then the test may be repeated every 5 years. 

Colposcopy: This is done in cases of abnormal Pap test results. It is a procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas from where a biopsy can be taken.

Biopsy: A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue (punch biopsy) is usually done in the OPD.

Healthcare providers in our country regularly see women with advanced, incurable cancers. The health of rural Indian women and her access to a health facility is compromised due to socio-cultural, economical, and environmental factors. The main barrier to using screening and early diagnostic services for all cancers is a lack of awareness about symptoms and the availability of tests. In conclusion, awareness programs need to be conducted regularly and to a larger extent and this basic awareness can go a long way in preventing our women from these most commonly occurring cancers.

Reference

• Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013.
• Bray F, Ren JS, Masuyer E, et al. Estimates of global cancer prevalence for 27 sites in the adult population in 2008.; 2013; Int J Cancer.; 132(5):1133-45.
•  http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors
•  http://www.cancer.gov/cancertopics/pdq/prevention/breast/Patient
•  American Cancer Society. Detailed Guide: Breast Cancer. 2014. Accessed at http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/index on November 13, 2014
• American Cancer Society. Breast Cancer Prevention and Early Detection. 2014 Accessed at http://www.cancer.org/cancer/breastcancer/detailedguide/index on January 15, 2015
•  Kurkure AP, and Yeole BB. Social inequalities in cancer with special reference to South Asian countries. Asian Pac J Cancer Prev 2006;7:36-40
•  Vashishtha VM, Choudhury P, Kalra A, et al. Indian Academy of Pediatrics (IAP) recommended immunization schedule for children aged 0 through 18 years–India, 2014 and updates on immunization. Indian Pediatr. 2014 Oct; 51(10):785-800.
•  Moyer VA; U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;156:880-91
•  Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV Screening for Cervical Cancer in Rural India. N Engl J Med 2009;360:1385-94
•  Sankaranarayanan R, Budukh AM and Rajkumar R. Effective screening programmes for cervical cancer in low- and middle-income developing countries. Bull World Health Organ 2001;79:954-62
•  Miller AB, Chamberlain J, Day NE, et al. Report on a workshop of the UICC project on evaluation of screening for cancer. Int J Cancer 1990;46:761-9