Know Your Cervical Cancer - Prevention & Screening Strategies

Know Your Cervical Cancer – Prevention & Screening Strategies

𝗞𝗬𝗖 : 𝗞𝗻𝗼𝘄 𝗬𝗼𝘂𝗿 𝗖𝗲𝗿𝘃𝗶𝗰𝗮𝗹-𝗖𝗮𝗻𝗰𝗲𝗿 – 𝗘𝗽𝗶𝘀𝗼𝗱𝗲 𝟮 | What are the best prevention and screening strategies for staying a pace ahead of cervical cancer threat? Find out from experts in this special intervention.
Join Dr. Hrishikesh Pai, President – FOGSI; Director- Bloom IVF Group and Dr. Chandrika Anand, Consultant, Obstetrics & Gynecology, Fortis Hospital, Nagarbhavi, Bangalore on 𝟮𝟱𝘁𝗵 𝗝𝗮𝗻 𝟮𝟬𝟮𝟯 𝗮𝘁 𝟲:𝟬𝟬 𝗣.𝗠.

[Music] [Applause] [Music] thank you all right good evening everyone welcomes you all to these virtual discussions know your cervical cancer and initiative by voice of healthcare to Mark cervical cancer awareness month today is the episode 2 of know your cervical cancer in today's discussion our leading experts shall share their Insight on the prevention and screening strategies for cervical cancer before moving on to our discussion I would like to welcome our eminent speakers for today we have Dr rishikesh D Pai president foxy director Bloom ITF group welcome Dr pie hello also I would like to welcome Dr chandrikanan consultant OBGYN Fortis Hospital nagarbhavi Bangalore who will moderate this interview today good evening moderating with you on a very important topic of cervical cancer in India and thanks to voiceover for healthcare for giving me this opportunity uh to the benefit of our viewers globally cervical cancer continues to be one of the most common campus around two rates being the fourth most common after breast colorectal and lung cancer and unfortunately the majority of new cases and also the deaths due to cervative cancer is very common in the low and middle income countries in which India is included in India the cancer of the cervix European cervix is third most common cancer with the incidence rate upon 18 per month population of women and the second leading cause of death with a mortality rate of 9.1 percent as per the natural cancer registry program is a more common cancer among females and cervical cancer around for 6 to 29 of all cancers among women in India in Asia sir please enlight important is the role of gynecologist in the diagnosis of cervative cancer first of all I am the President of the Federation of operating and gynex societies of India which is the cult of Foxy just like IMA is the you know the main body the foxy is the body of the gynecologist and the gynecologists are the ones who come in direct contact with women so I always say that we are the custodians of women's health in the country and in the world also worldwide but people are not aware of our organization so much as they are for example aware of the IMA which is the Indian Medical Association so we are because we are in direct contact we have the uh you know directly related to Women's Health now as far as the Women's Health is concerned there are two important parameters when we look at Women's as one is mortality and one is morbidity so maternal mortality is a very important parameter to gauge Women's Health what are the levels of women's health Delivery Systems in a particular country and in our good old days our mortality following was 600 for pregnant women so every uh 100 600 is to die now it has fallen down because of lot of advancement to 97. so there are in parallel with the pregnant related mortality there's another mortality and that is related to cancer so one of the other killers in women are the cancer related mortality so in that cancers in our country for example the breast cancer is the most common followed by cervical cancer oral cancer colon and other kinds of cancer ovarian Cancers and all that but cervical cancer especially in the Lower State of society and is very high you know so the we are to focus on cervical cancer as far as you know the the cancers are concerned you know I always believe that we need to be holistic in our Focus so I personally in during my presidency now this year I have learned the bad love Campaign which is made up of three parts that is a key current that is integration so whatever we do including cancels we should integrate our action and then second is Samantha that is equality and third is technology so utilizing technology to implement integration and Equity is very important for us and in this National program of mine cervical cancer is screening and prevention and treatment is become is a very important place a very important role so as Sir told uh the women most of the women uh come to the gynecologist first even if she has got a BP or if she's got a sure they will expect the gynecologist to be her primary caregiver as her told so we are undoubtedly we are responsible for the women's holistic health and Foxy this year has launched a number of screenings making cervical cancer as a priority so uh coming to the second question see now we know India accounts for the highest number of cervical cancer cases in Asia followed by China maybe thanks to the population thanks to the lack of awareness and the preventive strategies according to all assets study India has got the highest number now this research also revealed out of the 40 of total debts from pervading cancer in Asia 23 occurred in India it is a well-known fact that 90 of cervical cancer is associated with a viral infection called human papilloma virus for all the sexually active women are prone for to develop okay equivalence in India is for cervical cancer hello and here yeah so can you just reframe the question because that was the last one minute I lost the last one minute what are the recommended screening methods women are good yes sir hello so I was just saying that Mr Foxy has got various layers of you know cancer initiative with them we are having program going on in the Northeast uh where the prevalence is very high prevention program we are got a training program for our own members you know called possible training program just now just now as you are talking we have launched a new three-day training program for our members so that's one aspect of it the training program the second aspect is to Target our end or audience that is our patience and from that angle we need to do what is known as the biggest problem I feel in India is that the cultural problem is there so simple examination of the cervix per speculum examination very very people are very resistant to undergo that examination of course when you do the examination with visual examination of cervix and using acid to acidic acid is a very simple screening test which can be done by anywhere by any person and it can be a good pickup technique for as a dangerous cervix and then we have the simple pap smear which has been there for many many years now uh more than many decades now and that's called the Pap test or the pap smear and we now have a new test also called HPV test which is it presudes today rightly that HPV virus can cause also cervical cancer so a simple HPV test nowadays we combine both the test pap smear and HPV test but let me tell you just now I did the Norris yatra where I covered for 21 cities over five states and we also in that yatra did a camp also everywhere we went we did about 100 150 patients and we asked them up there was a big question that we asked them and let me tell you hardly anyone has done any pap smear in their life they did the first time passion so there is a problem of access so first first of all there's a hurdle of awareness second hurdle is cultural they don't want to do Under was any vaginal examination and third problem is a problem of access also they don't want to do the test at all so all these things are there coming back to this test so before the age of 29 or 30 you should do the test once in three years of pap smear and HP returns and between 30 and 65 you should do it once in five years if you do only pap smear you can do it once every three years and after 65 you don't want don't need to do any test but in this time band of 22 65 years that's the time when the highest chance of cancer can be there of the cervix you should do the pap smear and the HPV test but forget all that even simple per speculum examination is very important so you know many people will be okay if I do a password no I was just now about a week back I was just chatting with my one of my colleagues from the south only from Tamil Nadu and she was telling me that uh see that a patient 35 year old she just did she came for a pap smear and when she put the speculum a very small tiny poly like a small came out of the cervix she took the biopsy of it she did a colposcopy and a biopsy and turned out to be adenocarcinoma they were they were all taken aback all the family was very pumped up and she did a hysterectomy she said so she also agreement and said Doctor by you are correct we respect your whether you do a pap smear order you must also do a speculum examination that is the basic test we should not forget the speculum examination I think in fact as a president I want to start a moment please do a speculum examination forget the past HP which are in our country are the luxury I would say exactly so um what sir is telling you is that all the asymptomatic women whether they have any symptoms or not once they are sexually active they should start cervical cancer screening examination um they should go to the doctor and uh once in three years they need to get the first speculum examination and the pop spirit and if they are combining with HPV DNA uh once in five years and up to 65 after 65 years there is no screening necessary because whatever the damage would have the HPV would have caused by then it would have passed not not exactly it may not cost so late and also uh dries a message to all the gynecologists and all the doctors who are watching this is that please do a perspeculum Examination for every patient who comes with any symptoms any AUB or any other problem please do more perspective don't skip that examination because that is one of the most important examination that is a message for the young doctors and also the data shows that our lifetime study prevalence as Sir told only 30 of women are getting screened for cervative cancer in India the rest is 70 percent are not available so the problem is also cultural and I don't know I personally feel that uh all of us now human beings unless we are faced with a crisis we don't act on it so you know prevention is better than cure but in actuality we know we all know that we should eat good food healthy food fiber rich food less glucose we should go for a walk we should do exercise all that we know but we'll never do it you understand some of the human body is not programmed to do voluntarily work so we have to make it uh you know we have to go out of our way to do it so a health checkup is very important and as I told you my my philosophies of integration so when you go to the gynecologist she should do your blood pressure she should SRI or BMI she should do your blood sugar your thyroid level he should do a vitamin DC should then give examine your breasts to look for breast cancer look at your thyroid do an internal examination see if there's any tumor or something do abdominal examination to just simple stress if there is a tumor ovarian tumor so all of that should be done simultaneously it's not that you are only going to do cervical cancer you must change the woman holistically and that that checkup should be done once in a year but cello if you can't do it once in here at least do it once in two three years okay so as you told sir we are the primary care physicians so so often even if one comes with a white discharge we do that breast examination instantly find the lump once it so happened at home so many of us have related to breast pumps the way before the patient complain about it and it is how to check that social and cultural prohibitions and the doctors gynecologists have to see the treat the patient as a whole screen for all the metabolic problems and also the breast examination messages and I forgot the sugars sorry I forgot the sugar so yes it should be because we are the diabetic capital of the world we are all possible diabetics of potential diabetic so earlier we catch it is better so it should be a holistic examination yes so um as you told sir one thing is creating patient awareness and creating awareness is one thing but how can women all the women reduce the risk of developing a cervical cancer we know it is associated with the HPV infection Factor what lifestyle changes or what is what are the screening changes what are the medications or vaccines you are going to recommend to reduce the risk for permatic cancer right so the one of the things is prevention and because of the HPV so you must try to prevent HPV infection right at the beginning because that is known to cause cervical cancer fortunately you know what happens is that the cervical cancer is a slow process so the service will first develop something called cervical winter Plaza pneumoplasia CIA and we call it one two three then it will develop slowly so it takes a it has a spectrum so even if you can pick up a CN early it's not cancer but it's pre-cancerous we can treat it by using advanced technology like colposcopy and puppy directed biopsy or a leap or whatever so the but prevention so HPV so protection against infection using protected sex so unprotected sex is a dangerous thing so using a condom is very important to to prevent infection try you know many people if they have multiple partners try to reduce the number like I mean that's a Moral Moral issue or a ethical issue I can't tell you as a doctor that don't have sex with that have sex only with one person but if you are by any chance exposed to multiple partners then it is important to be having a safe sex so condom female condom is also now available or a male condom is supposed to be you should use it and of course you have to do the uh you know HPV tests and you know the before the age of 15 now it has been shown that if you vaccinate the girls especially there is a lot of people say that boys should be also but that's a controversial area but definitely less than 15 year old girls between ages of 12 and 14 15 you can view HPV vaccine two shots at six months interval and fortunately this vaccine is costly but now the government we have as Foxy also has recommended to the government recently that they should in Incorporated in their National vaccination program one that happens then government will procure the vaccine and give it to all the people free of charge just like they did for the coveted vaccine they gave it free of charge so similarly HPV vaccine there's a moon now to see that it is uh Incorporated in our vaccination program once that happens all the girls will start getting immunized and that will protect them against HPV vaccine HPV infection and indirectly also protect them against uh cancer in the long term of course the other thing I told you lifestyle is very important but no one follows it trying to reduce your weight stay within a normal BMI range of 18 to 24 25 then have a good food healthy fiber Less meat you know Mediterranean diet vegetables green leafy vegetables no smoking no alcohol exercise for 30 minutes no one thought that's all this you know here tell them but who does it very few so there are okay my about my advice would be try to do things in moderation rather than telling people not to do it because people are not going to listen so you know whatever is in a plate so one of the things I my my wife always tell me so don't only take food once don't go and take one more time plate so by doing that automatically you would reduce the consumption so all these are lifestyle thing which also contribute to cancer risk good so as a sir is telling uh to all the public who is listening please vaccinate your young children educate them about uh sex early and multiple partners and healthy sex practices and uh using condoms or barriers avoiding and also if you are doubting us actually translated since promptly go to the doctor and get it checked that also will go a long way and quitting smoking also helps you now prevention of cervical cancer and one question sir because now all of us know because of the bad lifestyle in the cervical the cancer of breast cancer and cervical cancers are coming in early age groups that is in the reproductive age group so you even and also the women are getting pregnant late so pregnancy age has gone up from 25 to 32 now it is going up to 40. cancel the equivalence also is coming down from 60 to 50 40 and 30. So like um now one very important question is can cervical cancer occur during pregnancy uh so how do you suspect a cervical cancer in a pregnant woman and if so what are the protocols so basically it can occur in pregnant women also but you know many of the time it is it may be asymptomatic sometimes of course you may have some bleeding coming in doing pregnancy and you would do a speculum examination but normally you know we don't do a speculum examination as much but I think maybe one at least one may be simple in the early phase one speculum can be done but normally if they symptomatic only then we would say if there's a breeding in the first or second trimester of pregnancy would put a speculum to see if there is unfortunately a cancer then most of the time you know if the pregnancy is Advanced then it is better to deliver the baby and then start the treatment but so that is very important so uh uh you know it is all related to the gestational age the cancer but the general philosophy would be to get the delivery done as soon as is possible and then start the treatment as far as the pregnancy related cancer the concerned so because uh the cervical cancer is the disease of the Fertile women so obviously during pregnancy we are going to occasionally come across these patients who have got a pregnancy as well as who's got a cancer so as much as possible defer the treatment till the pregnancy is taken care of and then started of course you have to weigh the balance if you think that the cancer is quite spread and all and then it is better to terminate if it is early pregnancy better to terminate the pregnancy and then start the treatment but if it is late and you can wait for a few weeks or a month or so then might as well deliver the baby and then as soon as the baby is mature and then go for the treatment yes sir so sir is recommending all the gynecologists to have at least one perspective examination due in the pregnancy even if they complain so that it does not miss a unhealthy or a bad cervix and also once the pregnancy certificate cancer cervix is diagnosed in pregnancy if it is your term better to deliver and then go for the treatment ugly pregnancy and advanced disease I think better to terminate and then start the cancer treatment so sir this is the last question that is the other way around suppose uh if there is a woman who is who's a young woman of around 25 40 or maybe 35 she has been diagnosed with cervical cancer she is not married or she wants to conceive later so what are what about the treatment we give to this woman with a cervative cancer what do you advise her to go so that you know her fertility is preserved later and also her pregnancy what are the prime complications can happen during her pregnancy if she has taken any treatment for cancer service okay so before I uh go and answer this question I would like to also say that in one of the diagnostic newer tests that have come a lot of artificial intelligence related Cloud related tests have also come there's one test where you can now use a callposcope and you know you can just take a photograph of the cervix and Export it to the cloud and the computer tells you whether there's a danger of this particular woman having cervical cancer or not so new uh cloud computing analysis tests are there now even pap smear and all can be we can use artificial intelligence to do the pap smear reading you know in abroad they already started doing it and I'm sure that as our number because India then the number is very large so once the once we are saying do this do not do that do the ones people start doing the test will come in a situation where we will not have enough people to read the pap smear so that's where the AI is going to come in just two days back is the new AI has come chatbot CG and ght where the chatbot has even passed the MBA exam so the the chatbot AI is become so good that they will take over the reading of the test as well so that's the one thing which is now coming in a very big way and coming to the fertility so basically in a young woman fertility preservation so if there is a cervical obviously the treatment is chemo ready chemotherapy which damages the ovaries or radiation therapy which will damage everything possible around the ovary as well the bowel the the worry the uterus and then you may have the surgery where you can do conservative you can just remove the users you know do a conservative or dime surgery but now there are new technologies that are also coming so we can freeze the eggs so who said freezing can be done or you can freeze the ovarian tissue if you don't have time before the surgery you can go in and remove the ovarian tissue and freeze the ovarian tissue and then later on utilize surrogacy so suppose the uterus is taken out then you know the if you have Frozen the eggs then then we can create an embryo by the husband's later on when she gets married her husband's form the Frozen whose side make the emperor and put it in a surrogate because in our new surrogacy law if the uterus is not there by after taking permission of the medical board and giving her taking her order from the magistrate you can undergo surrogacy it's not that government has banned surrogacy what government is that is it has prevented lifestyle surrogacy from taking place that is not a lot but people like genuine people like such this patient where uterus is lost or overseas and then if the ovaries are totally damaged and you have not preserved here who said you can borrow an egg so you can do an egg donation also and of course obviously there's always something called adoption the problem is that adoption now is the there's a lot of waiting list and not people children are by that's not good news that not many children are there for adoption which is good news because we don't want uh foreign so I think assistant reproductive Technologies are going to be a good answer to these women and remember you must preserve your fertility because many of our doctors are not aware of that so you as patients should ask for it see the whole thing boils down to awareness hello in my campaign what I'm doing is we need to do a lot of awareness awareness promotion is very important uh not only about cancer but about everything and I feel that I've created a 12 minute cartoon film which I have which we all created the foxy has created and we are going to dissimulate it which tells you about everything from whom to Wellness that is I can call it boom to tomb but boom to well less and 12 minutes and so that is very important you must tell patient everything what can happen go wrong with her and you know in a very less time period otherwise people forget you put them 20 things and you take nine hours to tell them they'll forget if you give that 10 minute information they'll remember all that important information that is what my uh I Would by conclusion is awareness awareness and awareness like like is the best way of uh having a very successful hospital or a restaurant is three words location location similarly the best way for Women's Health is awareness awareness awareness foreign hello hello okay hello is there anyone there I think hello yeah yeah [Music] [Laughter] right and you know later on they can also go for surrogacy if there are them I've done a lot of patience during my younger days before 2013 when saragasi was easier I have done even patients from abroad where they had Bhutan War times hysterectomy and all and then come and I had done the uh you know I'd done the uh one pickup one personally is not that it is not illegal or something they have just regulated it and people like this patients of young patients with cancer where they have lost their uterus they can definitely go for surrogacy so thank you so much for talking to us and talking to the public about the a prevention strategies what toxins and doctors have to take the patients so please tell me your take home message to the public and to the end doctor and you are for under the boxes so basically you have to basically the who strategy is that to vaccinate people early to vaccinate then test testing is very important and then treatment is early treatment is important because in cancer now everything is early so I would like to leave you with an exciting breakthrough that has come in that is just like you know the in the cancer early precursor cells they leak into maternal circulation so we can now collect the blood and try to isolate these cells and test them so you know nearly 10 to 15 cancers now can be located using this new technology it has got the and this technology can tell you which is the organ from which those cells are coming so even before the the malignancy becomes clinically apparent if you will be able to say okay this is coming from the colon then you can start looking for the cancer before the cancer becomes clinically apparent so just like we do a normal test of the blood sugar or we do foreign we'll be able to do these tests in the future about five ten years it will become more and more precise and you will be able to make out where the cells are coming yeah early diagnosis and will be so that is what doctor you will Harari is a author who writes about the future and he has said that the longevity of women is going to go to 150 years because we will be able to pick up the cancers very early we'll be able to do that stroke management early we'll be able to pick up cardiac Problem by doing City angels and treat them we'll be able to do diabetes management hypertension management and we'll be able to prolong the wild lives of women so too so much so that he has predicted that many women will start becoming pregnant they'll get remarried at the age of 70 75 and become pregnant again so this is the future [Music] we are working hard foreign happy Republic Day and uh you know we will take care of your body it's very important and be preventive be do more preventive of course indulge you can not indulge otherwise you will not enjoy life but enjoy it in regulation in control thank you so much thank you so much thank you madam thank you bye [Music]

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