Changing Trends in the Epidemiology of Cervical Cancer in Upper Middle Class Women
Vijaya Srinivasan, Sadasiva P Meenakshi, Koramadai S Mouleeswaran, Gopalakrishnan V Praveen, Tom Michael
Cervical cancer, Postmenopausal bleeding, Postparity, Socioeconomic status
Citation Information :
Srinivasan V, Meenakshi SP, Mouleeswaran KS, Praveen GV, Michael T. Changing Trends in the Epidemiology of Cervical Cancer in Upper Middle Class Women. J South Asian Feder Menopause Soc 2018; 6 (2):97-102.
Introduction: Changing trends in the epidemiology of cervical cancer are reported from developing countries, but the new factors are not well documented, especially socioeconomic (SE) status.
Aim: To study the prevalence and factors associated with cervical cancer in upper middle SE class women from a tertiary care hospital in Chennai, South India.
Materials and methods: This is a case–control study of cases with cervical cancer and twice the number of asymptomatic controls, among women who underwent papanicolaou (PAP) smear test during 2009 to 2015.
Results: Of the 3,536 PAP smears examined, 48 (1.36%) had cervical cancer and 96 age- and year-matched controls were selected for the cases. The mean (± standard deviation, SD) age of cases was 51.3 (± 12.7) years and controls was 51.7 (± 12.7) years (p not significant, NS). Over 90% of both groups underwent surgical sterilization and had long married lives. The median parity of cases and controls was 2. Parity was 3 or more in 22 (44.9%), compared with 27 (28.1%) in controls (p < 0.05; relative risk, RR: 1.6 and 95% confidence interval, CI: 1.3–1.9). Among all the cases, 23 (48.0%) were asymptomatic. More than half, 28 (58.3%), of the cases and 50 (52.1%) of the controls had attained menopause (p = NS). About 7 (25%) of these cases reported postmenopausal bleeding (PNB).
Conclusion: Among the PAP smears tested, high prevalence (1.36%) of cervical cancer was noted. The associated factors were age >50 years, median parity of 2, history of PNB, and a long duration of sexual exposure. Nearly half the cases were asymptomatic, highlighting the need for routine screening of all postmenopausal women.
WHO. Human papillomavirus (HPV) and cervical cancer. Fact sheet. Geneva: WHO; 2016. [cited 2016 Jun]. Available from: http://www.who.int/mediacentre/factsheets/fs380/en/.
HPV Information Centre. Human papillomavirus and related diseases report in India. Annual number of cervical cancer cases. Spain: HPV Information Centre; 2016. [cited 2017 Jul 27]. Available from: http://www.hpvcentre.net/statistics/reports/IND.pdf.
Ferlay J, Shin HR, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010 Dec;127(12):2893-2917.
Mishra GA, Pimple SA, et al. Prevention of cervix cancer in India. Oncology 2016 Jul;91(Suppl 1):1-7.
Sreedevi A, Javed R, et al. Epidemiology of cervical cancer with special focus on India. Int J Womens Health 2015 Apr;7:405-414.
Senapathy JG, Umadevi P, et al. The present scenario of cervical cancer control and HPV epidemiology in India: an outline. Asian Pac J Cancer Prev 2011;12(5)1107-1115.
Sankaranarayanan R, Nene BM, et al. HPV screening for cervical cancer in rural India. N Engl J Med 2009 Apr;360(14):1385-1394.
ICO Information Centre on HPV and cancer (Summary Report 2014-08-22). Human papillomavirus and related diseases in India. Spain: HPV Information Centre; 2014.
Baka S, Tsirmpa I, et al. Inflammation on the cervical papanicolaou smear: evidence for infection in asymptomatic women? Infect Dis Obstet Gynecol 2013 Sep;2013:184302.
Mhaske M, Jawadekar SJ, et al. Study of association of some risk factors & cervical dysplasia/cancer among rural women. Natl J Community Med 2011 Jul-Sep;2(2):209-212.
Dutta S, Begum R, et al. Prevalence of human papillomavirus in women without cervical cancer: a population-based study in Eastern India. Int J Gynaecol Pathol 2012 Mar;31(2):178-183.
Current Use of Family Planning Methods (currently married women age 15-49 years): Female sterilization (%) – Tamil Nadu Key Indicators – State Fact Sheet Tamil Nadu. NFHS-4 Reports – International Institute for Population Sciences– Government of India: 2015-2016. p. 2.
Centers for Disease Control and Prevention. Factors that contribute to health disparities in cancer. Socioeconomic Status (SES). Atlanta (GA): CDC; 2014. [cited 2014 Jul 21]. Available from: www.cdc.gov/cancer/healthdisparities/basic_info/challenges.htm.
Gakidou E, Nordhagen S, et al. Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PLoS Med 2008 Jun;5(6):e132.
Wang B, He M, et al. Cervical cancer screening among adult women in China, 2010. Oncologist 2015 Jun;20(6):627-634.
Brock KE, Berry G, et al. Sexual, reproductive and contraceptive risk factors for carcinoma-in-situ of the uterine cervix in Sydney. Med J Aust. 1989 Feb 6;150(3):125-130.
Lawson JG. Cancer of the uterine cervix: an enquiry into predisposing factors, with special reference to earlier diagnosis. J Obstet Gynaecol Br Emp. 1957 Aug;64(4):488-477.
Miller C, Elkas JC. Cervical and vaginal cancer. Chapter 36. In: Berek JS, editor. Berek & Novak's Gynecology. Philadelphia (PA): Lippincott Williams & Wilkins; 2014
Vinay Kumar R, Bhasker S. Potential opportunities to reduce cervical cancer by addressing risk factors other than HPV. J Gynecol Oncol 2013 Oct;24(4):295-297.
Crissman JD, Azoury RS, et al. Endometrial carcinoma in women 40 years of age or younger. Obstet Gynaecol 1981 Jun;57(6):699-704.