Latest on cervical cancer: Testing, inhibitions, and a new gene pathway

Chitra (name changed) knew something was wrong with her. She was suffering from abnormal vaginal bleeding, and there was immense pain.

Yet, she wouldn't get herself tested. The idea of undergoing a Pap smear test — the primary screening method for cervical cancer — was unpalatable. By the time the 43-year-old was diagnosed with cervical cancer, she had already progressed to stage three of the deadly disease.

Chitra is not alone. Numerous women in India avoid the Pap smear because they find it embarrassing.

What's a Pap smear?

A Papanicolaou test (abbreviated as Pap test, or Pap smear), essentially involves collecting cells from the cervix, which is the lower, narrow end of the uterus, at the top of the vagina. These cells are then tested for cancerous growth.

If detected early, cervical cancer is treatable. However, in India, cervical cancer kills one woman every eight minutes. One of the major reasons for that is the Indian women’s aversion to the Pap smear.

Chitra is undergoing treatment now. “I had a master health checkup three years ago, but I was hesitant to take the Pap test. Now I feel terrible about it. We should shed our inhibitions to save ourselves from preventable diseases. I’m now sharing my experience at awareness camps so that other women do not make the same mistake,” she told The Federal.

The PI3K gene pathway

Even as the healthcare sector is addressing the patient inhibition factor, researchers appear to have hit a potentially big medical breakthrough.

The Genetics Department of Madras University recently conducted a study on cervical cancer patients in South India. In the study, published in the Cancer Genetics journal, the researchers found that in 54 per cent of the cervical cancer patients they studied, mutations occurred in a particular gene pathway named PI3K.

They believe that any new drug designed to target the mutation of PI3K cell-signalling pathway can save scores of lives.

‘’The high incidence of PI3K pathway gene mutations observed in this study could be exploited for the therapeutic management of cervical cancers,” Prof  AK Munirajan, the lead author of the study, wrote in the research paper.

Speaking to The Federal, Prof Munirajan said over 90 tumours were collected from affected women, and the samples were tested in genome labs in Japan and Saudi Arabia.

“Cervical cancer is the second most common form of cancer in India. PI3K signalling is one of the most commonly activated pathways in cancer and comprises key molecules commonly targeted in cancer therapy. This study analysed six PI3K pathway gene mutations. When the mutations are arrested, proliferation would end and thus new cells growing in the affected body would not replicate viral infection,” he explained.

Managing side effects

But then, is any effort being made to design a pathway-specific drug to treat cervical cancer?

Vaccine and immunotherapy research expert, Kar Muthumani, Chief Scientific Officer at GeneOne Life Science in the USA, said such efforts are indeed underway. Several drugs targeting PI3K have shown promise in treating cancerous tumours. However, on the flipside, they often cause severe side effects on healthy cells.

Better understanding and management of these side effects can improve the safety profile while maintaining the effectiveness of PI3K inhibitors in cancer treatment, he added.

Need for counselling

Gynecologic-oncologist Dr Jayashree Natarajan of the Adyar Cancer Institute in Chennai (WIA) believes women need counselling to help them get over their inhibitions.

“The Pap smear test and a visual inspection with acetic acid test are used to detect cancer. The healthcare expert has to examine the cervix during the test. However, inhibitions and hesitation among women to undergo these tests make it difficult to identify cancer in the early stages,” she told The Federal.

Dr Jayashree says many women avoid undergoing the test for the second time even if they somehow agree to it for the first time.

“Many who attend screening for the first time fail to return for further screening. In a few cases, women who fail to return for regular screening end up with an advanced stage of cervical cancer. Women need counselling to undergo the screening regularly,” she added.

Preventable by vaccine

Not only by detection, cervical cancer, which results from an infection, is also preventable by vaccine. However, due to lack of awareness, very few women opt for it. The issue recently made headlines when Union Finance Minister Nirmala Sitharaman, in the Interim Budget speech, said the government would encourage vaccination against cervical cancer. After that, cervical cancer, its prevalence, detection, and the available drugs were widely discussed on several forums.

Most cervical cancers are caused by the human papillomavirus (HPV), a common infection that’s passed through sexual contact. It is the fourth most common cancer among women globally, with an estimated 3,42,000 deaths caused by it in 2020. However, in India, it is the second most common form of cancer.

Staying safe

But even superior drugs and more directed treatment can work only if women get screened on time. As Prof Munirajan also pointed out, many of the subjects who opted to provide samples for their research, confessed that they had inhibitions to undergo the Pap smear test.

Until the system becomes more fool-proof, the only way for women to keep themselves safe from cervical cancer is to get themselves screened regularly and take the vaccine, but of course, with medical advice.