how to stay healthy and fit?

cancer cervix is the leading cancer in indian women and the second most common worldwide. the precancerous changes start early, usually in the twenties, once the women is sexually active and if undetected and untreated  may turn into a full blown cancer by the time the woman is in her 50s.

ironically, there are several good things about this cancer.

Ø  it is a preventable cancer.

Ø  a known etiology, a hpv ( human papilloma virus)

Ø  a known mode of spread i.e sexually transmitted

Ø  a very good and inexpensive screening test called pap smear which identifies it several years ahead at a precancerous stage making it amenable to prevention and early treatment with good prognosis.

Ø  an effective vaccine

Ø  unlike other stis (sexually transmitted infections) it is not fully protected by condoms.

we live in an era of sexual liberalisation with far reaching consequences. stis are a rising concern, with long term consequences. hiv is just the tip of iceberg.

the high risk factors are those with

-        multiple sex partners

-        early initiation of sexual activity

-        poor knowledge of contraception

-        hesitation in using barrier method by male partners

-        low socio-economic status with poor access to health care services, including pap tests

-        prostitutes, prison inmates,  drug addicts, those attending sti clinics

-        smoking, low immunity status like hiv, use of birth control pills for > 5 years, being younger than 17 at the time of first delivery, multiparity i.e having 3 or more children.

even the first wife dying of a cervical cancer placed the second wife at high risk.

yet despite the familiarity with the disease, it continues to flourish especially in developing countries. most of those who suffered rarely made to the hospital in time. educated women, even doctors hardly turned up for their pap smear in time. may be it was a feminine trait, being indifferent to their own health.

an effective vaccine lay underutilised because of unawareness and sometimes non affordability.

a  report published by the centers for disease control and prevention (cdc) tells,

•       young people aged 15-24 years develop half of all new sexually transmitted infections (stis),

•       1 in 4 sexually active adolescent females has an sti

no wonder the lower limit of giving hpv vaccine, that acts best when given before the sexual debut has been brought down to 9 years of age; a definite sign of society’s paradigm

“this epidemic is one result of a sexually saturated culture and the myth perpetuated by academe, medicine and pharmaceutical companies that latex, contraception and  vaccines can make all sexual behavior risk free.” 

even among prime-time network television shows, there is only 1 portrayal of protective behavior or comment regarding stis for every 25 instances of sexual behavior shown.

sadly one-quarter of adolescents and young adults in high-risk age groups for stis did not have health care coverage.

only 11 percent of teenagers surveyed reported getting most of their information regarding stis from their parents or other family members.

knowledge and awareness of stis among the public is poor; almost two-thirds of women,18-60 years of age surveyed knew nothing or very little about stis other than aids.

young women and female adolescents are more susceptible to stis compared to their male counterparts because of their biological characteristics. during puberty and young adulthood, specific cells (columnar epithelium) are especially sensitive to invasion by certain sexually transmitted organisms are more exposed.

women and female adolescents may also find it more difficult than men to implement protective behaviors, partly because of the power imbalance between men and women

the only way to curb the rising epidemic was by :

• inculcating responsible behaviour

sounds like a cliché but if you don’t take a detailed sexual history of your partner on your date, you don’t know him well enough to have sex.

and ‘safe sex’ is sex with your faithful spouse!  

• encourage use of contraception ( barrier method )

§  enforcing pap smear in sexually active women ( 21-65 years) at least every 3 year( even in those previously vaccinated with hpv vaccine), or combining it with hpv testing every 5 years ( >30 years of age).

“screen-and-treat” and “screen, diagnose and treat” are both valuable approaches

• promoting cervical cancer vaccine; may be a government initiative making the vaccine cost effective, mandatory or even free to all adolescent girls.
• health education
• tracing contact/ partner & treatment  for stis , wherever possiblecancer cervix is the leading cancer in indian women and the second most common worldwide. the precancerous changes start early, usually in the twenties, once the women is sexually active and if undetected and untreated  may turn into a full blown cancer by the time the woman is in her 50s.

  ironically, there are several good things about this cancer.

  Ø  it is a preventable cancer.

  Ø  a known etiology, a hpv ( human papilloma virus)

  Ø  a known mode of spread i.e sexually transmitted

  Ø  a very good and inexpensive screening test called pap smear which identifies it several years ahead at a precancerous stage making it amenable to prevention and early treatment with good prognosis.

  Ø  an effective vaccine

  Ø  unlike other stis (sexually transmitted infections) it is not fully protected by condoms.

  we live in an era of sexual liberalisation with far reaching consequences. stis are a rising concern, with long term consequences. hiv is just the tip of iceberg.

  the high risk factors are those with

  -        multiple sex partners

  -        early initiation of sexual activity

  -        poor knowledge of contraception

  -        hesitation in using barrier method by male partners

  -        low socio-economic status with poor access to health care services, including pap tests

  -        prostitutes, prison inmates,  drug addicts, those attending sti clinics

  -        smoking, low immunity status like hiv, use of birth control pills for > 5 years, being younger than 17 at the time of first delivery, multiparity i.e having 3 or more children.

  even the first wife dying of a cervical cancer placed the second wife at high risk.

  yet despite the familiarity with the disease, it continues to flourish especially in developing countries. most of those who suffered rarely made to the hospital in time. educated women, even doctors hardly turned up for their pap smear in time. may be it was a feminine trait, being indifferent to their own health.

  an effective vaccine lay underutilised because of unawareness and sometimes non affordability.

  a  report published by the centers for disease control and prevention (cdc) tells,

  •       young people aged 15-24 years develop half of all new sexually transmitted infections (stis),

  •       1 in 4 sexually active adolescent females has an sti

  no wonder the lower limit of giving hpv vaccine, that acts best when given before the sexual debut has been brought down to 9 years of age; a definite sign of society’s paradigm

  “this epidemic is one result of a sexually saturated culture and the myth perpetuated by academe, medicine and pharmaceutical companies that latex, contraception and  vaccines can make all sexual behavior risk free.” 

  even among prime-time network television shows, there is only 1 portrayal of protective behavior or comment regarding stis for every 25 instances of sexual behavior shown.

  sadly one-quarter of adolescents and young adults in high-risk age groups for stis did not have health care coverage.

  only 11 percent of teenagers surveyed reported getting most of their information regarding stis from their parents or other family members.

  knowledge and awareness of stis among the public is poor; almost two-thirds of women,18-60 years of age surveyed knew nothing or very little about stis other than aids.

  young women and female adolescents are more susceptible to stis compared to their male counterparts because of their biological characteristics. during puberty and young adulthood, specific cells (columnar epithelium) are especially sensitive to invasion by certain sexually transmitted organisms are more exposed.

  women and female adolescents may also find it more difficult than men to implement protective behaviors, partly because of the power imbalance between men and women

  the only way to curb the rising epidemic was by :

  • inculcating responsible behaviour

  sounds like a cliché but if you don’t take a detailed sexual history of your partner on your date, you don’t know him well enough to have sex.

  and ‘safe sex’ is sex with your faithful spouse!  

  • encourage use of contraception ( barrier method )

  §  enforcing pap smear in sexually active women ( 21-65 years) at least every 3 year( even in those previously vaccinated with hpv vaccine), or combining it with hpv testing every 5 years ( >30 years of age).

  “screen-and-treat” and “screen, diagnose and treat” are both valuable approaches

   

  • promoting cervical cancer vaccine; may be a government initiative making the vaccine cost effective, mandatory or even free to all adolescent girls.
  • health education
  • tracing contact/ partner & treatment  for stis , wherever possible