Cervical Cancer- Care Delayed-Care Denied and Death Invited
Authors: MS Navya 
Published: December 2021

With about 78 billion global population, in 2020, 19 million new cancers and nearly 1 million deaths due to all types estimated to occur. Cervical cancer does not figure in top 5 most common cancers in both sexes globally, but with 6.5% incidence it forms the fourth top among women worldwide. The cancer registry data across the country in India with simple average of the most recent local rates applied to 2020 population estimates a figure of 1324413 cases and 851678 in 2020 and cumulative prevalence around 2.7 million cases in last 5 years of all categories of cancers in India. Cervical cancers in India account for 10% of all cancers in both sexes and about 18% of cancers among women in India as per the international agency for Cancer Research. Nearly one-third of the global cervical cancer deaths occur in India. It is a preventable condition as it has a long precancerous stage amenable for screening and treating. Cervical cancer Cervix uteri is no 3 with about 123 907 cases (9.45) next only to Breast and Oral cancers with a 2.01 cumulative risk. Cervical cancer death risk as 60000 women die annually. While the incidence and mortality rates of cervical cancer in the world are 13.1/ and 6.9/ per lakh population, in India, it is estimated to be 14.7/and 9.2/ per lakh population. Resulting in about 96,922 new cervical cancer cases and 60,078 deaths ranking second among women cancers. The incidence varies within Indian population basically due to ggeographical and socio-economic disparities in screening practices and care seeking practices across the districts of India. Epidemiologically the symptoms are mild and mimic a venereal disease of low infectiousness and therefore delay in seeking care and reporting at a time when the prognosis is poor. The 5-year survival rate is around 76.0% for those aged ≤50 years with much poorer survival among cases with involvement lymph nodes. We present one such case of a 45 year’s old rural women reporting on 4th May 2021 with symptoms vaginal bleeding, back pain, urine leakage & pelvic pain since 2 months to a gynecologic oncology service at a cancer hospital & research center, Bangalore. She had the history of taking treatment for another 2 months earlier from a traditional healer with no progress. She had consulted a family doctor first who referred her to the Cancer hospital. After an evaluation for abnormal vagina bleeding, cervical biopsies that demonstrated invasive adenocarcinoma of the cervix (Stage IV B CA Cervix) the diagnosis was confirmed. Since it was in an advanced stage, a palliative management including radiation therapy for control of bleeding & pain, and systemic chemotherapy for disseminated disease was opted. After 22 days of treatment she got discharged along with medications prescribed Inj. Amikacin 100mg IV OD, Inj. Pantoprazole 40mg IV OD, DNS which was given by the local doctor. But there was no progress and finally she died on 17th June 2021 after 23 days of discharge. This case emphasizes the need for early care seeking behavior, regular screening for all women over 35-45 years and HPV vaccination for adolescent girls in India.