Cervical Cancer Screening and Prevention

Cervical Cancer is preventable, if screening and timely intervention is done. Screening for cervical cancer is done not only to detect early lesions in cervical cancer or the pre-cancerous lesions but also to identify the presence of high risk HPV virus and its DNA in the cervical smears. Screening plays a crucial role in identification of at risk patients and thus helps to bring down the incidence of Cervical cancer.

Risk Factors for Cervical Cancer

• HPV infection (Human Papilloma Virus)
• Early sexual activity
• Multiple sexual partners
• Cigarette smoking
• Multiple pregnancies
• Early age at first pregnancy
• Immuno-deficient status
• Low socio-economic status

What does Cervical Cancer mean?

Cervical Cancer involves the development of cancer/ abnormal growth of cells in the cervix. Cervix is the part of uterus which connect it to the vagina. The symptoms of early cervical cancer are abnormal vaginal bleeding i.e. post coital-bleeding, post-menopausal bleed, unusual bleeding between periods, discharge per vagina – could be foul smelling watery, persistent pelvic pain. The symptoms of advanced cervical cancer include lower limb swelling, pain abdomen, painful bowel movements, painful urination and chronic exhaustion.

How does Cervical Cancer Screening help

All cancers develop from into invasive cancer from a dysplastic cell. In case of cervical cancer, the time taken for dysplastic cells to turn into invasive cancer is roughly 3-7 years. This time period allows us to detect dysplastic cells before the cancer has actually developed. Secondly, around 90% of Cervical Cancer is linked to HPV infection in the genital tract which means that 90 out of 100 women develop cervical cancer because they have been infected with HPV virus. Detection of HPV infection early on helps to eliminate this infection thus reduce the subsequent risk of developing cancer.

Thus the screening modalities used not only screen for the presence of abnormal/dysplastic cells but also the presence of HPV infection in the genital tract.

Who should get screened for Cervical Cancer?

Screening for Cervical cancer starts at the age of 21 years and for women between 21-29 years every 3 yearly pap’s smear should be done. Between 30 and 65 years, cervical cancer screening can be done using one of these methods

• HPV testing every 5 years
• HPV/Pap cotest every 5 years
• Pap’s smear every 3 years

After 65 years of age Cervical Cancer Screening is not required, unless the last test was abnormal.

Exception to Cervical Cancer screening

• Post Hysterectomy status
• HIV positive patients – might need more frequent screening
• Those who are pap’s positive or diagnosed case of cervical cancer, screening has no value.

How to get screened for Cervical Cancer?

You need to visit a Surgical Oncologist/ Gyane-oncologist for a pelvic examination and Pap’s smear. The test is done in the OPD procedure room and is a simple painless technique. After a complete pelvic examination, a speculum is introduced through the vagina and the cervix is examined. The smear from cervical canal is taken and the same sample goes for HPV DNA as well.

The reports are usually available within 48 hours.

How to understand the results of Cervical Cancer Screening?

HPV DNA

• Negative – Next test is due after 5 years
• Positive- More tests are needed

Pap’s smear

• Normal – Also called as a negative test
• Unsatisfactory – The test did not yield the satisfactory cells in smear to conclusively tell normal or abnormal
• Abnormal- Suspicious or cancerous cells seen in the smear. This would need further testing and management based on the results.

What to do if the test gives a positive result?

All abnormal, unsatisfactory Pap’s smear and Positive HPV tests should meet their Oncologist to discuss the further lines of follow-up/management. It is important to realize that the importance of these test is to detect early disease and hence any delay in further tests or management should be avoided.

Prevention

Cervarix-TM (HPV4) and Gardasil-TM (HPV-2) are safe, and effective for girls aged 9 through 26 years. IAP ACVIP recommends that all girls who are 11 or 12 years old get the 2 doses of HPV vaccine to protect against cervical cancer. Girls and young women ages 14 years or older should get 3 doses of an HPV vaccine if they have not received all doses yet.

People who have already had sexual contact before getting all 2/3 doses of an HPV vaccine might still benefit if they were not infected before vaccination with the HPV types included in the vaccine they received. The best way to be sure that a person gets the most benefit from HPV vaccination is to complete full series before sexual activity begins.