Cervical Cancer

Cervical cancer is one of the most preventable cancers, thanks to the availability of screening methods that can detect abnormal changes in the cervix before they become cancerous. The cervix is the lower part of the uterus that connects to the vagina, and cervical cancer often develops slowly over time. Regular screening tests allow for early detection and treatment, dramatically reducing the risk of developing cervical cancer..

Cervical cancer is primarily caused by persistent infection with high-risk types of the human papillomavirus (HPV). HPV is a sexually transmitted infection, and while most HPV infections resolve on their own, some types of the virus can lead to precancerous changes in cervical cells that may develop into cervical cancer over time.

Screening for cervical cancer is crucial because:

• Cervical cancer often has no early symptoms: By the time symptoms appear, the cancer may be in advanced stages and harder to treat.
• Screening detects abnormal changes before cancer develops: Through regular screening, doctors can find precancerous lesions (cervical intraepithelial neoplasia) and remove them before they turn into cancer.
• Early detection leads to higher survival rates: When cervical cancer is detected early, the chances of successful treatment and survival are much higher.

Methods of Cervical Cancer Screening

There are two main types of tests used in cervical cancer screening: the Pap smear (or Pap test) and the HPV test. Both tests are essential in detecting changes in cervical cells that may lead to cancer.

1. Pap Smear (Pap Test)

The Pap smear is a procedure that involves collecting cells from the cervix to examine for abnormalities. Here’s how it works:

• A healthcare provider uses a small brush or spatula to gently scrape cells from the surface of the cervix.
• These cells are then examined under a microscope to look for any abnormal changes.
• If abnormal cells (such as dysplasia or precancerous cells) are detected, further testing or treatment may be required.

The Pap test is primarily designed to detect precancerous changes (cervical dysplasia) or early stages of cancer, allowing for early intervention before the disease progresses.

2. HPV Test

The HPV test is used to detect the presence of high-risk HPV types that are most likely to cause cervical cancer. The procedure for collecting cells is similar to a Pap smear, but instead of examining the cells for abnormal changes, the test looks for the DNA or RNA of the HPV virus itself.

The HPV test is often used:

• In combination with a Pap smear (co-testing): For women aged 30 and older, both tests are often done at the same time to increase the accuracy of screening.
• As a primary screening tool: In some cases, an HPV test may be used on its own to assess the risk of cervical cancer.

Cervical cancer screening is recommended for most women, but the age at which screening starts and the frequency depends on a woman’s age and health history. Here’s a general guideline:

Women Aged 21-29

• Screening should begin at age 21 with a Pap smear every three years.
• HPV testing is generally not recommended for this age group unless a Pap smear result is abnormal. This is because HPV infections in younger women are often transient and clear up on their own.

Women Aged 30-65

• For women in this age group, co-testing (Pap smear and HPV test) every five years is recommended. Alternatively, a Pap smear alone every three years is also an option.
• Women who test negative for both the Pap test and HPV test have a very low risk of developing cervical cancer over the next several years.

Women Over 65

• Women aged 65 and older who have had regular screenings with normal results in the past may stop screening. However, those with a history of cervical pre-cancer or abnormal results should continue to be screened.

Special Considerations

• Women who have had a total hysterectomy (removal of the uterus and cervix) and do not have a history of cervical cancer or pre-cancer may no longer need screening.
• Women who have been vaccinated against HPV should still follow the recommended screening guidelines because the vaccine does not protect against all types of HPV that can cause cervical cancer.

Risk Factors for Cervical Cancer

Understanding the risk factors for cervical cancer is essential to determine whether more frequent or early screening is necessary. Common risk factors include:

1. HPV infection: This is the leading cause of cervical cancer. High-risk strains, such as HPV 16 and 18, are responsible for the majority of cases.
2. Multiple sexual partners: Engaging in sexual activity with multiple partners increases the risk of HPV infection, which can lead to cervical cancer.
3. Weakened immune system: Conditions like HIV/AIDS or medications that suppress the immune system can make it harder for the body to fight off HPV infections, leading to an increased risk of cervical cancer.
4. Smoking: Women who smoke are twice as likely to develop cervical cancer compared to non-smokers, possibly due to the carcinogenic chemicals in tobacco that can affect cervical cells.
5. Long-term use of oral contraceptives: Some studies suggest that prolonged use of birth control pills may slightly increase the risk of cervical cancer, though this risk decreases after discontinuation of the pills.
6. Lack of regular screening: Women who do not undergo regular cervical cancer screening are at much higher risk of developing and dying from the disease.

What Happens If Abnormal Results Are Found?

If an abnormal result is found during screening, further testing is necessary to determine the severity of the changes in the cervical cells and whether treatment is needed. Follow-up procedures may include:

• Colposcopy: This procedure allows the doctor to closely examine the cervix using a magnifying device to look for abnormal areas. A biopsy may be taken during the procedure.
• Biopsy: A small sample of tissue is removed from the cervix and examined for precancerous or cancerous cells.
• Treatment of precancerous lesions: If precancerous cells are detected, treatments like cryotherapy (freezing abnormal cells) or loop electrosurgical excision procedure (LEEP) may be recommended to remove the abnormal tissue and prevent the development of cancer.

Cervical cancer is highly preventable with regular screening and vaccination against HPV. The HPV vaccine is recommended for girls and boys starting at ages 11-12, with catch-up vaccinations available for older individuals up to age 26. Vaccination can significantly reduce the risk of cervical cancer by protecting against the most common cancer-causing strains of HPV.

In addition to vaccination and screening, the following measures can help reduce the risk of cervical cancer:

• Safe sexual practices: Using condoms and limiting the number of sexual partners can reduce the risk of HPV infection.
• Avoiding smoking: Quitting smoking lowers the risk of developing cervical cancer.
• Regular gynecological visits: In addition to screening, routine visits to a gynecologist can help detect any potential issues early.

Cervical cancer screening plays a critical role in detecting precancerous changes and preventing cervical cancer. Women should follow the recommended guidelines for their age group and risk factors to ensure early detection and successful treatment. By combining regular screening with HPV vaccination and other preventive measures, the incidence and mortality rates of cervical cancer can be drastically reduced.