Cervical Cancer Screening

Author: Dr. Amal Hassan Hassan Ismail, Specialist – Obstetrics & Gynecology, Thumbay Hospital – Ajman

January is the month for cervical cancer awareness.
Cancer of the uterine cervix is the third most common gynecologic cancer. Approximately 84,000 new cases are diagnosed and about 28,000 deaths occur each year from gynecologic cancer among women in the United States. Cervical cancer has lower incidence and mortality rates than uterine corpus and ovarian cancer, as well as many other cancer sites. These rankings are similar to global estimates for other developed countries
Unfortunately, in countries that do not have access to cervical cancer screening and prevention programs, cervical cancer remains the second most common type of cancer (17.8 per 100,000 women) and cause of cancer deaths (9.8 per 100,000) among all types of cancer in women.

Cervical cancer comes in in 2 forms: Squamous cell carcinoma and adenocarcinoma of the cervix.

Prior to becoming a full blown cancer, it is preceded by precancerous changes in the cells of the cervix. (Carcinoma in situ CIN), which comes in 3 stages CIN I, II and III.

It takes a relatively long time for cancer to develop from the precancerous stages, and this is why screening at this stage and treating it will prevent cervical cancer.

Infection with high risk Human Papilloma Virus (HPV) and persistence of this infection are most important determinant of progression to cervical cancer.

Most women will clear HPV infection within 8-24 months , but some will not, especially those who are immunosuppressed.

Oral contraceptive Pills use and cigarette smoking increase the risk of squamous cell carcinoma of the cervix.

Screening for cervical cancer aims at detecting early pre-cancerous changes  allowing timely treatment , itis done through either :

1-cervical smear where cells from the cervix are examined under the microscope for any abnormalities-these cells are obtained during pelvic examination usind a brush

2-HPV virus co testing-where high risk HPV strains are checked during smear

Recommendation of cervical screening:

Women between 25-49 years: every 3 years

Women between 50-65 every 5 years

For immune-compromised women due to disease or medication, screening is done every year

Co testing with HPV:

Done for women above 30 years every 5 years provided the initial result of smear and HPV are negative.

Women who had subtotal hysterectomy , who still have their cervix should continue cervical screening.

In case of abnormal results of any of the tests, the lady is referred to colposcopy where the cervix is examined under magnification and any lesion is biopsied or excised and tested.

If precancerous cells are detected  they can be removed easily and closer follow up is done.

In Summary:

Cervical cancer is an almost 100% preventable cancer, yet it kills 260000 women every year, 85% of those occur in the developing world. The incidence of cervical cancer has dropped in the USA and Europe by more than 70% after adopting routine cervical screening programmes.

More than half of the women diagnosed with cervical cancer fail to adhere to the cervical screening programme.

Cervical screening is the single most effective way to prevent cervical cancer.

Cervical screening saves lives!