Prevent cervical cancer
CERVICAL cancer starts with abnormal cells on the cervix that can turn into cancer. This change normally takes about 10 to 15 years.
The Pap test can find these abnormal cells before they turn into cancer. These cells can be removed to prevent cervical cancer. Cervical cancer does not have any early symptoms. That is why regular screening is important.
Cervical cancer can also appear in younger women. That is why all women aged 21 and above are urged to get screened and follow up with treatment.
It is evident that early diagnosis is crucial. There are several screening tools or tests but accuracy and reliability varies. Among the screening tests potentially appropriate for primary care settings include cervical cytology (the Pap test), conventional and liquid-based (LBC), and tests for HPV infection (HPV-DNA test).
What causes cervical cancer and can it be prevented? Cervical cancer is etiologically linked with the human papillomavirus (or HPV). There are many types. Only a few of the HPV types can cause cervical cancer. These are called high-risk HPV types, which can also cause cancer of the vagina and vulva. However, most high-risk HPV infections go away on their own without treatment.
Who is at risk?
The most important risk factor is not getting regular Pap tests and treatment when needed. Also, having persistent HPV infection increases the risk of cervical cancer. Women smokers are more likely to get cervical precancer and cancer (Winkelstein W 1990).
Most sexually active men and women are at risk. The risk of getting HPV goes up with the number of sex partners. Even with one partner for life, a woman still has some chance (20%) of having HPV infection, if her partner has ever been with someone else.
Most men and women who have HPV never know they are infected as the virus causes no symptoms and goes away on its own. A weak immune system makes your body less able to fight HPV.
What is new in cervical cancer screening and prevention?
Some doctors now use a new liquid-based Pap (liquid-based cytology or LBC) instead of the conventional Pap test. Liquid-based cytology has been reported to give better samples and pick-up rates.
Another new test is the HPV-DNA test. This test uses a molecular technique for the detection of HPV. Cells are collected from the cervix for the HPV test at the same time they are collected for the Pap test.
If you don’t have HPV and your cervical cells are normal, you are at a very low risk for getting cervical cancer in the next few years.
If both tests are normal, you only need this combined test every three to five years. The HPV DNA test should not be used on women younger than 30, unless they have ASC-US (Atypical Squamous Cells of Undetermined Significance).
There are currently two commercially available prophylactic vaccines against HPV. Both have demonstrated excellent immunogenicity against the targeted HPV strains.
However, vaccination protects against only two oncogenic strains, women remain vulnerable to other (non-vaccine) HPV strains, and therefore remain at risk for cervical dysplasia and cancer.
Therefore, vaccinated women should continue to undergo Pap smears at the interval appropriate for their age and health status – the vaccine does not abrogate the need for Pap smears (ACOG Practice Bulletin 109, 2009). For it to be effective, vaccines should be given before commencement of sexual activity. In Malaysia, a vaccination programme was implemented in 2010 targeting 13-year-old schoolgirls.
This article is presented by Pantai Premier Pathology.
The Pap test can find abnormal cells before they turn into cancer.
Prof Dr Sharifah shares some facts about cervical cancer.