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).

HPV vac­ci­na­tion

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.

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