The Importance of Cervical Cancer Screening
The most preventable cancer but still the third most commonly reported cancer in women!
With effective screening methods and vaccination against Human Papilloma Virus (the main culprit in causing this cancer) being available, the cancer should have been of very low incidence by now. But how does it still boast of being the second most common cause of cancer-related deaths in women worldwide?
Studies show that lack of women participation in the screening programs is one of the main reasons for this high incidence. The reasons for non-participation in the screening programs include low-level of awareness of the test’s indications and benefits; considering oneself not to be at risk of developing cancer; fear of embarrassment or pain of the procedure and fear of detection of cancer.
Why is this screening necessary even if you seem to be safe from developing cancer?
The most common cause of this cancer is Human Papilloma Virus (HPV) infection. 99% of cervical cancers are attributed to HPV infection. HPV infection is most common in young sexually active women. The risk of acquiring this infection increases with early age of sexual activity; multiple sexual partners and having more number of children. The other risk factors are low-level of immunity, smoking, longer duration usage of contraceptive pills, poverty and family history of cervical cancer.
The early stage of cervical cancer, called the pre-cancerous stage starts as mild changes in the cytology of cervical cells. During this stage, there may not be obvious symptoms like pain, to alarm you of something abnormal. In the progressive stages, common symptoms like abnormal bleeding or increased vaginal discharge show up. These symptoms are usually confused with other gynecological conditions. By the time the symptoms like pelvic pain, leakage of urine or feces from vagina, weight loss, back pain and bone pain occur, the abnormal cells would have spread deeper into the cervix and invaded other organs leading to the advanced condition called invasive cervical cancer.
Screening for this condition is of growing necessity these years to lower the incidence of cervical cancer and to treat the condition in its very early stage when it is completely curable. In the early stages, where only borderline or mild changes in cell cytology are noted, the treatment involves laser therapy or cryo-therapy. If left untreated, the pre-cancerous changes may progress into invasive cervical cancer demanding surgery, radiotherapy or chemotherapy depending on the extent of the disease.
Of course, it usually takes many years (ten years or more) for this transition and that is why effective screening and detection in the early stages can considerably reduce the disease incidence.
What is the screening test?
The most common and effective method of cervical cancer screening is by performing a pap (papanikolaou) test. The test finds out any abnormal cells in the cervix which is the lower part of the uterus. It is very effective in detecting pre-cancerous changes but a single pap test is not sufficient to decide whether the changes are present or not. Reports show that invasive (advanced) cervical cancer is often diagnosed in women who have never undergone or who have not undergone regular pap screening tests or who have not followed-up on abnormal pap test results.
When should women step forward for screening?
The recommended guidelines are to start screening from the age of 21.
From 21-29 years of age, a pap test is advised every 3 yrs.
Between 30-65 years, a 5 yearly HPV testing paired up with pap test is preferred but a 3 yearly pap test alone is also acceptable.
There is no need of testing beyond 65 years of age if prior screening test reports were negative and there exists no risk factors.
Abnormal pap test results need follow-up pap tests after 6 months or 1 year.
Positive cases need colposcopy and biopsy.
Creating awareness about the screening program is the key challenge and women have to step forward to screen themselves, shedding away their shyness, fear and ignorance to uproot and defeat cervical cancer.