Understanding Cervical Cancer Screening for Early Detection

Incidence of Cervical Cancer. Why should we prevent it?

Cervical cancer is the fourth most common cancer among women worldwide, with approximately 604,000 new cases and 342,000 estimated deaths in 2020, according to the World Health Organization (WHO). 

Most of these cases and deaths occur in low- and middle-income countries due to inequalities in access to HPV vaccination, screening, and treatment. However, efforts are underway to eliminate cervical cancer by 2030.

How Does Cervical Cancer Develop?

Cervical cancer typically develops gradually, originating in the cells of the cervix that undergo changes known as dysplasia, turning into abnormal cells. If these abnormal cells are not eliminated or removed, they can become cancerous and spread to deeper parts of the cervix and surrounding areas.

Cervical cancers are classified based on the type of cell they originate from. The two main types are squamous cell carcinoma, accounting for up to 90% of cases, and adenocarcinoma, originating in the glandular cells of the endocervix, which is the part of the connection between uterus and vagina. Sometimes, cancer may have characteristics of both types, known as mixed carcinoma.

Cervical Cancer Prevention

Reducing the risk of cervical cancer involves understanding and managing various key factors:

  • HPV Infection: The primary cause of cervical cancer is persistent infection with certain high-risk strains of the human papillomavirus (HPV). While most HPV infections are naturally cleared by the immune system, long-term infections with high-risk strains can lead to changes in cervical cells over time, which can develop into cervical cancer if left untreated.
  • Exposure to Diethylstilbestrol (DES): a medication once used to prevent miscarriages and premature births, is an independent risk factor for clear cell adenocarcinoma, the previously mentioned rare type of cervical cancer. Women exposed to DES during pregnancy are at an increased risk of developing cervical cell abnormalities and clear cell adenocarcinoma in the vagina and cervix.

Additional Risk Factors:

  • Weakened immune system, such as that resulting from conditions like HIV.
  • Smoking or exposure to tobacco smoke can heighten the risk of developing cervical cancer.
  • Reproductive factors like the use of oral contraceptives, multiple pregnancies, and childbirth.
  • Obesity, which may impede the early detection of cervical cancer and increase the likelihood of its development.

While this can all sound a bit overwhelming, taking proper measures to protect yourself can help give you peace of mind. It’s important to recognize these risk factors and undergo regular medical screenings to detect and prevent cervical cancer at its earliest stages.

Cervical Cancer Diagnosis. Is Early Detection Possible? 

Cervical cancer often does not present any symptoms in its early stages, making detection challenging, but not impossible. Symptoms may include:

  • Abnormal vaginal bleeding after intercourse
  • Pelvic pain and vaginal discharge with a strong odor or blood in early stages 
  • Abdominal pain, leg swelling, and back pain in advanced stages when the cancer has spread. 

It is crucial not to ignore symptoms to avoid delays in receiving treatment and increase its effectiveness.

Cervical Cancer Screening

Screening tests are procedures aimed at identifying precancerous changes in the cervix cells to prevent cancer development through appropriate treatments. Occasionally, cervical cancer may be detected incidentally during these assessments. Generally, treating cervical cancer at an early stage is more likely to result in a better outcome. When symptoms manifest, the disease may have already spread, complicating its treatment.

When should I get screening tests?

You might be wondering, “How can I protect myself from cervical cancer?” or “What are useful steps for early detection?”.

According with the WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention:

From 30 years old

Women should be screened for cervical cancer every 5-10 years.

Women living with HIV

This group should be screened every 3 years starting at the age of 25.

This strategy encourages a minimum of two lifetime screening tests with a high-performance HPV test by ages 35 and 45 years.

The main tests for cervical cancer screening are:

Pap smear test

Involves collecting cervical cells to identify changes associated with HPV, which could lead to cervical cancer.

  • Normal results: No abnormal cervical cells are observed. It is also known as a negative result for intraepithelial lesions or malignant neoplasia.
  • Unsatisfactory results: The sample is not suitable for analysis, so repeating the test in 2 to 4 months is recommended.
  • Abnormal results: Changes in cervical cells are identified, requiring surveillance, additional tests, or treatments.

Human Papillomavirus (HPV) screening test

This test is similar to the pap smear, except that it looks for infections by high-risk HPV types, known to cause cervical cancer.

  • Negative result: Indicates the absence of high-risk HPV. It is recommended to repeat the test in 5 years. In case of previous abnormal results, it may be necessary to perform the test earlier.
  • Positive result: High-risk HPV presence is detected. The medical team will suggest follow-up tests and additional procedures, depending on the specific result.

Combined Pap and HPV test

This assessment detects high-risk HPV types and cellular changes in the cervix.

After obtaining abnormal results in the Pap or HPV test, it is essential to follow medical recommendations, which may include repeating the test, undergoing a colposcopy, or a biopsy. Depending on the biopsy results, immediate treatment may be necessary to prevent serious complications. It is important to adhere to the doctor’s instructions since, in most cases, abnormal results do not indicate cancer, but receiving medical attention for a comprehensive evaluation and appropriate treatment, if necessary, is crucial.

Available Treatments for Cervical Cancer

The treatment of severe abnormalities in cervical cells at risk of becoming cancerous aims to eliminate or destroy these abnormal cells. Common treatments include conization, a procedure that involves removing a cone-shaped portion of tissue from the cervix. This intervention can be performed using loop electrosurgical excision (LEEP) or surgical conization.

Additionally, other treatment options such as laser therapy and cryotherapy exist, involving the removal or destruction of abnormal tissue through laser or freezing, respectively. In more severe cases, a total hysterectomy may be necessary, involving the removal of the uterus and cervix.

It is important to note that during pregnancy, these procedures may carry additional risks, such as an increased risk of premature birth or spontaneous abortion. Therefore, if you are pregnant or planning to become pregnant, it’s a good idea to discuss with a healthcare professional about your treatment options and the appropriate timing to undergo them.

How will WHO achieve the prevention of cervix cancer?

The World Health Organization designed a strategy for Cervical Cancer Elimination by 2030. The steps to reach this goal are:

  • Vaccinate 90% of girls against HPV before the age of 15.
  • Screen 70% of women aged 35 to 45 using highly accurate methods.
  • Ensure that 90% of women diagnosed with cervical disease (precancer or cancer) receive appropriate treatment and care.

These efforts could potentially prevent over 62 million deaths related to cervical cancer by the year 2120.

HPV self-sampling

The World Health Organization (WHO) has proposed incorporating HPV self-sampling as an additional option in cervical cancer screening services for women aged 30 to 60. This measure could significantly contribute to achieving the global goal of 70% availability of screening tests by 2030. Self-sampling allows women to take their own samples, potentially providing them with less discomfort compared to undergoing tests performed by medical personnel in a medical setting.

Active prevention and early symptom management are important to mitigate the impact of cervical cancer on women’s lives. Early detection through regular screenings, HPV vaccination, maintaining a healthy lifestyle, and avoiding known risk factors are fundamental pillars in the fight against this disease.

Recognizing signs and symptoms, such as abnormal bleeding, pelvic pain, or changes in vaginal discharge, and seeking timely medical attention to develop a personalized prevention plan based on medical history and individual risk factors can make a difference in the prognosis and quality of life of affected individuals.

Prevention not only saves lives but can also offer the opportunity for effective treatment and successful recovery, allowing patients to move forward with a fulfilling and healthy life.