Description
Cervical cancer screening is a vital preventive measure that significantly reduces mortality through early detection of pre-cancerous lesions. Physicians should be familiar with current guidelines recommending HPV testing alone or in combination with Pap smear (co-testing) for women aged 30–65, and Pap smear alone starting from age 21. High-risk human papillomavirus (HPV) types are the primary cause of cervical cancer, making HPV testing a crucial tool. Timely screening, follow-up of abnormal results, and patient counseling on HPV vaccination are essential components of comprehensive care. Physicians must also be aware of screening modifications for immunocompromised individuals or those with prior cervical pathology.
Summary Listen
- Cervical cancer is a major health problem, particularly in developing countries, where it's a leading cause of death for women aged 40-60. The social imbalance caused by the loss of a woman at this age, impacting children and elderly parents, is significant. In India, a woman dies of cervical cancer every 9 minutes, with many cases diagnosed at advanced stages.
- Human Papilloma Virus (HPV) is a necessary cause of cervical cancer. There are 150 types of HPV, with 14 being oncogenic. HPV types 16 and 18 are responsible for about 80% of cervical cancers, highlighting the importance of targeting these types in vaccines.
- HPV infection cycle begins when the virus enters the basal layer of the cervix through wear and tear. While 90% of HPV infections clear, persistent infection, coupled with co-factors like early marriage, multiple partners, poor hygiene, and smoking, can lead to cancer development over 10-15 years. E6 and E7 are onco-proteins produced from our own DNA after HPV becomes a part of it, that degrade tumor suppression genes, promoting cancer.
- Cervical cancer screening involves primary prevention (education, awareness, HPV vaccination) and secondary prevention (early detection, treatment of pre-cancerous lesions). Screening methods include Pap smear, visual inspection with acetic acid (VIA), and HPV DNA testing.
- Pap smear, invented in 1943, examines cells exfoliated from the cervix surface. Liquid-based cytology is superior to conventional slide methods. All women between the ages of 21 to 65 must be screened.
- Visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) is an alternative method, especially in rural areas with limited resources, where the dysplastic cells stain white.
- HPV DNA testing is a molecular test that prevents more deaths than other tests, with fewer false negatives. HPV DNA testing can detect the transient infection while the RNA testing focuses on you know active infection. Persistent HPV infection for over two years increases the risk of cervical cancer by 300 times.
- HPV self-testing is emerging as a valuable method for women to screen at their convenience, especially during disruptions like COVID-19. It should be offered to non-attenders to increase the coverage of screening.
- Colposcopy is used for a magnified view of the cervix, and is must for each and every patient once diagnosed positive with the screening of cervical cancer. It helps to identify abnormal areas that are not visible to the naked eye.
- WHO recommends HPV DNA detection as a primary screening test from age 30. It calls for 90% of girls vaccinated, 70% of women screened by age 30, and 30% reduction in cancer treatment mortality by 2030 for elimination of cervical cancer. HPV awareness, testing, and vaccination are the keys to prevention.
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About the Speakers
Dr. Anjana Chauhan
Senior Consultant Gynecology Cancer Surgeon, Global Hospitals, Ahmedabad
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