Cervical Cancer

Cervical Cancer is a major cause of mortality for women in India. It is caused by changes in cervix with Human Papilloma Virus infection, over a period of time. In 9 out of 10 females it can be prevented with regular cervical screening, follow up and treatment of abnormal test and vaccination against Human Papilloma Virus.

Let’s shed some light on the common questions that arise with the issue.

What is a cervical screening test and how is it done?

The cervix is the lowest part of the womb (uterus) which is screened by regular Pap smears or liquid based cytology whereby cells from cervix are picked and examined under microscope.
For this test you will be asked to lie on your back on the examination couch. A Gynaecologist will put an instrument called a speculum into your vagina. This gently opens the vagina and allows the cervix to be seen (at the top of the vagina). She then uses a thin plastic stick with a small brush at the end to gently scrape some cells from the surface of the cervix.

Why are cervical screening tests advised?

Cervical Cancer is the second most common cancer in females in India. Cervical cancer is a disease that can often be prevented. Early changes can be detected in the cervix, which indicate that cancer may develop. A cervical screening test samples some cells from your cervix. These are examined under the microscope in a laboratory.

The cervical screening test is not a cancer test. The test is used to detect early abnormalities of the cervix which, if untreated, could lead to cervical cancer in the future.

What do the results of the cervical screening test mean?

The results are reported as one of the following:

• Normal.
• Inadequate.
• Abnormal
• The test also looks for Human papillomavirus (HPV). This is a type of wart virus that can be passed on by having sex. It is involved in the development of most cases of cervical cancer. However 9 in 10 infections with HPV will clear completely from the body within two years. This means that most women who are infected with HPV do not develop cancer.

Normal result

About 9 in 10 routine cervical screening tests are normal .A normal result means you have a very low chance of developing cervical cancer. It is not a guarantee that cervical cancer will not occur.

 Inadequate test

About 2 tests in every 100 are inadequate and need to be repeated. Inadequate simply means no result can be given, as not enough cervical cells were present for examination under the microscope. In the unusual event that a woman has three inadequate tests in a row, she should be referred on for colposcopy examination.

Abnormal result

• About 1 in 20 tests is reported as abnormal. There is a range of changes that may occur. In nearly all cases, these changes do not mean cancer.
• Nearly all abnormal tests show no more than small changes in the cervical cells.

Depending on the degree of abnormality, women with abnormal results may have Colposcopy and biopsy if needed.

What is colposcopy?

Colposcopy is a more detailed examination of the cervix. In this test a speculum is gently put into the vagina so the cervix can be seen.  The gynaecologist uses a magnifier (colposcope) to look at the cervix in more detail. . A liquid is used to paint the cervix, which shows up the abnormal cells. It takes longer than a normal cervical screening test (about 15 minutes). It is usually done in a specialist colposcopy clinic at hospital. During colposcopy it is usual to take a small piece of tissue from the cervix (biopsy) to make a more detailed assessment of the cells.

Can abnormal cells be treated?

Yes. A minor abnormal change often goes away by itself. This is why a repeat test after 3-12 months may be all that is needed. If the cells remain abnormal, or the changes are more marked, then treatment is offered. This will stop cancer from developing in the future. Treatment, if needed, is simple and almost 100% effective.

I have never had sex. Do I need a cervical screening test?

The test is recommended for all women - even if you have never had sex. However, the risk of getting cervical cancer is very low if you have never had sex. This is because the main cause of cervical cancer is a past infection with HPV - the type of common wart virus that is normally passed on by having sex. There are other, less common types of cervical cancer, not caused by HPV, so women who have never had sex are still at risk. 

I have had a hysterectomy - do I need to have a cervical screening test?

This depends on the type of hysterectomy, and why it was done. Your doctor will advise you on this. In general, if you have a total hysterectomy (removal of the uterus and cervix) for a reason not due to cancer, then you no longer need cervical screening tests. Some types of hysterectomy leave the cervix (called subtotal hysterectomy), and some are done to remove a cancer which need to be followed by Pap smear.

Then how frequently should I have Pap smear or Pap smear with HPV -DNA testing (co testing) done?

If you are between 21-29 years you need to get Pap smear every three years.

Between ages 30 to 65 years you need Pap smear every 3 years or Pap smear + HPV DNA test (co test) every 5 years.

Can I have my cervical screening test or colposcopy when I am having my period?

It is best to have your cervical screening test when you are not having your period (menstruating). Ideally, the test is best performed mid-cycle.

Similarly, it is probably best to delay your colposcopy examination if your period starts.

Can I have cervical screening when I am pregnant?

If you are due your routine cervical screening test and you are pregnant, this should be put back until after your baby is born. Usually, it is advisable to wait until you are at least 12 weeks postnatal.

Does being immunosuppressed increase my risk of cervical cancer?

Yes - women who are immunosuppressed are at an increased risk of having changes that may become cancerous.eg Women with HIV - the virus that causes AIDS. These women need yearly cervical screening.

• Women who has had a kidney transplant.

HPV Vaccine -A cervical cancer preventing vaccine

The Advisory Committee on Immunization Practices currently recommends routine vaccination of females aged 11–12 years with three doses of the HPV vaccine. At 0 month (first visit), 2 months and 6 months. Vaccination can be given to females as young as 9 years as well as in those aged 13–26 years who have not previously completed vaccination. Vaccines are not 100% protective against cervical cancer and not a replacement for periodic screening. Hence, screening programs should continue as per recommendations.