Mea is a final year medical student with a diploma in psychology and a certificate in Gene Technology.
The Burden of Cervical Cancer
While cervical cancer is rare in girls under 15, the risk increases between the late teens and mid-30s, with the greatest risk in women over the age of 40.
According to WHO, cervical cancer is the fourth most common cancer in women. Approximately 90% of the deaths from cervical cancer in 2015 occurred in low- and middle-income countries. This situation could be easily improved with medical education and proper screening.
There is an initial, precancerous stage—cervical intraepithelial neoplasia (CIN)—that can be detected with a Pap smear, meaning it is highly preventable. Pap smears detect the early signs of cervical cancer—hopefully, before it becomes cancer. In the UK, screening has prevented up to 70% of cervical cancer deaths since 1988.
Cervical Cancer Risk Factors
Identifying the risk factors is the first step towards prevention.
- Human papillomavirus (HPV) infection
- Weak immune system
- Diet that is low in fruits and vegetables
- Low socioeconomic status
- Family history of cervical cancer
- Long-term usage of oral contraceptive pills
The human papillomavirus or HPV is very common and spreads through sexual intercourse. Therefore, having an increased number of sexual partners and unprotected sexual intercourse are risk factors for infection. It is one agent responsible for the changes that occur in the female reproductive tract during cervical carcinoma. There are many subtypes of HPV; some are cancer-inducing, while others can cause less harmful diseases such as genital warts. HPV-16 and 18 commonly cause cervical cancer.
Symptoms of Cervical Cancer
- Bleeding between periods
- Bleeding after intercourse
- Bleeding after menopause
- Abnormal or unpleasant vaginal discharge
- Pain during sex
- Continuous pelvic or back pain that cannot be explained.
In advanced cases:
- Increased frequency of urination
- Incontinence (loss of bowel and bladder control)
- Swelling of legs
Seek help from your gynaecologist if any of the above symptoms are present.
What Is a Pap Smear, and Why Should You Get One?
A Pap smear is the gold standard for screening for cervical cancer while it's still in the pre-malignant state. In other words, it can detect abnormalities in the cervix before they can lead to cancer. This is why it's so important to get screened regularly. Early detection is the best way to prevent cervical cancer.
As you might already know, the female reproductive system consists of the vagina, cervix, uterus, two fallopian tubes and two ovaries.
The transformation zone of the cervix is the junction between the inner cervix and the outer cervix. It increases in size depending on age and hormones. This area is particularly vulnerable to HPV infection, which may cause mutations in the cervical cells and lead to cervical intraepithelial neoplasia (CIN), a benign condition. Abnormal cells can be seen when a sample from the transformation zone is examined under a microscope. If left undetected, CIN will ultimately become cervical cancer.
How Are Pap Smears Performed?
- The woman is positioned on her back with her legs spread and feet resting on supports (stirrups).
- The doctor will slowly insert a speculum into the vagina to keep it open for easy access.
- A small cytobrush, cytobroom, or a spatula will be inserted. A small cell sample will be scraped off and placed onto a slide or in a liquid medium.
- The sample will be sent to the lab for analysis.
Frequently Asked Questions About Pap Smears
Should you get a Pap smear test done?
The American Cancer Society recommends all women between the ages of 21 and 65 undergo cervical cancer screening every three years. If a Pap smear is combined with a HPV test, screening should be done every five years for women over 30.
What precautions should I take prior to the test?
Screenings cannot be done during menstruation. If you have your period on the day before the scheduled Pap smear, it should be postponed.
Avoid douching, applying creams in the vagina, and sexual intercourse on the day prior to the appointment to avoid confounding the results.
What Happens After the Pap Smear?
After 1- 2 weeks, you will be informed about the result of the test. It is analysed by a method called the Bethesda system, which assess the degree of cellular changes in the transformation zone. Your doctor will recommend the next step you should follow based on the severity of the result. You may be asked to undergo a colposcopy test, in which the cervix and vagina are viewed using an instrument with a light source and a microscope. A tissue sample (biopsy) might also be taken for further evaluation.
Are there any adverse effects following the procedure?
There have not been any recorded adverse effects following a Pap smear. You might feel mild discomfort from the scraping and experience light vaginal spotting (light bleeding) immediately after the procedure. These symptoms will only be temporary, but if discomfort and bleeding persists after the day of the test, you should tell your doctor right away.
There Are Vaccines to Fight HPV Infection
Girls between the ages of 12-26 are recommended to be vaccinated in order to prevent HPV infection. Gardasil and Cervarix are the two currently available vaccines. They provide immunity from HPV types 16 and 18, which are responsible for most cases of cervical cancer. Three doses are needed over a six-month period.
Pap smears should still be done even after receiving the vaccine. This is because you can still get infected by a subtype of HPV that is not covered by the vaccine. It is also important to remember that not everyone reacts to the vaccine in the same way.
It is important to educate women about this condition and encourage them to get screened. The combination of an HPV vaccine and regular Pap screening is highy efficient in preventing cervical cancer. Women in developing countries are often reluctant to get medical advice and proper testing due to certain cultural factors. They must be educated in a sensitive manner about the importance of prevention to ensure better quality of life.
- Campbell, S and Monga, A. (2000). Gynaecology by Ten Teachers (17th ed.). / edited by Stuart Campbell, Ash Monga (17th edition). London: Hodder Arnold H&S.
- Overview: Cervical Cancer. National Health Service.
- American Cancer Society
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: What are some other causes of cervical cancer?
Answer: 1) Having given birth to at least one child. Researchers have found that there is an increase of 15% in the risk when compared to those without any children. The risk is higher if you've had more than three children.
But it does not mean that you have to stay childless! A lot of factors work in synergy to cause this cancer. So, you can't attribute it to a single entity!
2) Young age of pregnancy - especially if you were 17 or younger during your first childbirth.
3) Immunosuppression. HIV infection; long term corticosteroid use.
4) History of lower genital tract cancers such as vulval and vaginal cancer.
5) Risk factors for HPV infection.
Multiple sexual partners, early age of first intercourse, unprotected sex, having intercourse with a someone who has multiple sexual partners.
6) History of chlamydial infection.