B) Screening of cervical cancer
Three screening tests are important for prevention of cervical cancer. Death due to cervical cancer has decreased dramatically over the 40 years as proper screening has increased the survival rate to more than 90 percent for patients of early stage cervical cancer. Increased screening decreased the incidence of invasive cervical cancer by 50 percent between 1975 and 2014.
The first is liquid-based cytology (LBC) test that involves scraping of the cervix with a small brush to collect mucosal cells. The head of this brush is then removed and preserved in liquid. It is then sent to pathologist for look out for any abnormalities. There is general agreement that high quality cytology is a highly specific screening test, with estimates of the order of 95–99%.
Second is the Pap test (or Pap smear) which looks for precancerous conditions that can transform into cervical cancer if they are not treated as early as possible.
Third is the HPV test that looks for DNA of the virus (human papillomavirus) that can cause these cell changes in the cervix of human. HPV 16 and HPV 18 are most common causes of invasive cervical cancer.
Alternative approach in low income countries:
In developing countries, few technical and financial constraints are the reason for introduction of alternative approach for effective screening. Visual inspection with 3–5% acetic acid (VIA) appears to accomplish the basic standard of a satisfactory screening test. VIA involves non-magnified visualization of uterine cervix soaked with 3–5% acetic acid. Research has revealed that VIA and cervical cytology has similar sensitivity to detect CIN, although VIA has lower specificity.
When to Get Screened
Different screening criteria has been set for women of different age groups.
If You Are 21 to 29 Years Old
Doctor advise Pap tests at the age of 21. If Pap test result is normal, person is advised to repeat the test every 3 years. Younger women are more prone to low-grade squamous intraepithelial lesions (LSIL) which can easily be treated.
If You Are 30 to 65 Years Old
The average age of diagnosis of cervical cancer is 50. Cases most frequently occur between ages 35 to 44 (SEER). Following tests can be advised in certain situations:
- A Pap test only. If test results are normal, repeat every 3 years.
- An HPV test only. This is called primary HPV testing. If test result is normal, repeat every 5 years.
- An HPV test along with the Pap test. This is called co-testing. If both of test results are normal, repeat them after 5 years.
If You Are Older Than 65
If you are 65 years old and your test results are normal, you may be advised not to be screened anymore. Certain conditions when further screening is not required are:
- Normal screening test results for several years.
- Person has his cervix removed as part of a total hysterectomy for benign conditions, like fibroids.
Test results normally come in 3 weeks. If your test shows any abnormality, doctor plan appropriate plan of treatment. Proper follow up of the patient is very important for proper diagnosis and effective treatment of the disease.
Normal test result alleviates person’s chance of developing cervical cancer in the next few years. But it is always advised to visit the doctor for regular checkup. Women who have been vaccinated against HPV should also be screened regularly. Cervical screening is no longer advised yearly as additional screening can cause more harm than benefit. A false positive result can lead to stress and cause long-term risks to the patient.
» Now, let’s discuss cervical cancer prognosis.