What is cervical cancer screening?
The cervix is the opening to the uterus and is located at the top of the vagina.
Cervical cancer doesn't cause any symptoms at first, or only very few, so it is often not detected for a long time.
Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer and thereby helping in early detection.
Screening includes cervical cytology (also called the Pap test or Pap smear) and, for some women, testing for human papillomavirus (HPV).
How does cervical cancer occur?
Cancer occurs when cervical cells become abnormal and, over time, grow out of control. The cancer cells invade deeper into the cervical tissue. In advanced cases, cancer cells can spread to other organs of the body.
Most cases of cervical cancer are caused by infection with HPV (Human Papilloma Virus). HPV is a virus that enters cells and can cause them to change. Some types of HPV have been linked to cervical cancer as well as cancer of the vulva, vagina, penis, anus, mouth, and throat. Types of HPV that may cause cancer are known as “high-risk types.”
HPV is passed from person to person during sexual activity. It is very common, and most people who are sexually active will get an HPV infection in their lifetime. HPV infection often causes no symptoms. Most HPV infections go away on their own. These short-term infections typically cause only mild (“low-grade”) changes in cervical cells. The cells go back to normal as the HPV infection clears. But in some women, HPV does not go away. If a high-risk type of HPV infection lasts for a long time, it can cause more severe (“high-grade”) changes in cervical cells. High-grade changes in cervix are more likely to lead to cervical cancer.
Why is cervical cancer screening important?
It usually takes 3–7 years for high-grade changes in cervical cells to become cancer. Cervical cancer screening is very important as it may detect these changes before they become cancer. Women with low-grade changes can be tested more frequently to see if their cells go back to normal. Women with high-grade changes can get treatment to have the cells removed.
Cytologies every 3 years for women between the ages of 21 and 65 reduce the risk of death from cervical cancer.
- Of 1,000 women who do not get screened, 10 could die from cervical cancer.
- Of 1,000 women who do get screened, 2 could die from cervical cancer.
Therefore, there are 8 less cervical-cancer-related deaths in the 1,000 women who get screened.
This is due to the fact that:
- Screening helps detect abnormal cells in the cervix, which can develop into cancer. Surgical Oncologist can remove the parts of the cervix that contain these cells before a cancer develops. In this way, screening reduces the risk of getting cervical cancer.
- If a cancer is already present, early detection due to screening improves the chances of recovery.
How is cervical cancer screening done?
Cervical cancer screening includes the Pap smear test and, for some women, an HPV test. Both tests use cells taken from the cervix. The screening process is simple and fast.
Patient lies on an exam table and a speculum is used to open the vagina. The speculum gives a clear view of the cervix and upper vagina.
Cells are removed from the cervix with a brush or other sampling instrument. The cells usually are put into a special liquid and sent to a laboratory for testing:
- For a Pap test, the sample is examined to see if abnormal cells are present.
- For an HPV test, the sample is tested for the presence of 13–14 of the most common high-risk HPV types.
How often cervical cancer screening is done and which tests should be done?
It depends on age and health history:
- Women aged 21–29 years should have a Pap test alone every 3 years. HPV testing is not recommended.
- Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred). It also is acceptable to have a Pap test alone every 3 years.
When to stop cervical cancer screening?
cervical cancer screening should be stopped after age 65 years if
- no history of moderate or severe abnormal cervical cells or cervical cancer, and
- three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.
Are there any women who should not follow routine cervical cancer screening guidelines?
Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV), have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth may require more frequent screening and should not follow these routine guidelines.
Having an HPV vaccination does not change screening recommendations. Women who have been vaccinated against HPV still need to follow the screening recommendations for their age group.
What does it mean if cervical cancer screening test result are abnormal ?
Many women have abnormal cervical cancer screening results. An abnormal result does not mean that they have cervical cancer. Remember that cervical cell changes often go back to normal on their own. And if they do not, it often takes several years for even high-grade changes to become cancer.
If screening test result is abnormal, additional testing is needed to find out whether high-grade changes or cancer actually are present. Sometimes, only repeat testing is needed. In other cases, colposcopy and cervical biopsy may be recommended to find out how severe the changes really are. If results of follow-up tests indicate high-grade changes, it may need treatment to remove the abnormal cells.
How accurate are cervical cancer screening test results?
As with any lab test, cervical cancer screening results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a “false-positive” result. Cervical cancer screening also may not detect abnormal cells when they are present. This is called a “false-negative” result.
To help prevent false-negative or false-positive results, one should avoid douching, sexual intercourse, and using vaginal medications or hygiene products for 2 days before the test and also should avoid cervical cancer screening during menstrual period.