Prevention is always better than a cure, and in the case of cervical cancer, modern medical advancements have made it much easier to identify warning signs before they develop into something more sinister.
When it comes to screening for gynaecological precancer and cancer (including the cervix, uterus, ovary, fallopian tubes and vulva), cervical screening is the only routine test. Ovarian cancer, though more deadly, has no effective screening tool to date. As for uterus cancer, it usually presents early with abnormal bleeding, which will alert a woman to seek medical attention.
Where in the past cervical screening was in the form of a Pap smear carried out every 2 years, doctors now recommend HPV testing as a much more effective method of detecting precancerous changes to the cervix.
What is cervical cancer?
Cervical cancer is the growth of abnormal cells in the cervix (the lower part of the uterus connecting to the vagina). It generally develops slowly, but if left undetected, can spread to other parts of the body, such as the vagina, bladder, liver and lungs. The changes that occur in the tissues of the cervix that lead to the development of cancerous cells are associated with infections of certain strains of the HPV virus.
What Is HPV?
HPV stands for human papillomavirus, and is a common infection with over 100 variations. Many of these variations result in warts on the hands or feet, as the virus lives inside the epithelial cells that are found on the surface of your skin. However, there are also many types that enter the body via sexual contact, and infect the genital areas, causing genital warts. Most sexually active adults will contract some form of HPV at some point in their life. Not every strand of HPV is high-risk, but certain types do cause cervical cancer.
Symptoms of HPV
- Many do not experience any symptoms of a HPV infection, and it usually clears up on its own
- Genital warts may appear around the genital area, and are either flat or cauliflower-like lesions that may be itchy but are usually painless
- Common warts are rough bumps on the hands or fingers, and can be painful
- Plantar warts are hard bumps on your feet that may be painful
Why is HPV testing important?
Precancerous changes in the cervix occur many years before cancer develops, which leaves a large window of opportunity for screening and detection.
Until recently, the recommended screening test for cervical cancer has always been a regular Pap smear, where cells are taken from your cervix by your gynaecologist or GP and tested for abnormalities. As this process is subject to sampling and interpretation errors, false negatives can occur, meaning abnormal cells can sometimes go undetected. HPV testing has proven to be a better screening tool than a Pap smear, and is now recommended for women age 30 and above every 3 – 5 years. As cervical cancer is caused by high-risk HPV subtypes, HPV screening offers an even earlier point of intervention. Precancerous changes can be easily treated, and early treatment can not only save a woman’s life but also her womb.
Why is the HPV vaccine recommended?
Because HPV is often sexually acquired, the majority of women are exposed to the virus during their lifetime, and usually in their early 20s. There are very few cancer vaccines available and the development of the HPV vaccination was a scientific breakthrough. Medical professionals now recommend that all women are vaccinated, and men too, from the age of 9 onwards before any form of sexual activity. Although the vaccinations do not protect against every strain of HPV, they are almost 100% effective in protecting against the high-risk strains that cause 70% of cervical cancers, and some other cancers too.
If you have a positive screen test (eg. abnormal cells detected on a Pap smear, or a positive test for high-risk HPV subtypes) you may be referred for a procedure called colposcopy. Colposcopy is a procedure that uses an instrument called a colposcope to closely look at your cervix for abnormalities.
If you do have HPV, there are various treatments available to remove the warts and abnormal cells.
- Topical medication can be applied to warts to remove them from the skin
- Cryotherapy is a process where the warts are frozen off with liquid nitrogen
- Electrocautery is a process where the warts are burned off with an electric current
- Laser surgery or standard surgical removals are also options to remove abnormal cells
There is no simple way to avoid the risk of contracting HPV, unless you abstain from all sexual contact. It is therefore important to visit your gynaecologist regularly and follow their recommended screening programme to ensure early detection if HPV is present, or if abnormal cells are found. The HPV vaccination is the best way of protecting yourself against infection, but even if you receive it, you must continue to be screened.
Article reviewed by Dr Chia Yin Nin, obstetrician & gynaecologist at Gleneagles Hospital
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