Cervical cancer is one of the most common cancers in women. Unfortunately, due to the lack of appropriate prophylaxis, it is also one of the most common causes of death in the course of oncological diseases. Meanwhile, early detection of changes and undertaking appropriate treatment may be a chance for health and life.
The data and what follows from them
The statistics are alarming. Every year in the world over half a million new cases of cervical cancer are reported, and in almost 250,000 cases the disease ends in death.
In Poland, cervical cancer is the sixth most common cancer, accounting for more than 10% of all cancers diagnosed in women. In our country, around 3 000 new cases are recorded every year, and over 1 500 patients die of this disease.
These figures sound alarming? It is true that untreated cervical cancer inevitably leads to death. However, it is worth remembering that its early detection and application of appropriate treatment – mainly surgery, but also radio- and chemotherapy – often allows for effective cure of the disease. Most importantly, the development of cervical cancer can be effectively prevented through effective preventive measures.
Strategy against cervical cancer
In 2020, the World Health Organisation announced a global strategy to accelerate the elimination of cervical cancer. It includes three elements of prevention:
– HPV (Human Papillomavirus) vaccination,
– screening, and
– treatment of precancerous conditions as soon as possible.
HPV – an important risk factor
The most important risk factor for cervical cancer is infection with HPV. This virus is mainly transmitted sexually by direct contact with an infected person. Human papillomavirus infection can also lead to the development of benign lesions – genital and anal warts. Long-term presence of the virus in genital tissues causes changes in the structure of cervical cells. Normal cells of the squamous epithelium, which protect the cervix against the harmful influence of the vaginal environment, are replaced by abnormal cells, occupying successive layers of epithelium. This leads to the development of lesions which on cytological examination are described as small (LSIL) or large (HSIL) degree intraepithelial neoplasia. The above-mentioned cervical pathologies can regress spontaneously without treatment but can also develop into cervical cancer.
HPV vaccine
In 2006, the first HPV vaccine was registered in the USA. Currently available vaccines contain virus-like particles obtained by genetic recombination. There are three HPV vaccines on the market, depending on the number of virus types they protect against: 2-valent, 4-valent and 9-valent. All of them protect against the most oncogenic virus types (those with the greatest potential to cause cancer) – HPV 16 and HPV 18.
Effects of mass vaccination
After 10 years since the introduction of HPV vaccination programmes, countries which carry out the vaccinations noted a 90% reduction in infections with virus types 6, 11, 16 and 18. Moreover, the number of diagnosed high-grade cervical pathologies leading to cancer decreased by as much as 85%. For this reason, the HPV vaccine is called the first anti-cancer vaccine in the world.
For whom is vaccination against HPV recommended?
The vaccines are recommended for girls and young women as well as boys and young men. They can be used from the age of 9. The purpose of the vaccine is not to treat lesions caused by HPV infection, but to prevent infection with the virus and its further transmission.
In Poland, vaccination against HPV is not refunded, but many local governments organise free vaccination programmes.
Preventive screenings are essential
Another strategy for preventing the development of cervical cancer is regular preventive examinations. Population-based and case-control studies have shown that screening for cervical cancer is effective in reducing the incidence and mortality of this type of cancer.
The basic preventive test to detect abnormalities of the epithelium of the cervix or an early stage of cervical cancer is a cytological examination.
A few words about cytology
A cytological examination is nothing to be afraid of. Taking the material for analysis is short and painless. During your appointment, your midwife or gynaecologist will use a sterile toothbrush to remove the material from your womb and cervix for examination. The cervical epithelial cells are then examined under a microscope in the laboratory after special staining. The presence of abnormal cells on examination may be an expression of inflammation or their early transformation to a precancerous state after the onset of carcinogenesis. In such cases, it is necessary to differentiate between benign and precancerous lesions, which require appropriate therapeutic management. For this purpose, the material is examined for the presence of special biomarkers – p16 and Ki-67.
Cytology results
A positive result of such an examination is an indication for an in-depth diagnostics which includes colposcopy (examination lasting several minutes and performed in a gynaecologist’s office with the use of a special apparatus after inserting a speculum into the vagina). It may also be necessary to take biopsies from the most suspicious areas of the cervix and to curettage the cervical canal. Sometimes HPV DNA testing is also used in the diagnosis. The final diagnosis confirming the presence of high grade lesions (HSIL) is an indication for treatment, i.e. removal of the lesion within the limits of healthy tissue. Research shows that 1.5- 2% of cytological smears are abnormal and require further diagnostics.
How often should I be examined?
Every woman over the age of 25 should have regular prophylactic cytological examinations. In Poland, the test is reimbursed every 3 years for women aged between 25 and 59 as part of a programme to prevent cervical cancer. The examination can be performed in every obstetric-gynaecological clinic which has signed a contract with the National Health Fund and in selected primary health care clinics which have signed a contract for the services of a primary health care midwife in the cervical cancer prevention programme.
Education and health awareness are also of great importance in the prevention of cervical cancer. HPV infection is not the only risk factor for developing the disease. One of them, equally dangerous, is smoking. The development of the disease can be influenced by early initiation of sexual life and a large number of partners. Indirect risk factors for cervical cancer include unhealthy diet, HIV infection and indirectly, long-term use of hormonal contraceptives. Therefore, education on healthy lifestyle, smoking and safe sexual behaviour plays a very important role in the prevention of cervical cancer.
Remember:
Vaccinations, regular examinations, an appropriate lifestyle and the right treatment when it is necessary – these are the most important forms of preventing cervical cancer and the development of the disease. Thanks to prevention, you can gain health and life.
Author: Dr Agnieszka Dawczak-Dębicka.
References:
- Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization 2020
- Krzakowski M. (red.), Warzocha K. (red.), wsp. i (red.) Zalecenia postę̨powania diagnostyczno-terapeutycznego w nowotworach złośliwych. Via Medica. 2013
- Hu Z, Ma D. The precision prevention and therapy of HPV-related cervical cancer: new concepts and clinical implications. Cancer Med. 2018;7(10):5217-5236.
- Jach R., Sznurkowski J., Bidziński M., Misiek M., Knapp P., Bodnar L., Bieńkiewicz A., Blecharz P., Kojs Z., Kotarski J., Markowska J., Mądry R., Sawicki W., Wicherek Ł., Basta A. Zalecenia Polskiego Towarzystwa Ginekologii Onkologicznej dotyczące diagnostyki i leczenia raka szyjki macicy. Curr Gynecol Oncol 2017, 15 (1), p. 24–33.
- Nasierowska-Guttmejer A., Kędzia W., Rokita W., Wojtylak S., Lange D., Jach R., Wielgoś M. Rekomendacje dotyczące diagnostyki i leczenia płaskonabłonkowych zmian śródnabłonkowych szyjki macicy na podstawie wytycznych CAP/ASCCP. Ginekologia i Perinatologia Praktyczna 2016;1(3):130-138
- https://pacjent.gov.pl/program-profilaktyczny/profilaktyka-raka-szyjki-macicy
- https://vaccination-info.eu/pl/informacje-o-chorobach/wirus-brodawczaka-ludzkiego-hpv
- https://szczepienia.pzh.gov.pl/szczepionki/hpv/
- https://www.historyofvaccines.org/index.php/content/articles/human-papillomavirus-infection