INFORM, PROTECT, PREVENT CERVICAL CANCER,
PRE-CANCERS AND PAPILLOMAVIRUS INFECTIONS
why, how, who?
WHY PREVENT CERVICAL CANCER?
What is cervical cancer? It is a cancer that develops in the area where the uterus projects into the vagina. It is caused by a very widespread virus known as Human Papillomavirus or HPV. Abnormal cells multiply first in the cervical lining and cause high-risk lesions or pathological growth. At a more advanced stage, this cancer may spread to nearby organs.
What is cervical cancer frequency? This cancer strikes over 500 000 women every year throughout the world. Nearly half of these women are under fifty. In developed countries, the frequency of cervical cancer has markedly decreased in the past few decades thanks to Pap smear screening. In developing countries, cervical cancer strikes at a much greater rate and most often leads to death. On a worldwide scale, it represents the second leading cause of cancer in women. In Europe, around 70 000 cases of cervical cancer and 700 000 pre-cancerous lesions are recorded each year. Thanks to screening, cervical cancer is ten times less frequent than pre-cancers. Every half an hour the disease kills.
Body of the Uterus Uterus
Feminine Genital Apparatus
What are the causes of cervical cancer? All cervical cancers are caused by Human Papillomavirus (HPV). Over 100 types of Papillomavirus are known, and around fifteen of these cause cervical cancer. HPVs are transmitted mainly by sexual contact or intercourse. Around eight out of every ten sexually active persons will be exposed to an HPV during their life. In general, HPV infections are silent and heal without leaving after-effects. But in 10% of cases, HPV infection persists. The viruses become lodged in the cervical cells and can lead to precancerous lesions within two to five years or cervical cancer within 15 to 20 years.
HOW CAN CERVICAL CANCER BE PREVENTED?
Preventing cervical cancer through screening 1. Why be screened? Screening serves to locate anomalies in the cervix at a benign and precancerious stage, where it is easy to treat them before they evolve into cancer. The sooner an anomaly is detected, the better the chances for a definitive cure are.
Development of Cervical Cancer
2. How and where is screening done? During routine examination, the attending physician or gynecologist scrapes a few cells from the cervix at the deep end of the vagina using a brush or spatula. This is a simple, non-painful procedure that takes only a few minutes. The cell sample is then sent to a specialized laboratory for examination and interpretation.
3. When should screening be done? All women from 25 to 65 years old should be screened. However, if sexual relations started before the age of 16, the first screening can be done at 20.
Cervix Cervical Epithelium
The Pap smear is the usual method used for screening for cervical cancer. However, the HPV test, looks for the presence of the virus in the cervix, has also been proposed as an effective screening tool in women over 30 years old.
4. How often?
The Papillomavirus enters through a tiny lesion and infects the basal cells
Appearance of abnormal cells
The recommendations may vary from country to country. Depending on the method used, the schedule is different. The official schedule is every three years after the first two normal smears done a year apart. However, in some countries where the screening is on voluntary basis, it is recommended to undergo screening every two years. This schedule must be respected throughout a womanâ€™s lifetime, including for women with a stable partner or who no longer have sexual relations. When both the Pap smear and the HPV test taken together are negative, the testing interval may be safely extended to three-five years. The absence of an HPV-risk marker is a good indicator of long-term protection.
Abnormal cells proliferate (low-grade lesion)
Precancerous lesion (high-grade)
Cancer: abnormal cells invade nearby tissues
HOW CAN CERVICAL CANCER BE PREVENTED?
Preventing cervical cancer through vaccination 1. Why be vaccinated?
3. What does HPV vaccination not protect against?
Although screening is very effective, it has not allowed eradicating this cancer. For this reason, using a vaccination to protect against the cause of this cancer, the papillomavirus, is particularly indicated. Vaccination stimulates the production of specific antibodies against the vaccine viruses. If one of these viruses later comes into contact with the cervix, it is neutralized by the presence of these antibodies.
Vaccination protects against the two HPV types that are the most often implicated in cervical cancers (around 70% of cases). But vaccination cannot provide protection against other HPV types that are also responsible for cervical cancer. For this reason, screening remains essential, even for young women who have been vaccinated.
Vaccination thus protects against certain precancerous lesions and certain cervical cancers caused by the viruses contained in the vaccine.
2. What does HPV vaccination protect against? HPV vaccination protects against diseases caused by certain types of HPV.
The quadrivalent vaccine protects against the four types of HPV that are most often
implicated in cervical pre-cancers and cancers (types 16 and 18) and genital warts (types 6 and 11).
The bivalent vaccine protects against the two types of HPV that are most often implicated in cervical pre-cancers and cancers (types 16 and 18).
HPV vaccines are administered in three injections with an interval of one or two months (depending on the vaccine) between the first and second dose, and an interval of five or four months (depending on the vaccine) between the second and third injections.
HPV vaccines are preventive and not curative. They will not heal an HPV infection or a lesion associated to HPV that has already developed.
4. Do the vaccines have undesirable side effects? The vaccine safety profile is good. This was the conclusion from analysis of clinical tests and from the national and international agencies in charge of monitoring the vaccinated population, which is currently estimated to have received over 50 million doses. Use of these vaccinations in pregnant women is not recommended, even if available data does not report harmful effects.
5. How long does protection last? Currently, vaccines protect for more than 8 years. Protection against precancerous lesions remains very high. Preliminary data seem to indicate that these vaccines protect over the long term.
HPV vaccination lowers the risk of cervical cancer but does not eliminate it.
HOW CAN CERVICAL CANCER BE PREVENTED?
6. Who should I talk to?
Why continue screening?
You should talk with your attending physician or gynecologist, who will be able to answer all your questions.
For young women under 26, who are or will be vaccinated, screening must be maintained because the vaccines do not protect against all cervical cancers. Vaccination protects against certain HPV viruses (HPV 16 and 18) responsible for 70% of cervical cancer but not against all of them. All women should thus continue to be screened regularly and effectively.
- For girls and young women: The vaccine can be proposed when contraception or the morning-after pill are prescribed or during any other type of gynecological or nongynecological consultation (vaccination, medical certificate for sports). These are good occasions to talk about sexuality, the prevention of sexually transmissible diseases and pregnancy and to promote condom use. - For parents: Since they are the ones who decide on vaccination for the adolescent, it is important to make them aware of their responsibilities and to reassure them without involving them in the sexual life of their child.
7. Who should be vaccinated? To be effective, vaccination must be proposed to persons who have not encountered the HPV viruses that the vaccines protect against. Since HPV infection is very common and contact with the viruses takes place starting from the first sexual relations, vaccination of girls and teenagers is recommended. The vaccine is today indicated from 9 to 26 years old. Check with your gynaecologist or family doctor about the specific age recomendation in your country. Itâ€™s always better to vaccinate young girls before first exposure to a papillomavirus. Even if young women have already been in contact with a papillomavirus type in the past, vaccination can still protect them fromâ€Żother types contained in the vaccine. For vaccines to be effective, it is necessary to give three vaccine doses. For the time being, the vaccination is not proposed to boys or to young women over 26.
WHAT SHOULD BE DONE IF A SMEAR IS ABNORMAL?
An abnormal smear can indicate a precancerous lesion or cervical cancer, but it can also detect a minor lesion that does not require treatment, only closer monitoring.
How is a cervical pre-cancer or cancer diagnosed?
What are the symptoms of cervical cancer?
After an abnormal smear or a positive HPV test, a microscopic examination of the cervix and the genitalia is performed. This examination is called a “colposcopy” and enables better visualization of cervical anomalies. Next, a sample, called a “biopsy”, is sent to a laboratory for analysis. This analysis will establish the definitive diagnosis.
Cervical lesions often do not show symptoms. Lesions in an advanced stage can cause blood loss between periods or after sexual relations.
How is a pre-cancer treated? Treatment is not always necessary and depends on the severity of the diagnosis. The goal is to remove the abnormal cells from the cervix. Treatments are given under local anesthesia, most often on an outpatient basis. Treatment types most frequently used are: - Laser treatment that allows superficial and deep cauterizing of the abnormal area, - Electro-cauterization that provides a less precise way to destroy the abnormal sector, - Electro-resection with a diathermy loop that removes the part of the cervix containing abnormal tissue, - Laser or scalpel conization that can be done in certain cases.
How is cervical cancer treated? Treatment of cervical cancer depends on its extent. Traditionally, the uterus and ovaries are removed by ablation (total hysterectomy), as well as nearby ganglia. This treatment can be preceded by local irradiation of the cervix (Curietherapy) and followed by external irradiation (radiotherapy).
For more answers to your questions and more practical advice, please visit our website www.wacc-network.org For more information: www.eurogin.com www.ecdc.europa.eu www.path.org www.cdc.gov www.uicc.org www.health.gov.au/cervicalcancer www.e-cancer.fr www.who.org www.gavialliance.org
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