Cervical cancer happens when normal cells in the cervix change into abnormal cells, and grow out of control. Most women whose cervical cancer is found and treated early do very well. Cervical cancer is the fourth most frequent cancer in women world over. Approximately 90 per cent of the 270,000 deaths from cervical cancer in 2015 occurred in low and middle income countries (WHO statistics). The high mortality rate from cervical cancer globally could be reduced through a comprehensive approach that includes prevention, early diagnosis, effective screening and treatment. There are currently vaccines that protect against common cancer-causing types of human papilloma virus and can significantly reduce the risk of cervical cancer. Cervical cancer may not cause any symptoms at first. When it does cause symptoms, it can cause vaginal bleeding that occurs in between menstrual cycles (other than during your period), after sex or even after menopause. These symptoms can also be caused by conditions that are not cancer, hence, if one has vaginal bleeding, especially, at these times, they need to consult a doctor for proper assessment. The most important risk factor for cervical cancer is infection with the human papillomavirus (HPV). There are over 100 different types of HPV, however, most types of HPV do not cause cancer. At least 80 per cent of women are exposed to the HPV virus during their lifetime. Most of the time, the body’s immune system gets rid of the virus before it does harm. HPV is spread by direct skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (e.g., hand to genital contact). It is not possible to become infected with HPV by touching an object, such as a toilet seat. Most people who are infected with HPV have no signs or symptoms. Most HPV infections are temporary and resolve within two years. When the virus persists (in 10 to 20 per cent of cases), there is a chance of developing cervical pre-cancer or cancer. However, it usually takes many years for HPV infection to cause cervical cancer. There are several ways to screen for cervical cancer. The traditional and commonest screening test is called a Pap test. The Pap test is a method of examining cells from the cervix (the cervix is located at the lower end of the uterus). To perform a Pap test, a doctor or other health care provider will perform a pelvic exam and use a small brush or spatula to collect cells from the cervix. These cells are then smeared on a glass slide and examined for presence of abnormality An HPV test can be done along with a Pap test or as a separate test. Like a Pap test, the HPV test is done during a pelvic exam, using a small brush to collect a sample from the cervix. Women who are under age 30 are not usually tested for HPV because many women in this age group have temporary infections, which will go away without treatment. If one is 30 years or older, their doctor might recommend HPV testing in addition to a Pap test. If the HPV test and Pap test are negative, repeat testing is not usually needed for five years. HPV testing may also be done if the results of the Pap test results are unclear. The first Pap test is recommended at age 21 years, although some other countries suggest that screening begin at age 25. Cervical cancer is very rare in younger women. Even if one has had a vaccine for human papillomavirus, they will still need cervical cancer screening. In the past, experts recommended that every woman have a Pap test every year. This has changed, and Pap testing is suggested every three years for most women over age 21. More frequent testing may be needed if test results are not normal, or for women with HIV disease or other specific immune system conditions. Women who have had surgical removal of uterus and cervix for non-cancer reasons don’t need routine Pap smears, and neither do women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. Dr. Ian Shyaka Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com
