I would like to commemorate Blouberg Family Practice’s opening blog by paying tribute to Women’s month and focusing on an important women’s health topic where screening can prevent the occurrence of this disease. Cervical cancer is the 2nd most common cancer among South African women and the leading cause of female cancer deaths in South Africa. Most patients with cervical cancer have no symptoms. Patients with symptoms might present with vaginal bleeding especially after intercourse, vaginal discharge or symptoms relating to advanced disease.
What causes cervical cancer?
The human papillomavirus (HPV) causes over 99% of cervical cancer, with HPV type 16 and 18 causing over 70% of cervical cancers. HPV infections are very common amongst men and women, with most people being infected at some point in their life. It is usually transmitted through intimate sexual contact and 9 out of 10 infections go away by themselves. Infections that persist can cause cancer in areas like the cervix, vagina, penis, anus, and throat. Other factors associated with an increased risk of cervical cancer include smoking, being immunosuppressed, long-term use of oral contraceptives.
In 2014, the Department of Health implemented the HPV school vaccination programme aimed at reducing this cancer risk. The HPV vaccine is most effective when given before any exposure to HPV and is, therefore, administered in the public schools to Grade 4 girls (9 years and older). Parents need to provide consent for their daughters who are less than 12 years of age, while girls who are 12 years and older can consent themselves to receive the vaccine. The vaccine is given by intramuscular injection in 2 doses, 6 months apart. The vaccine provides protection against HPV 16 and 18 which causes most cases of cervical cancer.
The current national cervical cancer prevention programme offers three pap smears (cervical cytology smears) starting at age 30yrs, at 10-year intervals if HIV negative and every 3 years if HIV positive. Pap smear can also be done in pregnant women till 24 weeks gestation. Based on WHO (world health organization) recommendations, this form of screening is likely to phase out in the coming years to be replaced by HPV testing which is deemed more effective at protecting against cervical cancer. In developed countries, the Pap smear test with HPV testing is recommended every 5 years, till 65 years of age. Women who have had a total hysterectomy (removal of uterus and cervix) can stop screening.
The abnormalities picked up on a pap smear are graded as low grade (cells are mildly abnormal) or high grade (cells are severely abnormal). In the case of mildly abnormal findings, the pap smear can be repeated in 12 months, while high-grade abnormalities will require further testing. Tests like colposcopy and endocervical scrapings are then done to find out if there is pre-cancer or cancer present in high-grade abnormalities.
What is a colposcopy test?
During a colposcopy test, the patient lies on the exam table and a speculum is inserted into the vagina, like for a pap smear. The doctor then uses a magnifying instrument called colposcope to look closer at the cervix. If any abnormal areas are picked up during this examination, a biopsy of that area is done, and the specimen sent to the pathologists. The biopsy result will then confirm if there is cancer or not in the cervix. Pre-cancer lesions can be treated with procedures like cone biopsy, cryosurgery, and laser surgery while cancer lesions will need more extensive surgery and investigations.
Cervical cancer is easily preventable through HPV vaccinations in young girls and routine screening among women. I encourage all women to use this women’s month to ensure their cervical screening is up-to-date.