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Cervical cancer is highly preventable and one of the most successfully treatable forms of cancer especially if it is diagnosed early. Regular screening helps women determine their risk of developing cervical cancer.
Screening tests check for the presence of high-risk human papillomavirus (HPV) in the body and for abnormal cells in the cervix.
More than 90% of the cases of cervical cancer can be attributed to HPV, a group of common viruses, which transmit through skin-to-skin contact during sexual activity. There are more than a 100 types of HPV, of which about 14 are high risk or those that can cause cancer. According to the World Health Organisation (WHO), two HPV types, 16 and 18, cause 70% of cervical cancers and pre-cancerous cervical lesions.
“If there is any type that has a higher propensity to stay, rather than being transient in the body, it is these two HPV genotypes (16 and 18),” says Dr. Ajit Nambiar, director & head, pathology and lab medicine, Karkinos Healthcare. He points out that HPV infections are usually transient, which means that when people are exposed to the virus, the body fights back.
“However, we do not know whether an individual’s immune system can throw out the virus. If someone’s immune system is unable to fight the virus, it remains within them and may get integrated into cells and turn normal cells into abnormal cells,” he says.
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HPV Test
What is an HPV test?
Dr Nambiar says the intention behind the HPV test is to pick up high-risk HPV viruses which may cause cervical pre-cancers and cancers. Mucosal or genital HPV, which often affect the anal and genital area, are spread even if a person does not display any symptoms. Most people who have had sex will contract HPV in their life, which makes screening essential.
During an HPV test, a doctor or a healthcare professional uses a special tool to gently scrape or brush the cervix, the lower narrow end of the uterus that connects to the vagina, to collect cells which are tested.
As of now, HPV testing is available only for women. There are no approved HPV tests for men yet. For women, these can sometimes be recommended with a pap smear (co-test).
When can you not have an HPV test?
The guidelines for the age to start HPV screening may differ. Women can start screening for HPV after the age of 30, the age may be 25 years in some countries. Dr. Nambiar says the only time women cannot have an HPV test is if they are pregnant, are on their period, or have had an abortion recently.
What do HPV test results mean?
HPV test results can either be positive or negative.
If a high risk HPV type has been identified in the patient’s cervical cells, the result will be “positive”. If no high-risk HPV types were found in the cervical cells, the result will be “negative”.
A positive HPV test does not imply that a person has cervical cancer. But they could develop it in the future. In case of a positive result, doctors recommend a follow up test to check whether the infection has cleared or if there are any signs of cancer.
What happens if you test positive?
Colposcopy
Dr Nambiar says if a woman tests positive for a high-risk HPV type, doctors may recommend a colposcopy (diagnostic procedure to examine the cervix, vagina and vulva for signs of disease), which allows the doctor to see a magnified view of the cervix and check for any malignancies.
If abnormal cells are found, the doctor will recommend a procedure to remove them. “We can thermocoagulate (use heat to destroy the abnormal cells on the cervix; it can be used in treating cervical pre-cancer) that area. In these cases, we ask women to come back for a test after about three years and we can check if there have been any changes in the HPV status,” he says.
Biopsy
In a biopsy procedure, a small sample of tissues from the cervix is examined for abnormal or precancerous conditions. This is usually done at the same time as a colposcopy.
Removing abnormal cells
The doctor may remove abnormal cells using cryotherapy (a procedure that uses liquid nitrogen to destroy precancerous cells) or laser treatment.
In certain cases doctors may recommend a hysterectomy or the removal of the womb if abnormal cells have been found more than once on the cervix or are severely abnormal.
Pap Smear
What is a pap smear test?
A Pap test looks for precancers and cell changes on the cervix that may become cervical cancer if left untreated. During a pap test, the doctor or a healthcare provider places a speculum in the vagina to open it and gently scrapes cells from the cervix. These cells are then sent to a lab. If the results are not normal, the doctor may recommend more tests and remove some tissue from the cervix for a biopsy in order to identify any cancerous cells and treat them to prevent them from becoming cancerous.
What do pap test results mean?
Pap test results show if cervical cells are normal or abnormal. Sometimes they may be “unsatisfactory”. Here’s what each of the possible result means:
Normal: A normal or negative test result means no cell changes were found on your cervix.
Abnormal: An abnormal or a positive test result does not imply that you have cervical cancer. It means that abnormal cells were found on the cervix, which have likely been caused by HPV. The doctor or healthcare provider will recommend follow up steps in this case.
Unsatisfactory: This means that the sample did not have enough cells or it couldn’t be properly examined. You will be required to get another screening in a few months.
Screening Guidelines
21-29 years old
If your Pap test result is normal, your doctor may recommend that you wait three years until the next one.
30-65 years old
Ask your doctor which one of the three options work for you:
Pap smear: If your results are normal, the doctor may recommend that you wait for three years for the next one.
HPV test: If your result is normal, your doctor may recommend that you wait five years until the next one.
Co-testing: If both results are normal, your doctor may recommend that you wait five years for the next screening.
Over 65
Women over 65 years may not need screening if their screening has shown normal results for several years and if they have had their cervix removed in a total hysterectomy for a non-cancerous condition.
Immunosuppressed
Women who are immunosuppressed, have the human immunodeficiency virus (HIV), or have been treated for a precancerous cervical lesion or cervical cancer, may need more frequent screening.
Sources:
- American College of Obstetricians and Gynaecologists
- American Cancer Society
- National Cancer Institute
- Centres for Disease Control and Prevention
Disclaimer
Information on this website is provided for general informational purposes only, even when it features the advice of a physician or healthcare professional. It is not intended to be and should not be used as a substitute for direct medical advice from your physician or other qualified healthcare professional. As always, you should consult your physician.
The views represented in the articles are the views of the experts featured and do not necessarily represent the views of Femoai.
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