Cancer cervix screening and early diagnosis

Cervical cancer screening tests play a crucial role in not only detecting cervical cancer, but also identifying precancerous cells that could potentially develop into cervical cancer in the future. Most guidelines suggest starting screening for cervical cancer and precancerous changes at 21 years of age or after three years of first intercourse. These tests typically repeated every year for first 3 years and if no abnormality is detected then it can be done after every 2 years till the age of 65 years.

Researchers have been tirelessly working on developing and improving screening methods to detect cervical cancer before any signs or symptoms appear. The ultimate goals are to reduce or eliminate the number of people who die from this cancer, and to minimize the number of people who develop it.

The two primary screening tests include the Pap test and the HPV DNA test. Both tests can be done as simple outpatient procedures, usually as part of a gynecological check-up. The Pap test is conducted by a healthcare professional by scraping and brushing cells from the cervix. The samples are then examined under a microscope for cell abnormalities that might suggest precancerous changes or detect the presence of cervical cancer. The HPV DNA test involves testing cells from the cervix for infection with any of the types of human papilloma virus (HPV) that most likely lead to cervical cancer.

Another screening method is the visual inspection with acetic acid (VIA). This is done with a few tools and the naked eye. A diluted solution of white vinegar is applied to the cervix, which will turn white if abnormal cells are present. This screening test is valuable in places where access to medical care is limited.

It is recommended that all women receive at least 1 HPV test, at a minimum during their lifetime, repeated every 5 to 10 years. Women aged 25 to 65 years should receive an HPV test once every 5 years. Women above the age of 65 years or those who have undergone a hysterectomy can stop screening if the HPV test results have been negative over the previous 15 years.

Screening recommendations are now becoming increasingly individualized. Personal risk factors, health history, birth history are important factors to consider. Women who have tested positive for the human immunodeficiency virus (HIV) or are immunosuppressed should receive HPV testing as soon as they are diagnosed. Women who have given birth must be screened for cervical cancer 6 months after childbirth.

Once detected, a comprehensive examination of the cervix is essential. Early cervical cancer is limited to either the presence of precancerous cells lining the cervix (stage 0 or carcinoma in situ) or when the cancer is limited to specific areas of the cervix and has not spread elsewhere (stage 1). Determination is carried out by retrieving cervical tissue samples by a colposcope, a special instrument that magnifies visualization.

Confirmation of a cancer is done by a biopsy and if only stage zero or dysplasia (carcinoma -in-situ) is found then either cone-biopsy or hysterectomy (for women, who have completed child bearing) is recommended.

Early identification and treatment of cervical cancer offers a 91% 5-year survival rate for stage 1 (one). Treatment is typically by surgery or radical radiotherapy with addition of brachytherapy. Some patients may require radiotherapy and /or chemotherapy after surgery. Since early cervical cancer does not produce any symptoms, screening tests are vital to identify early signs and reduce the associated morbidity and mortality.