Cervical cancer is preventable and can be effectively treated when it is detected early. Regular screening is crucial for identifying precancerous changes in the cervix, allowing for timely intervention and reducing the risk of developing cervical cancer.

Despite advancements in screening and treatment, cervical cancer remains a significant public health concern, particularly in developing countries like India.

This article provides a comprehensive overview of cervical cancer screening, including information on who should be screened, the frequency of screening, where to get screened, and the benefits of regular screening.

By understanding the importance of cervical cancer screening and taking proactive steps to protect your health, you can reduce your risk of developing this disease.

Cervical cancer screening: What is it and how it's done?

The goal of screening for cervical cancer is to find changes in the cells of the cervix which can possibly prevent the development of the condition or detect it early. Studies show that when cervical cancer is diagnosed early due to good quality and reliable screening, the cases of cancer can be reduced by upto 90%. 1,2

Screening of cervical cancers can be done using the following methods:

• HPV test or the human papillomavirus test: Used to check if the cervical cells are infected with the HP virus, which increases the risk of developing cervical cancer.1
• The PAP smear test, commonly known as the PAP test: This involves the collection of the cervical cells which are diagnosed under the microscope to check for changes caused by HPV. It can also diagnose non-cancerous conditions like inflammation or infections.1
• Community-Based Programs: Implement community-based programs to raise awareness and provide education on cervical cancer prevention and early detection.
• HPV/PAP test is a combination test: Checks for both high-risk HPV and HPV-related changes in the cells of the cervix. These can detect just one or more kinds of oncogenic genes i.e. the genes responsible for the development of cancer, but may not be able to confirm or predict malignancy.1
• Ploidy test: A DNA test that detects the HP virus and delivers accurate and reliable confirmation or prediction of cervical cancer using an AI-powered technique. It can detect abnormal DNA or cancerous changes in cervical cells (called aneuploidy) 3 earlier, even before it becomes apparent as visible changes in the cells.

More invasive methods such as Visual Inspection with Acetic Acid (VIA), Colposcopy and Cervical biopsies, may not be preferred by many women.⁴

The World Health Organisation launched a global strategy in 2020 to accelerate the elimination of cervical cancer globally. The goals of this strategy are to: ⁵

• Vaccinate at least 90% of girls who are at risk of developing HPV
• To screen 70% of women at risk of developing HPV at least twice in their lifetimes
• To effectively treat 90% of women detected with a positive screening test or a cervical lesion confirmed with a biopsy

Who should be screened?

The WHO has recently recommended the following cervical cancer screening guidelines for women: ⁶

• Screen and treat women from 30 years onwards: HPV DNA test to screen, followed by regular screening every 5 to 10 years. Treatment is prioritised based on the severity of the condition.
• Screen, prioritise and treat women living with HIV from 25 years onwards: HPV DNA test to screen followed by regular screening every 3 to 5 years.

India's cervical cancer screening program recommends that women aged 30–65 get screened every five years. ⁷

When to stop screening?

Women can stop screening for cervical cancer after the age of 65 years in the following conditions – ⁴

• If they do not have a history of abnormal findings in previous screens
• If they have had three consecutive negative results of PAP smear within the last 10 years, with the most recent one being done at least 3 years back.

Should women who have undergone a hysterectomy (surgical removal of the uterus) still undergo cervical cancer screening?

Women who have undergone a hysterectomy may still be advised to get regular screening, based on certain conditions like – ⁴

• Whether or not the cervix has been removed during the surgery
• The reason for the hysterectomy
• A history of positive PAP smear results or severe changes observed in the cervical cells
• A history of cervical cancer

Do women who have taken the HPV vaccine still need to be screened? ⁴

The HPV vaccine protects women from only certain types of cervical cancer, so regular screening is mandatory irrespective of the vaccination status.

Where to screen?

Most gynaecologist clinics and laboratories offer cervical cancer screening tests. Community healthcare workers are also being trained to screen women for cervical cancer in rural areas. ⁷

Why should you screen regularly?

Studies show that it takes about 3 to 7 years for the DNA changes in the cervical cells to become cancerous. If low-grade changes are observed, screenings can be done at shorter intervals to assess the changes and see if the cells go back to normal. On the other hand, women with high-grade changes should undergo immediate treatment to remove the cancerous cells. ⁴

Also, women with risk factors like smoking, previous history of cervical cancer or those living with HIV may be advised to screen more often, since they are at a higher risk of developing HPV infection. ⁴

Does an abnormal cervical cancer screening test confirm a diagnosis of cervical cancer?

Abnormal cervical screening results are quite common, but does not mean that they have cancer. Most often abnormal cervical cells go back to normal on their own or if they remain abnormal, they may take several years to actually turn cancerous. ⁴

Abnormal test results are not a cancer diagnosis, but doctors may recommend some follow-up tests and in some cases a biopsy to rule out a cancer diagnosis. ⁴

Cervical cancer screening is a vital tool for preventing and detecting this disease. By undergoing regular screenings, women can significantly reduce their risk of developing cervical cancer and improve their chances of survival if diagnosed. It is essential to follow the recommended screening guidelines, be aware of any abnormal symptoms, and seek medical attention if necessary.

be aware of any abnormal symptoms, and seek medical attention if necessary

References:

• National Cancer Institute. Cervical cancer screening. Available [Online] at: https://www.cancer.gov/types/cervical/screening Accessed on 14 Oct 24
• Basoya S and Anjankar A. Cureus. 2022;14(11): e31312. DOI: 10.7759/cureus.31312 3. Singh M, Mehrotra S, Kalra N, Singh U, Shukla Y. Correlation of DNA ploidy with progression of cervical cancer. J Cancer Epidemiol. 2008;2008:298495.
• ACOG. Cervical cancer screening. Frequently asked questions. Available [Online] at: https://www.acog.org/womens-health/faqs/cervical-cancer-screening Accessed on 14 Oct 24
• WHO news. WHO recommends DNA testing as a first-choice screening method for cervical cancer prevention. Available [Online] at: https://www.who.int/europe/news/item/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screening-method-for-cervical-cancer-prevention Accessed on 14 Oct 24
• WHO. New recommendations for screening and treatment to prevent cervical cancer. Available [Online] at: https://www.who.int/news/item/06-07-2021-new-recommendations-for-screening-and-treatment-to-prevent-cervical-cancer Accessed on 14 Oct 24
• Mehrotra R and Yadav K. Indian Journal of Gynecologic Oncology. 2022;20:4. Doi: 10.1007/s40944-021-00602-z