The institution of routine Pap test has reduced the incidence of cervical cancer by 50% over the past 3 decades but it still remains a problem. It is the second most common cancer in women worldwide. It has been estimated that there are over 500,000 new cases each year. There are over 12,000 new cases of cervical cancer and over 4000 deaths in the U.S. yearly, attributed to this malignancy.
Recent understanding of the role of Human Papilloma Virus (HPV) in the development of cervical cancer has lead to the development of new screening tools. Even though there are approximately 35 types of HPV that infect the genital area, only a subset of these is known to cause cervical cancer. Types 16 and 18 are responsible for over 75% of the cervical cancers and another 10 types are responsible for the rest. These are described as the high-risk types and their presence can be determined using a simple swab. This screening can be done at the same time as the pap smear.
The Pap smear collects a sample of cells from the cervix. Cytologic examination allows identification of any potential abnormalities. It is important to remember that the Pap is a screening test. Screening test tend to over call abnormalities with the goal of not missing any real problems. The consequence is that there will be many reported abnormal Pap smears that upon further testing may yield normal findings. On the other hand the Pap smear is unlikely to miss any cervical abnormalities.
The cells taken during the pap smear are examined for changes that reflect cervical dysplasia or cervical cancer. The reported abnormalities may include atypical squamous cells, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion which includes moderate and severe dysplasia, atypical glandular cells, and carcinoma. Further evaluation is dependent on the report. The presence or absence of high-risk HPV types can also influence the decision for additional tests.
An abnormal pap smear should trigger further evaluation. The colposcopy is a procedure by which the cervix is examined under magnification. A dilute acetic acid solution is placed on the cervix. Abnormal and normal areas have a characteristic appearance. The colposcopic exam allows identification of abnormal areas, which can then be biopsied. The tissue biopsy, taken at the appropriate site, yields the correct diagnosis. This step is important because the pap isnít expected to be accurate. The pap may suggest a low-grade lesion but colposcopic biopsies may find severe dysplasia or even cancer.
The cervical biopsy results should then guide further treatment. If the results show mild dysplasia, then observation maybe recommended in young women or those who have not completed their childbearing. Severe dysplasia requires immediate treatment. Resection of the affected area is the usual treatment and this is done by a procedure commonly called a cone biopsy. This process allows detection of early changes so that appropriate treatment can be undertaken.
Cervical cancer is one of the few cancers that can be prevented. This is due to the availability of an effective screening program. The combination of screening cytology and HPV testing allows for the prompt identification of high-risk individuals. Once precancerous lesions are identified, effective and low risk treatments can be performed. If detected early, even invasive cervical cancer can be successfully treated. The goal is early detection through screening so that treatment can be provided as early as possible.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!