Guest Author - Dr. Denise Howard
Cervical cancer can be prevented. Fortunately we have the ability to offer primary and secondary prevention. Secondary prevention entails the identification of disease process in its initial stages, allowing for early treatment and thus the prevention of the disease end stage. Primary prevention describes a mechanism by which the disease is prevented in its entirety.
The identification of precancerous lesions within the cervix provides us with the opportunity to offer secondary prevention of cervical cancer. The pap smear or screening cytology has been the main tool used to find early changes that might lead to cervical cancer. The test however is imperfect in that a good percentage of women have had to undergone more invasive procedures to determine if they are indeed at greater risk of developing cancer.
The addition of Human Papilloma Virus (HPV) testing has made identification of true cervical abnormalities much easier. The known association of HPV virus types with dysplasia and cervical cancer allows for more aggressive management of those at greater risk. If the Pap test has atypical squamous cells and HPV testing reveals the presence of the high-risk virus types then colposcopic evaluation is indicated. If the pap reflects any degree of dysplasia a colposcopy is also required.
Colposcopy is a procedure in which the cervix is examined under magnification after being painted with a weak acidic solution. Abnormal cells take up the solution and these cells are easily visualized with a magnified view. The identification of areas of abnormality then allows directed biopsy. A tiny sample of tissue is obtained and sent for pathologic examination. This gives the pathologist a sample of tissue rather than a few cells to evaluate allowing for a much easier diagnosis.
Once dysplasia is diagnosed then management can be determined. Low-grade dysplasia typically resolves over time, especially in younger women. Thus observation with serial Pap test every 6 months to document resolution is often recommended. The loop electrosurgical excision procedure (LEEP) is the most common method for managing dyplasia in the office setting. It is a simple, quick and effective procedure. Removing the involved area provides treatment for the dysplasia and prevents cervical cancer development. The excised tissue can also provide an even larger tissue sample to the pathologist who can then make an even more definitive diagnosis. Other possible treatments might include a cone biopsy, which is typically performed in the operating room using a scalpel to obtain an even more precise sample. This is typically done when cancer is suspected and the presence of invasion needs to be documented.
The identification of Human Papilloma Virus as the culprit in cervical cancer paved the way for the development of a vaccine. Vaccinations are the main tool for primary prevention of infection related diseases. Two vaccines are available on the market and are recommended for girls and now boys. They have proven to be 97-100% effective in the prevention of cervical carcinoma in-situ, the last stage before the development of invasive cancer.
The early diagnosis and appropriate treatment of cervical dysplasia has been an effective strategy in cervical cancer prevention. When cervical cancer is diagnosed it is usually in some one who has never had a Pap test or has not had one in many years. The identification of HPV virus as the causative agent of cervical cancer has allowed the development of a vaccination, which has the potential to decrease the incidence of severe dysplasia and cervical cancer even further. Given time, cervical cancer may even be eradicated.
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!