January is the month dedicated to raising awareness of the importance of prevention and early detection of cervical cancer and human papillomavirus (HPV) and on this occasion, BHAAAS member Dr. Azra Sadiković, Gynecology specialist, and Dr. Vedka Begović, specialist in internal medicine, prepared the most important information and advice to point out the importance of prevention and early detection of this malignant disease.
Cervical cancer is the second most common cancer and the second most common cause of cancer death in women of reproductive age worldwide. In Bosnia and Herzegovina, more than 60 women die annually. The highest incidence and mortality from cervical cancer are in countries with limited resources and underdeveloped protocols for screening and vaccination against HPV infection. Cervical cancer can be diagnosed in earlier stages when it is easier to treat, and potentially eliminated with proper screening and vaccination of groups of patients according to the recommended age.
It is important to emphasize that cervical cancer is a disease that can be controlled and prevented through an organized process of vaccination against the HPV virus and through finding early changes on the cervix, so-called precancerous lesions. Finding these lesions involves screening with the so-called pap smear and, even more effectively, additional HPV testing, according to the approved recommendations of health organizations based on scientifically proven and widely accepted facts.
Screening methods for early detection of cervical cancer
The cervix is the lower part of the uterus. Cervical cancer in its early stages often causes no symptoms. Therefore, the best way for early detection is to test all women even if they do not have symptoms. This is known as cervical cancer screening. Two tests can be used to screen for cervical cancer: the Papanicolaou (Pap) smear and the human papillomavirus (HPV) test. Depending on the woman’s age and health history, one or both tests are recommended.
Screening and testing are recommended to begin at age 21 for all individuals regardless of their sexual history or previous vaccinations.
For women over 30 years of age, a Pap test can be combined with a test for the human papillomavirus (HPV) – a sexually transmitted infection that is thought to be the cause of cervical cancer in almost 99% of cases. The HPV test is also done using a sample of cells from the cervix. These cells can be analyzed to find traces of infection with high-risk strains of the HPV virus (16, 18, 45 are just a few). Infection with this virus does not cause symptoms in most cases. Still, it causes changes in the cells of the cervix that can eventually lead to the appearance of cervical cancer. It is known that it takes a long time (up to ten years) for infection and changes in the cervix to lead to cancer. Therefore, the use of Pap smears and HPV testing has led to a significant reduction in the number of women suffering from this cancer in developed countries where these testing guidelines are applied.
Recommendations from 2012, and later updated in 2018, replaced older recommendations that stated women should be tested annually. That is no longer the case. The US Preventive Services Task Force and the American College of Obstetricians and Gynecologists (ACOG) have released recommendations on who should be screened for cervical cancer, how often, and what types of tests should be done.
All women should have their first Pap test at age 21. Testing before the age of 21 is not recommended, even for women under 21 who are sexually active. If the results are normal, a Pap test should be done every 3 years until the age of 30. After age 30, women can continue to have a Pap test every 3 years or they can have an HPV test every 5 years. Women can stop having Pap smears at age 65 if they have had routine screenings with normal results in the previous 20 years. Women who have abnormal Pap test results may need either additional testing (such as a cervical biopsy) or a follow-up Pap test before three years pass between two tests.
HPV vaccination is the process of administering a vaccine that protects against the human papillomavirus (HPV). HPV is a group of viruses that are transmitted through sexual contact. There are more than 200 types of HPV, some of which can cause changes in the skin and mucous membranes, including genital warts and lesions that increase the risk of certain types of cancer, especially cervical cancer, but also cancer of the vagina, anus, penis, and throat.
HPV vaccines are recommended as a preventive measure in adolescents and young adults before they become sexually active, as they provide the greatest benefit when administered before exposure to the virus. However, vaccination can also be useful in people who have already had sexual experience because it protects against those types of HPV that they have not yet received.
It is important to note that vaccination does not protect against all types of HPV and does not replace regular medical examinations and cervical cancer screening. However, it is an important part of preventing certain types of HPV-related infections and cancers.
Vaccination against HPV is recommended for adolescents of both sexes. The first dose is usually given at the age of 9-12, and until recently it was recommended until the age of 26. However, it has been shown that vaccination gives results even if it is applied at a later age. Thus, recently, vaccination in America has been recommended up to the age of 45. A series of two or three doses is given, depending on the age at the start of vaccination. If started before the age of 15, two doses 6-12 months apart are sufficient. If started after age 15, a third dose is recommended.
The effectiveness of the vaccine is high and protects against different strains of HPV. The vaccine has been shown to protect against 90% of cervical cancer cases and significantly reduces the risk of other HPV-related diseases.