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Cervical cancer (CC) ranks 5th among oncological diseases in women in our country. The incidence is steadily growing: if in 2008 the pathology was detected in 13 residents of Russia, then in 807 the number of cases was 20181. Mortality rates are also rising despite the fact that cervical cancer responds well to treatment at an early stage. The reason is that the pathology is diagnosed too late.
Doctors are confident that prevention of cervical cancer can be the solution to the problem. We will tell you about the best methods for preventing cervical cancer, which will help reduce the risk of developing the disease and detect a tumor at an early stage.
pap test
The Pap test (oncocytology smear or Pap smear) is considered the main screening method for the diagnosis and prevention of cervical cancer. This painless examination helps the gynecologist to detect altered cells of the cervix, and therefore, to detect precancerous and cancerous diseases in a timely manner.
During the examination, scrapings are taken from several zones – from the vaginal part of the cervix, the cervical canal and the transformation zone (where the border between the two types of epithelium passes). It is in the transformation zone that dysplasia and cervical cancer most often begin.
There are two types of Pap test:
- conventional cytology – the taken biomaterial is applied to a glass slide;
- liquid cytology – scraping is taken with a special brush with a removable tip, which, together with the collected material, is immersed in a container with liquid.
Liquid cytology is considered the most accurate. This method allows you to better preserve the biomaterial, which means that the information content of the study increases several times.
Colposcopy
With the help of colposcopy, you can examine the condition of the epithelium and vessels of the vagina and cervix with an increase of 10 or more times. During the study, the external genital organs and the vaginal mucosa are also examined. Colposcopy can be simple or complex. The first is carried out without the use of reagents, the second – with the help of various chemical compositions, to which pathological areas of the epithelium react.
With colposcopy, you can:
- detect foci of inflammation or tumors with an accuracy of a fraction of 1 millimeter;
- identify whether the lesion is benign or malignant;
- select a site for cyto- and histological studies;
- conduct a biopsy or take a smear for further diagnosis of the biomaterial.
Colposcopy, as a method of preventing cervical cancer, allows you to detect a precancerous condition – dysplasia and start treatment on time.
PCR diagnostics for HPV
HPV or human papillomavirus is considered the main cause of cervical cancer.1. Therefore, PCR diagnostics for HPV is an important method for the prevention of cervical cancer.
HPV is transmitted mainly through sexual contact and can stay in the body for a long time without manifesting itself. But at the same time, there is a risk that the virus will provoke the appearance of benign and malignant tumors of the genital organs.
There are many types of HPV, which are divided into two types – high and low oncogenic risk. Types 16 and 18 are considered the most dangerous (they are most often found in women diagnosed with cervical cancer).1). Highly oncogenic also include viruses 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 types. Viruses of low oncogenic risk (the most common are 6 and 11) rarely cause cancer and usually cause warts and genital warts.
There is no specific treatment for HPV, but this is not a reason to panic. In 90% of cases, the virus will not cause harm and will leave the body within 1-2 years without medical intervention.3. However, women with HPV should see a gynecologist regularly and have a Pap test and a colposcopy at least once a year.
HPV vaccination
The human papillomavirus is present in 70-80% of women who are sexually active.3. Many are re-infected because our body is not able to develop strong immunity against the virus. Therefore, an important step in the prevention of cervical cancer was the creation of a vaccine that protects against diseases caused by HPV.
Several vaccines have been developed in the world, but two are certified in Russia – Gardasil and Cervarix2. Gardasil protects against the two most dangerous HPV viruses – types 16 and 18, as well as low-oncogenic HPV types 6 and 11. Cervarix provides protection against HPV types 16 and 182.
According to scientific studies, the effectiveness of vaccines is 88-100%. Therefore, WHO invited all participating countries to include HPV vaccinations in their national immunization programs.2. Today, in 70 countries of the world, vaccination of girls against HPV is included in the national vaccination schedule.2. Vaccination of boys is mandatory in 10 countries2.
WHO experts recommend vaccinating before the first sexual contact and consider the optimal age for vaccination 9-13 years2. However, the vaccine also effectively protects adults, so today it is given to girls and women aged 9 to 45 years, boys and men from 9 to 26 years old.
Prevention after treatment of cervical cancer
After treatment for cervical cancer, relapse prevention is required. Patients should undergo a gynecological examination every 3 months for 2 years after completion of therapy3. During the 3rd and 4th years, it is necessary to visit the gynecologist every six months, and then annually3. According to the same scheme (every 3 months, every six months, and then annually), a cytological examination of smears from the vaginal mucosa is performed.3. If a recurrence is suspected, a biopsy with a histological examination is done.3.
In addition, every 3 months for 2 years, a woman should undergo an ultrasound of the pelvic organs, abdominal cavity and retroperitoneal space, as well as donate blood to determine the level of SCC if she was treated for squamous cell carcinoma.3. SCC is a tumor marker, the level of which is increased in squamous cell carcinoma. During 3 and 4 years, ultrasound and SCC testing is done every 6 months, and then annually3.
In addition, a chest x-ray should be done annually. According to the indications, the doctor may prescribe other examinations – CT and MRI3.
Popular questions and answers
Our experts answer popular questions about the incidence and prevention of cervical cancer: PhD, oncologist Anastasia Dubinina, obstetrician-gynecologist Aren Megrabyan and epidemiologist Nikolai Dubinin.
At what age is cervical cancer most common?
How common is cervical cancer?
Which factor increases the risk of cervical cancer?
– I would single out another risk factor – a rare visit to the gynecologist, – Anastasia Dubinina notes. – Many women spare no time and money for self-care, but do not care about their health. Meanwhile, a good gynecologist is much more important for a woman than a good cosmetologist or nail service master. Therefore, my advice is to find a competent specialist with a high level of cancer alertness. And at least once a year to come for a preventive examination, and once every 3 years to take a smear for cytology.
Sources of:
- Cervical cancer. Clinical guidelines 2020. “Association of Oncologists of Russia”, “Russian Society of Clinical Oncology”, “Russian Society of Specialists in the Prevention and Treatment of Tumors of the Reproductive System”. file:///C:/Users/sstar/Downloads/%D0%A0%D0%B0%D0%BA%20%D1%88%D0%B5%D0%B9%D0%BA%D0%B8%20 %D0%BC%D0%B0%D1%82%D0%BA%D0%B8%20%D0%BE%D1%82%202020.pdf
- Vaccination of diseases caused by the human papillomavirus: positions of evidence-based medicine. Review of clinical guidelines. https://clck.ru/ek9Y9
- Practical guidelines for drug treatment of cervical cancer. 2021 Khokhlova S.V., Kolomiets L.A., Kravets O.A., Morkhov K.Yu., Nechushkina V.M., Tyulandina A.S., Urmancheeva A.F. https://rosoncoweb.ru/standards/RUSSCO/2021/2021-13.pdf