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This cancer is still killing women in our country, but almost does not occur in Scandinavia. This is due to the fact that we neglect screening tests, i.e. ordinary cytology. Cervical cancer most often causes persistent infection with an oncogenic type of HPV. Unfortunately, there are about 200 of these dangerous varieties. It is comforting that it takes an average of 13 years from infection to cancer development. A cytology performed at this time can save your life. At the Warsaw Clinical Hospital. Fr. Anna Mazowiecka, it will be possible to perform it for a week for free and without a queue. Let’s hope that cities all over Poland will start a similar action.
Any woman can develop cervical cancer. It develops asymptomatically and initially does not cause any discomfort, and it can be detected during a routine pap smear test. Symptoms suggesting the possibility of pathological changes in the cervix are most often, for example, vaginal bleeding after intercourse, intermenstrual bleeding and vaginal discharge. Pain in the lower abdomen and lumbar region may indicate the spread of cancer and a stage where treatment is already difficult and severe for patients.
If you are still having a hard time getting used to this study, this text is for you.
Step by step cytology
During the cytological examination, cells are collected from the cervix with a special disposable plastic brush. They are then viewed under a microscope to see if they have early changes that, if ignored and not treated, can lead to cancer development. It is very unlikely that a cervical cancer will develop in a woman who gets regular Pap smears. If the cytology result shows any abnormalities, treatment is initiated to prevent the development of cancer. So having an abnormal test result doesn’t mean you already have cancer, but that you should receive treatment to prevent it from happening.
Cytology, what is it?
The cervix is the bottom part of the uterus that connects it to the vagina. Before the examination, you will be asked to undress from the waist down. If you are wearing a loose skirt, you can only take off your underwear. The examination is performed on a gynecological chair. Bend your knees and spread them sideways. Your doctor or nurse will insert an instrument called a speculum into your vagina. The speculum painlessly opens the vaginal canal. Your doctor or nurse will use a thin brush to pick up cells from the surface of the cervix. Placed on a special slide, they will be sent to the laboratory for testing.
Why is cervical screening recommended?
Cervical cancer is a disease that we can prevent because early changes that indicate the possibility of the cancer developing can be detected. Cervical cancer cases are declining as a result of Pap screening, so fewer women die from it. Mortality caused by this cancer in Poland is slowly but steadily decreasing. The current mortality rate for Polish women is 12 percent. lower than in 2009–2010. Cervical smear screening is not a cancer test. They are performed in order to detect early cervical lesions that, if left untreated, may lead to cancer in the future. In most women, the collected cells do not show any disturbing changes. According to data from the UK NHS, around 6 out of 100 women tested will have a result that requires further testing or treatment. The presence of abnormal cells indicates that cancer may develop in the future. Treatment will prevent the tumor from developing.
Free smear tests – what does it look like in practice?
Who can use the program?
The cervical cancer prevention program is addressed to women aged 25–59 who have not had a Pap smear test in the last 3 years. In women with risk factors: HIV-infected, taking immunosuppressants, infected with HPV – the high-risk type, the test is performed every 12 months.
Where can I do the test?
Prophylactic pap smear can be performed in any gynecological office that provides services under the contract with the National Health Fund. No referral is required to the gynecologist. Cytology may be the only purpose of a clinic visit. The examination may be performed by a doctor, as well as by a midwife with an appropriate certificate of abilities in the scope of taking cytological swabs issued by the Central Coordinating Center of the Cervical Early Cancer Detection Program.
Women younger than 25 and older than 59 can benefit from a Pap smear as part of the advice of a specialist doctor.
How to prepare for the test?
The optimal period for collecting cytological material is between the 10th and 20th day of the cycle. You should refrain from sexual intercourse for a minimum of one day before the examination.
You should not use vaginal medications or perform medical procedures on the vagina and cervix for several days before the examination.
Cytology may be performed at least one day after the gynecological examination or vaginal ultrasound.
The smear should be collected for a cytological examination at least 2-3 days after the end of menstrual bleeding.
The speculum examination should precede the vaginal examination – no smears should be collected immediately after the gynecological examination.
Pap smear is not performed during an active infection of the genital tract with accompanying vaginal discharge.
What do the results of the cervical cancer screening mean?
The result of the screening test performed as part of the preventive program should be reported on the Bethesda system and should be received within fifteen working days of the test date. If the cytological test result is abnormal, the obstetrician-gynecologist will apply appropriate treatment or refer the patient to further diagnostics, which is a colposcopic examination, performed as part of the program. If it is necessary to verify the colposcopic image, targeted specimens are taken for histopathological examination. On this basis, decisions are made regarding further diagnostic and therapeutic procedures: referral for treatment or setting the date of another cytological examination.
What is the Bethesda System?
Pap smear results are assessed using the currently recommended Bethesda grading system. It allows to determine whether the collected material is suitable for evaluation and whether the cytological image is correct. It is a detailed description of changes in accordance with the applicable terminology.
Classification of epithelial cell abnormalities in the Bethesda system:
ASC – atypical squamous epithelial cells
· ASC – US – cells with undefined meaning
LSIL – low grade intraepithelial changes
· HSIL – ASC – H – high grade intraepithelial changes
HPV – human papillomavirus infection
· CIN I – intraepithelial neoplasia, i.e. neoplastic cells
CIN II – moderate dysplasia
· CIN III – high-grade dysplasia · squamous cell carcinoma
If the description of the test result shows: AGUS / ASCUS, it means that the result is incorrect. It indicates inflammation, but no cancer cells were found in the sample. The abbreviations used are the names of cells that are difficult to unambiguously classify: atypical AGUS (cervical canal) or ASCUS (part of the outer cervix) cells. So you have to cure the infection, and then do another, follow-up cytology. The LSIL result shows that there are single cells in the sample that can develop into tumors. Perhaps it is also inflammation.
The cytological picture of HSIL shows that there are many cells in the smear, from which neoplasms can arise. Along with the cytology result, information about whether the sample collected for analysis is suitable for evaluation is also provided. If not, the test must be repeated.
What Happens After Getting the Results?
If the result was correct, you will get with the result:
– in the absence of risk factors, a recommendation to re-submit to the study after three years,
– if there are justified medical indications (women infected with HIV, taking immunosuppressants, infected with high-risk HPV type) – recommendation to perform an earlier cytological examination under the Program (after twelve months).
If the result was incorrect:
– you will receive the result along with a referral to the facility implementing the stage of in-depth diagnostics of the program,
– if you do not report the result within three months, you will be called to collect it and refer you to the facility performing the in-depth diagnostics of the program.
What is the stage of in-depth diagnostics?
The stage of in-depth diagnostics includes:
Colposcopic examination (using a colposcope – an optical device),
Collection of targeted specimens for histopathological examination (biopsy) – if after the colposcopic examination it was necessary to verify the examination,
· Microscopic examination of the collected material – histopathological examination,
Diagnosis based on the conducted tests,
· Making a decision as to what to do next (referral for treatment or appointment of the next Pap smear test).
Women diagnosed with cervical cancer or another condition requiring specialist treatment are referred – outside the program – for further diagnostic tests or treatment to a medical facility that has a contract with the National Health Fund for the provision of services for a given type of disease.
What is the human papillomavirus (HPV)?
An additional test is to check for the presence of HPV. Cervical cancer is caused by HPV in more than 99 out of 100 cases. That is why some EU countries fund HPV vaccination for girls.
What is colposcopy?
Colposcopy is a more detailed examination of the cervix. The doctor inserts a speculum and uses a magnifying glass to carefully examine the neck. He lubricates it with a special fluid that makes the abnormal cells visible. During a colposcopy, a piece of tissue may be cut from the cervix (biopsy) for a more accurate cell evaluation. The examination takes approximately 15 minutes. The doctor will order a colposcopy if the cytology result was abnormal.
Why is cervical screening important?
Cervical cancer is not uncommon. It is the sixth most common type of cancer in women in Poland. In recent years, the number of cases has decreased due to cervical screening. However, it is estimated that only when 75% of the population is screened, a 25% reduction in mortality can be achieved.
What are the main risk factors for developing cervical cancer?
• human papillomavirus (HPV) infections,
• age (incidence increases with age, the peak incidence is between 45 and 55 years of age),
• early start of sexual life,
• a large number of sexual partners,
• a large number of births,
• low social and economic status,
• smoking,
• a previously identified pathological change in a cytological examination,
• sexually non-monogamous partners with HPV infection (the risk of developing the disease increases 20 times).
Not only cytology
National Cancer Registry at the Oncology Center – Institute of Maria Skłodowskiej-Curie, informs that today the best strategy in the prevention of cervical cancer is vaccinating young women and continuing cytological screening in vaccinated and unvaccinated. Every sexually active woman must have a Pap smear before starting the vaccination. In this way, existing lesions or cervical cancer should be excluded.
Who should get vaccinated?
According to the recommendations of the Polish Gynecological Society, population vaccinations are recommended in girls before sexual initiation. Women infected with HPV may also benefit from vaccination. Vaccine-induced levels of anti-HPV antibodies have been shown to be very high. Testing for HPV before vaccination is not recommended. The gynecologist should advise the woman about the risks of prior HPV exposure and the potential benefits she may receive after vaccination. All vaccinated women should have regular Pap smears. The vaccine also prevents HPV disease in men. The American Advisory Council on Immunization (ACIP) now recommends routine immunization for all 11-12 year old boys. According to current medical knowledge, HPV vaccines can be safely administered simultaneously with a number of other vaccines.
Contraindications to vaccination against HPV infection are:
– a known allergic reaction to yeast
– severe systemic diseases,
– pregnancy,
– thrombocytopenia and other bleeding disorders that may cause hematoma at the injection site,
– feverish states,
– in people with allergic reactions to numerous antigens (atopy), special care should be taken.
The decision to allow the patient to be vaccinated is made each time by the doctor.
Who can be vaccinated?
The condition for proper vaccination is that the patient is properly qualified. It should be performed in girls and boys by paediatricians, and in teenagers and women by gynecologists and obstetricians. A well-collected medical history plays an essential role in the correct qualification, which should mainly concern:
– current health condition, acute (including febrile) and chronic diseases that the patient suffers from,
– allergies to drugs, foods, vaccine ingredients,
– side effects after previously administered vaccines,
– to know whether the patient has epilepsy,
– clarify whether the patient has diseases that impair the function of the immune system,
– checking whether the patient has been treated with cortisone, prednisone or other corticosteroids, cytostatics or radiation therapy in the past 3 months,
– information on whether a woman qualified for vaccination is pregnant or breastfeeding.
What HPV vaccines are available in Poland?
In Poland, 3 HPV vaccines are available in the form of injections for intramuscular administration:
– Cervarix against 2 carcinogenic types of virus: HPV16 and HPV18
-Silgard against 4 types of virus, including two carcinogenic types HPV16 and HPV18 and two types of HPV6 and HPV11 responsible for genital warts (genital warts)
– Gardasil 9 – against 7 carcinogenic types of HPV (HPV16, 18, 31, 33, 45, 52 and 58) and two types of HPV6 and HPV11 responsible for genital warts (genital warts).
All vaccines listed require 3 doses.
FREQUENTLY ASKED QUESTIONS:
How effective is cervical screening?
It is estimated that three-quarters of all cervical cancer cases can be detected and prevented by cervical screening.
I’ve never had sex. Should I do a Pap test?
The test is recommended for all women, even if they have never had sex. However, the risk of developing cervical cancer in this case is very low, because the main cause of this cancer is an infection caused by the HPV virus, which we become infected during sexual contact. However, there are other, rarer types of cervical cancer that are not caused by HPV. Therefore, women who have not had sex are also at risk.
I am a lesbian. Do I need to do a cytology?
Yes. If you are a lesbian, you should also get tested. There is a risk of developing cervical cancer not caused by HPV. In addition, HPV can also spread between partners. In addition, some lesbians may have had sexual contact with a man in the past.
I have irregular bleeding, do I need a Pap test right away?
Not. Cervical screening is a routine test done in women without any symptoms. Its purpose is to evaluate cells in the cervix that may cause cancer in the future.
Are HPV vaccinations paid?
Vaccinations against HPV are paid. Some local governments in Poland finance vaccinations for children from selected age groups.