As this week, 10 to 16 June 2019, is cervical screening awareness week, Penningtons Manches is supporting charities such as Jo’s Cervical Cancer Trust in the campaign to help women understand the vital importance of cervical screening.
Every year in the UK, around 3,000 women are diagnosed with cervical cancer. Although cervical cancer is the most common cancer in women aged 35 and under, it is preventable in 99.8% of cases.
In 2015, more than 3,100 women in the UK were diagnosed with cervical cancer of whom 854 died as a result of the disease. Once a diagnosis has been made, the survival rate at 10 years is around 63%.
Penningtons Manches is publishing a series of articles during the awareness week on a range of cervical screening issues. This first article focuses on the basics to help ensure that all women have a fundamental understanding of why cervical screening is so important.
The cervix is the narrow passage which connects the vagina and the uterus. There are two main parts of the cervix:
There is an overlapping border between the ectocervix and the endocervix known as the transformation zone.
HPV is a virus that affects the skin. It has over 100 different types or strains and can be spread by skin to skin contact of the genital area; vaginal, anal or oral sex; and through sharing sex toys. HPV can be contacted without penetrative intercourse.
In most people, HPV does not have any harmful effects but some strains of HPV can cause abnormal cell changes that may develop into cervical cancer.
Preventing the spread of HPV can be difficult. Safe sexual intercourse with condoms is encouraged. In 2008, a free vaccination was introduced to all girls aged between 12 and 18.
Testing for HPV is part of the cervical screening programme.
Cervical cancer is the growth of abnormal cells at the cervix. Almost all cases of cervical cancer are caused by HPV.
All women in the UK between the ages of 25 and 64 are invited to attend for a cervical smear test. There is a misconception that the smear test is undertaken to look for cancer but cervical screening is, in fact, undertaken to help detect abnormal cells which may develop into cancer at a later date if left untreated.
Recent studies reported by Public Health England showed a decline in the number of women attending their tri-annual smear test. In some areas of the UK, it is estimated that up to 50% of women had not attended them.
The cervical screening process is designed to detect abnormal cells in the cervix as well as HPV. HPV is found in 99% of all cervical cancers diagnosed. During the cervical screening, abnormal cells may be detected which can then be treated before they become cancerous.
Approximately one in 20 smear tests show abnormal changes to the cervical cells known as dyskaryosis.
Cervical abnormalities are either cervical intraepithelial neoplasia (CIN) - the abnormal growth of cells on the surface of the cervix called the ectocervix - or, less commonly, cervical glandular intraepithelial neoplasia (CGIN) - the abnormal growth of cells on the cervical canal called the endocervix. These are then graded between one and three according to the severity of the dyskaryosis with one representing mild and three severe.
An abnormal smear test does not mean you have cancer.
Results from a cervical smear test should be received within two weeks of the test. If the result is positive, there are a number of possible options.
Some abnormalities will not require any treatment at all and will simply be monitored with a further cervical smear test in six or 12 months’ time.
Most women with an abnormal smear result will be invited to have a colposcopy. This is an examination similar to the smear test which is undertaken by a nurse known as a colposcopist or a doctor who is a gynaecologist. The examination looks more closely at the abnormalities on the cervix. During a colposcopy, a biopsy may also be taken of the abnormal cells. This sample will be checked for pre-cancerous or cancerous cells.
In some cases, the biopsy may be sufficient to remove the abnormal cells while in others further treatment may be required.
The most common treatment is a large loop excision of the transformation zone (LLETZ). During this procedure, a thin wire loop heated with an electric current is used to remove the abnormal cells under a local anaesthetic.
Sometimes a second LLETZ treatment may be required. In 95% of cases two LLETZ procedures will be curative of the abnormal cells. Six monthly smear tests may then take place over the next year or so to monitor for any recurrence of abnormal cells.
Other treatment options include a cone biopsy which involves a general anaesthetic to remove the tissue containing the abnormal cells; cryotherapy to freeze and destroy the abnormal cells; laser treatment to pinpoint and remove the abnormal cells; and cold coagulation where a heat source is applied to burn away the abnormal cells.
In the early stages of cervical cancer there are often no symptoms. However, the most common symptoms include:
Such symptoms should be reported to a general practitioner who should refer the patient to a gynaecologist under the two-week wait procedure.
A referral to a gynaecologist for a colposcopy and biopsy is usually the first step in the diagnosis of cervical cancer. Other testing procedures such as a pelvic examination, blood tests, CT or MRI scan may be performed to further identify the cancer and determine whether it has spread to other areas of the body. Localised treatment such as LLETZ or cone biopsy may be possible if the cancer has not spread outside the cervix.
If cervical cancer is detected very early, surgery such as a trachelectomy to remove the cervix or a hysterectomy to remove the cervix and uterus may be performed. Sometimes the ovaries and fallopian tubes may be removed. These surgeries are known as an oophorectomy and salpingectomy respectively and they may be followed by radiotherapy.
Radiotherapy is thought to be the most effective treatment following surgery. Radiation is used to destroy the cancerous cells. Internal radiotherapy, known as brachytherapy, is also sometimes used as a treatment.
If the cervical cancer is more advanced, a combination of radiotherapy and chemotherapy is the usual course of treatment. Chemotherapy uses medication to destroy the cancerous cells by preventing the cells from growing and reproducing.
Cervical cancer can be curable if diagnosed early. The number of deaths from cervical cancer have fallen rapidly from 74% in the early 1970s to around 24% over the last decade.
In 2016, death from cervical cancer accounted for only 1% of all cancer deaths. This reduction in mortality rates is due to the preventability of cervical cancer. However, preventability depends on the engagement of women with the cervical screening programme, which is why it is so important that all women attend their smear test when called to attend.