It is Cervical Cancer Prevention Week this week. Cervical cancer is the 4th most common cancer in women and can be easily cured if diagnosed at an early stage and treated promptly.

Prevention

Prevention of cervical cancer starts at a young age. The HPV vaccine is offered to children aged 11-13 in the UK and can be offered to people up to age 25 if they missed their vaccine at school.

The human papillomavirus (HPV) is a very common virus which rarely causes problems and your body can fight off HPV without even knowing you had it. Some types of HPV can however cause problems such as cancer; these are known as high risk types of HPV.

The vaccine helps to protect against HPV infection and covers 9 strains of HPV. It is noted on Cancer Research UK that this vaccine has been proven to reduce rates of cervical cancer in England. The HPV vaccine | Cancer Research UK

Cervical screening

When you are coming up to your 25th birthday, you will be invited for a routine cervical screening test, sometimes referred to as a smear test. This is a test which looks for HPV. You will be invited to a cervical screen up to 6 months before your 25th birthday and should you receive the all clear, you will therefore be invited to attend cervical screenings every 3 years up until you reach 50 years and thereafter every 5 years until you reach 64 years old.

What happens at the cervical screening?

During this appointment, you will be seen by a nurse or doctor at your GP’s practice and you will be offered a chaperone. The test is a very short test, lasting approximately 5 minutes. You will lie on your back with your knees bent apart. A speculum is inserted into the vagina to provide a clear view to the cervix. A small plastic brush is swept across the cervix 5 times to take a sample of cells.

What do my results mean?

Following the screening, the sample of cells is sent to a laboratory for testing. The cells will be tested for high-risk types of HPV which can cause cell changes in the cervix. These cell changes, over time, can develop into cancer. It is worth noting that not all cell changes will develop into cancer. The test results can take up to 6 weeks to arrive via letter.

If no HPV is found, this means that you have no risk of HPV or cell changes, and you will be routinely invited back for cervical screening 3 years after your last test (or 5 years if you are over 50).

If HPV has been found but no there is no evidence of cell changes, this means you have a high risk of HPV but no changes of which to be concerned. You would expect to be invited back for a further screening after 12 months to check whether the HPV has gone.

If HPV is found and there are cell changes, you will need to attend for further testing at the gynaecological clinic at the hospital. The letter will reference these changes as “dyskaryosis” which means abnormal changes in the cells of the cervix. You should be reassured that changes in your cells does not mean that you have cancer. There are different stages of cell changes which are investigated further, some of which can return to normal on their own.

Colposcopy services

If you have been invited to the hospital for a colposcopy, this test looks at your cervix in more detail. This colposcope is a large magnifying glass that allows the doctor/specialist nurse to look closely at the skin of the cervix and allow the doctor/nurse to notice any changes.

During this appointment, it may be necessary to take biopsies of the cervix which will be sent off for testing. This allows testing for specific grading of the abnormal cells. The doctor/nurse may also see an area of abnormal cells which they may treat on the day.

Abnormal cells

During the colposcopy the doctor/nurse may be able to advise what type of cell changes you present with, or your biopsy will come back with the results of the cell changes. These include CIN1, CIN2 and CIN3.

CIN1

These are low grade changes, and the chance of developing cancer is unlikely. The abnormal cells usually go away on their own with your immune system fighting off the HPV and you will be invited into have a further cervical screening in 12 months’ time. This further screen will check the changes have returned to normal and you no longer have HPV.

CIN2 and CIN3

These are high grade cell changes, and you will qualify for treatment to remove the cells. For CIN2, you may be offered the watch and wait method whereby you attend the hospital for colposcopies and biopsies every 6 months for 2 years to check on the progress of the

abnormal cells. If after the 2 years the HPV and abnormal cells have not gotten any better or has worsened to CIN3, you will be advised to undergo treatment. This treatment will lower the risk of developing cervical cancer.

Treatment

The following treatment is used to remove the area of abnormal cells from the cervix and provides the clinicians the opportunity of examining the cells under microscope to ensure your screening results are accurate and ensure they have removed the full area of abnormal cells.

• LLETZ (large loop excision of the transformation zone) – this is where a thin wire loop is used to remove the abnormal cells on the area around the opening of the cervix.
• NETZ (needle excision of the transformation zone) – very similar to the LLETZ but instead of a loop it is straight. This treatment is used if the abnormal cells are inside the cervical canal.
• Cone biopsy – this is a minor operation where the doctor removes a cone shaped wedge of tissue from the cervix.
• Surgery – in some cases, if you are past your menopause, or have children, your doctor may suggest removing your womb which includes your cervix which prevents any risk of cervical cancer in the future.

Following the LLETZ, NETZ and cone biopsy you will be invited back for a cervical screen. This is to ensure the cervix is now free from abnormal cells and HPV. If you are not clear, you will undergo further treatment.

We would like to remind people how important it is to attend your cervical screening tests when invited to reduce the risk of cervical cancer in the future. If you are overdue a cervical screening test, contact your GP to arrange this as soon as possible.