The month of January is considered as Cervical Health Awareness Month and this is a chance to raise awareness about how women can protect themselves from Human Papillomavirus (HPV) and Cervical cancer. Nearly 13,000 women in the United States are diagnosed with cervical cancer each year, but the disease is virtually always preventable with vaccination and appropriate screening (Pap and HPV tests). Over last 30 years, cervical cancer death rate has gone down by 50%. The main reason for this change is the increased use of screening tests. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early -when it’s small, has not spread, and is easiest to cure. Another way to help prevent cervical cancer in the future is to have children vaccinated against human papilloma virus(HPV), which causes most cases of cervical cancer.

What Is Cervical Cancer?

Cervical cancer starts in the cells lining the cervix — the lower part of the uterus (womb) is uterine cervix or mouth of uterus .

In the development of cervical cancer cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. It usually takes several years for cervical pre-cancer to change to cervical cancer, but it also can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. These pre-cancerous changes can be detected by the Pap test and treating all cervical pre-cancers can prevent almost all cervical cancers.

What Are the Risk Factors for Cervical Cancer?

Several risk factors increase the chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it may not be possible to say with certainty that a particular risk factor was the cause.

1)Human papillomavirus (HPV) infection: The most important risk factor for cervical cancer is infection by the human papillomavirus (HPV). HPV is a group of more than 150 related viruses, some of which cause a type of growth called papilloma’s, which are more commonly known as warts.

HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs. HPV can be spread from one person to another during skin-to-skin contact. One-way HPV spread is through sexual activity, including vaginal, anal, and even oral sex.
Different types of HPV cause warts on different parts of the body. Certain types cause warts on or around the female and male genital organs and in the anal area. These are called low-risk types of HPV because they are seldom linked to cancer.

Other types of HPV are called high-risk types because they are strongly linked to cancers, including cancers of the cervix, vulva, and vagina in women, penile cancer in men, and cancers of the anus, mouth and throat in men and women. The high-risk types include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45, as well as some others. There might be no visible signs of infection with a high-risk HPV until pre-cancerous changes or cancer develops. Doctors believe that a woman must be infected with HPV in order to develop cervical cancer. Although this can mean infection with any of the high-risk types, about two-thirds of all cervical cancers are caused by HPV 16 and 18.

Infection with HPV is common, and in most people the body can clear the infection by itself. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as cervical cancer.

2)Multiple sexual partners: The greater your number of sexual partners — and the greater your partner’s number of sexual partners — the greater your chance of acquiring HPV.

3)Early sexual activity: Having sex at an early age increases your risk of HPV.

4)Other sexually transmitted infections (STIs): Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.

5)A weak immune system: You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.

6)Smoking: Smoking is associated with squamous cell cervical cancer.

Can Cervical Cancer Be Prevented?

The most common form of cervical cancer starts with pre-cancerous changes, and there are ways to stop this disease from developing. The first way is to find and treat pre-cancers before they become true cancers, and the second is to prevent the pre-cancers.

Get vaccinated against HPV: Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active.

Have routine Pap tests: Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest women begin routine Pap tests at age 21 and repeat them every few years.

Practice safe sex: Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer.

Don’t smoke.

What is The Pap (Papanicolaou) Test?

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under the microscope to find cancer and pre-cancer.

How often cervical screening tests needs to done?

The American Cancer Society recommends that women follow these guidelines to help find cervical cancer early. Following these guidelines can also find pre-cancers, which can be treated to keep cervical cancer from forming.
All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (it may be used as a part of follow-up for an abnormal Pap test).

Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This is called co-testing and should continue until age 65. Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.

Women who are at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long-term steroid use) or because they were exposed to DES in utero may need to be screened more often. They should follow the recommendations of their health care team.

Women over 65 years of age who have had regular screening in the previous 10 years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers (like CIN2 or CIN3) found in the last 20 years (CIN stands for cervical intraepithelial neoplasia and is discussed later in the section Work-up of an abnormal Pap test result under the heading How biopsy results are reported). Women with a history of CIN2 or CIN3 should continue to have testing for at least 20 years after the abnormality was found.

Women of any age should NOT be screened every year by any screening method. Women who have been vaccinated against HPV should still follow these guidelines.

Can a vaccine help prevent Human papilloma virus infection?

Yes. Vaccines are available to help prevent infection by certain types of HPV and some of the cancers linked to those types. All of these vaccines help prevent infection by HPV-16 and HPV-18. These 2 types cause about 70% of all cervical cancers and pre-cancers, as well as many cancers of the anus, penis, vulva, vagina, and throat. Gardasil 9 helps prevent infection by 4 types of HPV (16, 18, 6 and 11), plus 5 other high-risk types: 31, 33, 45, 52 and 58. Together these types cause about 90% of cervical cancers.

Who should be vaccinated against HPV and when?

HPV vaccine produces the strongest immune response in preteens. To work best, the HPV vaccines should be given at age 11 or 12. The vaccines are given in a series of shots.

The American Cancer Society’s recommendations for HPV vaccine use

Routine HPV vaccination for girls and boys should be started at age 11 or 12. The vaccination series can be started as early as age 9. HPV vaccination is also recommended for females 13 to 26 years old and for males 13 to 21 years old who have not started the vaccines, or who have started but not completed the series. Males 22 to 26 years old may also be vaccinated.

HPV vaccination is also recommended through age 26 for men who have sex with men and for people with weakened immune systems (including people with HIV infection), if they have not previously been vaccinated.

Cervical cancer is the only cancer which can be prevented to certain extent by vaccination. A well-proven way to prevent cervix cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. The Pap test (or Pap smear) and the HPV (human papillomavirus) test are used for this. If a pre-cancer is found, it can be treated, stopping cervical cancer before it really starts.

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