JOIN USCervix is the most susceptible site of cancer in women in the developing world and cervical cancer is one of the most common cancers among women world over. One in every five women in the world is suffering from cervical cancer and India has the largest numbers of such patients in the world. It closely follows the number of breast cancer patients in the nation.
Screening for cervical cancer is the most effective method of detecting it at an earlier asymptomatic stage. This aims to reduce the number of women who die from this condition as it provides an opportunity for early diagnosis and treatment, which is particularly relevant in India, where cervical cancer is mostly detected when the symptoms of advanced stage appear. Despite existence of national guidelines, the screening coverage here is not effective.
Screening principles
Cervical screening is a method of examining cells from the cervix (the lower part of the womb). Screening detects pre-cancerous abnormal cells. Once detected early, the chances of these cells to convert to cancer are minimised. The conventional Pap test has been the mainstay of cervical cancer screening. More accurate interpretations of cervical cancer precursors have been achieved by using new liquid-based cervical cytological smear technology. The HPV (human papilloma virus) test finds certain infections that can lead to cell changes and cancer. Regular cervical screening offers the best protection against developing cervical cancer.
Cervical screening aims to screen all women between the ages of 25 to 64 years. A three-yearly screening for the age group between 25 to 49 years and a five-yearly screening between the age group 50 to 64 years is recommended. Women aged 65 and above should undergo screening only if they haven’t been screened since the age of 50 years, or if they recently had abnormal test results. Women aged 65 and above, whose last three test results were normal, do not require further cervical screening tests.
As the risk of cervical cancer is very low in women who never had sex, women in this category may opt out of cervical screening. Cervical screening tests are not usually recommended in pregnancy. After giving birth, women should wait until three months before having a screening test. Women who had total hysterectomy (an operation that involves complete removal of the womb and cervix) do not require cervical screening. However, women who have had a hysterectomy with part or all of the cervix left “in place” will need screening.
Women who have had a total hysterectomy to treat cancer or who had cervical intra-epithelial neoplasia (a type of change in cervical cells that can lead to cancer) at the time of having a total hysterectomy, may need another type of test called a vault smear (sample of cells are taken from the vagina, close to where the cervix used to be).
(The author is consultant obstetrician and gynaecologist, Narayana Multispeciality Hospital, Bengaluru)