Cancer of cervix is second most common after breast cancer.

Reduction in incidence depands on quality of screening program.

Risk Factors:-

  • Age – 45 to 60 years
  • First intercourse in young age
  • Marriage or conception at young age
  • Multiple sexual partner
  • Smoking
  • High – risk sexual partners
  • Immunosuppresion – HIV
  • Infections
    • HPV (Genital wart – type 6 and 11; Oncogenic – type 16 and 18 most commonly)
    • Herpes Simplex Virus - 2

  • Asymptomatic - mostly
  • Postcoital bleeding
  • Postmenopausal bleeding
  • Intermenstrual bleeding
  • Offensive blood stained vaginal discharge

Screening Program:-

Pap Test (Papanicolaou)

Pap smear is screening test for cervical cancer. Cervical cytology is proved to be most efficacious and cost – effective method for cancer screening. By increasing detection of preinvasive and early invasive disease, there is decrease in both incidence and mortality from this cancer.

Types of Pap smear

1.  Traditional Pap Smear: - Cells are scrapped from the surface of cervix using wooden spatula. Then it is fixed and stained for cytological study.

2.   Liquid Cytology Method: - The scrapped cells are suspended in liquid to remove blood, mucus and debris. The remaining cells are then stained. This method helps in identifying the subtype of HPV.

Frequency of Screening

  • Start screening after 3yrs of onset of sexual activity or after attaining the age of 21years.
  • Screen annually – High risk women.
  • Screen every 2 to 3 years - >30years with low risk and 3 consecutive negative test
  • Stop screening - >70 years with 3 negative test in past 10 years
  • Discontinue screening – Total abdominal hysterectomy (uterus and cervix removal)

Vaccination for Prevention (Gardasil and Cervarix)

  • There are 2 vaccines available against HPV associated with development of cervical cancer and genital warts.
  • HPV is given 3 shots over 6 months.
  • 40 types of HPV causes infection in male and female genitalia mostly the wart. The vaccine covers subtype 6, 11, 16 and 18 only.
  • Recommend age for vaccination is 9 to 11 years (Also in-between 13 and 26 years). For women above 26 years, the best way is to get routine cervical screening.
  • Those whose are sexually active – Less effective
  • Not recommended – Pregnant women
  • No need of screening before vaccination. But after vaccination also, screening should be done as vaccine does not protect against all type of cervical cancer. Studies have shown that vaccine is effective for only 10 years.