TEST: This swab is used in a Pap smear to gather a few cells from the cervix. It is then smeared on a slide for the lab examination to check for abnormal cells. • MCT photo.
TEST: This swab is used in a Pap smear to gather a few cells from the cervix. It is then smeared on a slide for the lab examination to check for abnormal cells. • MCT photo.

Women need to start getting tested for signs of cervical cancer from the age of 21.

Although half of all cases of the disease occur in women aged 35 to 55, early prevention is key.

The cancer can easily be prevented through an HPV vaccine but can be detected early through regular Pap (Papanicolaou) tests or smears.

Your doctor or gynaecologist can perform the simple procedure at a routine check-up.

Deaths

Cervical cancer can take years to develop but takes hold when cancerous cells grow and divide to form a mass or tumour in the tissue of the cervix — the lower end of a woman’s uterus (womb).

If the disease is not detected early, the cancer becomes invasive and spreads from the surface to tissue deeper in the cervix and other parts of the body.

In the U.S., cervical cancer is the second-most common cancer to affect women’s reproductive organs.

Each year 10,000 women are diagnosed with invasive cervical cancer and 4,000 die.

In developing countries the disease is the leading cause of death from cancer for women, with rates highest in Central America and Sub-Saharan Africa.

Detection

But most cases of cervical dysplasia (abnormal cells) are detected during routine Pap tests.

The smear test examines cells from the cervix to find any abnormal changes before cancer develops.

If abnormal cells are detected early enough, treatment can be given and cervical cancer can be prevented.

It is important to remember that this cancer takes many years to develop.

Even if cells are detected, if they are in-situ (not invasive) the disease is highly-treatable and curable.

Therefore, having regular Pap tests is the best method to protect yourself.

Precautions

In Bermuda, it is recommended that:

  • Women should have their first Pap smear by the age of 21.
  • Women aged between  21 and 29 who are not at high risk should have a smear every two years.
  • Women aged 30 and older who have not had any abnormal Paps should have  them every three years. 
  • Women aged 65 and over who have had three or more consecutive normal tests and no abnormal results in the past 10 years, can discontinue the test.
  • Women of all ages should have an annual chat with their doctor to identify any risk factors which may require more frequent screening.
  • Half of all cancers of the cervix occur in women aged 35 to 55.

Risks

Various strains of a sexually-transmitted infection known as Human papillomavirus (HPV) cause most cases of cervical cancer. 

Other risk factors are:

  • Smoking — this can increase the risk of pre-cancerous changes.
  • A weak immune system —– such as from HIV infection.
  • Sexual history — multiple sex partners, or sex with someone who has had multiple partners, or sexual activity in adolescents.
  • Sexually-transmitted diseases (STDs) — Chlamydia, Gonorrhea, Syphilis or HIV/AIDS, increase the chance of acquiring HPV.
  • Prolonged use of birth control pills in women who have HPV infection.
  • Delivery of more than five children in women who have HPV infection.
  • Having the HPV virus or other risk factors however, does not mean a woman will develop cervical cancer. Most women with risk factors never develop the disease.

Symptoms

Early cervical cancer generally produces no symptoms.

That is the main reason why regular screening is so important. As the cancer progresses the following symptoms may occur:

  • Vaginal bleeding after intercourse, between periods or after menopause.
  • Watery, bloody vaginal discharge that may be heavy and have foul odour.
  • Pelvic pain or pain during intercourse.

Procedures

Since most cases of the cancer are detected during a Pap smear, if a woman has an abnormal result, more tests are needed to confirm a diagnosis. They may include:

  • Colposcopy — a special microscope that examines the cervix. This can be done in a doctor’s office.
  • Biopsy —  tissue from the cervix is obtained under local anaesthetic. The sample is then examined by a pathologist.
  • Cystoscopy — a visual examination of the bladder and colon using a special scope to see if the cancer has spread to surrounding organs.
  • Imaging Studies — a chest X-ray, CT scan, MRI scan or PET scan to determine the presence and spread of cancer cells.

Vaccine

In the last 50 years, the death rate from cervical cancer has greatly decreased, largely due to Pap smear screenings.

Today, most cases can also be prevented with the HPV vaccine. This safe and highly-effective vaccine protects against four types of HPV, including the high-risk HPV-16 and HPV-18, which cause 70 per cent of cervical cancer. 

Ashley DaCosta is the education officer for Bermuda Cancer and Health Centre. For more information on cervical cancer go to: www.chc.bm or contact your doctor.