India has a population of 511.4 million women aging 15 years and older who are at risk of cervical cancer. Nearly 1,23,097 women are diagnosed with cervical cancer and 77, 348 die from the disease. It is the second most frequent cancer among women between 15 and 44 years. It is caused by various strains of HPV ( Human Papillomavirus) and nearly 83.2% of invasion cervical cancer are attributed to HPV 16 or 18.Screening for HPV is very important in the prevention and management of cervical cancer.
Maybe asymptomatic or symptomatic Symptoms
1.Vaginal bleeding- irregular, inter menstrual postcoital ,post menopausal
2.Vaginal discharge- copious, purulent, malodorous Severe weight loss
3. Urinary Symptoms - Dysuria, frequency urinary incontinence due to VVF(in advance cases)
4. Rectal symptoms - rectal pain
6. Pain - Dyspareunia. low backache, deep pelvic pain.
Pap smear, also called pap test, is a procedure to test for cervical cancer in women. In this test, doctor collect cells from your cervix (the mouth of uterus) and send them to a pathologist for examination. Before complete cancerous changes, there are pre cancerous changes in cells of cervix. With this test, those changes can be detected and survival can be significantly enhanced. Detecting these normal cells early with a pap smear is your first step in halting the possible development of cervical cancer.
This is an OPD procedure taking only 5 to 10 minutes usually. During a pap test, a tool called speculum holds the vaginal wall apart. A sample from the cervix is collected using a soft brush and a
flat scraping device called spatula. The cells are placed in a bottle that contains a solution to preserve cells. Or the cells may be smeared onto a slide. Later the cells are checked under a microscope.
In general, pap test is done for all women between ages 21 to 65 years and to be repeated every 3 years. Women aged 30 and older can go for pap testing every 5 years if they combine it with HPV testing or they can under go HPV testing instead of pap test which is also done in the same way. If you have certain risk factors then doctor may advise you to undergo this test more frequently.
1. A previous pap smear that should pre- cancerous cells
2.HIV infection
3. Weakend immune system due to organ transplant, chemotherapy or chronic corticosteroid use
4. History of smoking
1. After total Hysterectomy - After removal of complete uterus with cervix, done for non cancerous reason such as fibroid you may discontinue routine pap smear after discussing with your doctor. But if your hysterectomy was not total, cervix was left behind or if it was done for a pre-cancerous or cancerous condition of cervix , doctor may ask you to continue test.
2. Older age- Pap tests can be stopped at age of 65 years if your previous tests were negative. But if you are sexually active with multiple partners, the doctor may advise you to continue pap testing.
With routine pap test, the risk of full blown cervical cancer can be reduced significantly It's s a mandatory part of routine gynecological checkup for every women around the world.
"Five warning signs include: 1) Vaginal bleeding (irregular, inter-menstrual, postcoital, post-menopausal) 2) Vaginal discharge (copious, purulent, malodorous) 3) Severe weight loss 4) Urinary symptoms (dysuria, frequency, incontinence) 5) Pain (dyspareunia, low backache, deep pelvic pain). Rectal symptoms may also occur in advanced cases."
If abnormal/positive, it doesn't mean cervical cancer. It means abnormal cells are found, likely caused by HPV. Changes may be low-grade or high-grade. A gynaecologist might recommend more frequent Pap tests, further tests like colposcopy or biopsy. Early detection through a Pap smear allows treatment before full-blown cancer develops.
"The 5 cervical cancer screening methods are: 1. Papanicolaou (Pap) test 2. HPV testing 3. Liquid-based cytology (LBC) 4. Visual Inspection with Acetic Acid (VIA) & 5. Endocervical curettage (ECC)"
Pap testing should begin at age 21 once sexually active, even if the cervical cancer vaccine was taken. It's done for women between the ages of 21 and 65 years and is repeated every 3 years. Women aged 30+ can undergo testing every 5 years if combined with HPV testing. Testing may stop at 65 if previous tests were negative.
