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Top 10 questions & answers about cervical cancer

To mark Cervical Cancer Awareness Week – a UK-wide initiative led by Jo's Cervical Cancer Trust – Mr Jullien Brady, Clinical Advisor for GynaeHealth UK (part of Check4Cancer group of companies), answers some key questions about cervical cancer, detection and treatment.

 

Jullien BradyMr Jullien Brady is a Consultant Obstetrician and Gynaecologist at Bedford Hospital,with extensive experience in the UK cervical screening programme.

He is one of the National Quality Assurance Directors and Lead Colposcopist representing the East of England for both of these roles, and a member of the Executive Committeeof the BSCCP, the governing body of Colposcopy.

Q1 What are the cervical cancer signs and symptoms?

If you experience bleeding between periods, after sex or after menopause, you should see your GP immediately. You may also have other vaginal discharge or pelvic pain – but early stage cervical cancer may have no symptoms at all, which is why regular screening is so important. Screening can spot the signs long before any symptoms will be felt.

Q2 How common is cervical cancer and is it on the increase?

Cervical cancer is the most common cancer in women under the age of 35. There were around 31,300 new cases of in situ cervical carcinoma in the UK in 2013 – that’s 86 cases diagnosed every day. But since the late 1970s, in situ cervical carcinoma incidence rates in females have more than quadrupled (a 339% increase) in Great Britain, but over the last decade, in situ cervical carcinoma incidence rates in females have increased by less than a fifth (16%) in the UK. So, the increase is slowing, and we are getting much better at detecting and treating it. This is almost entirely due to the effectiveness of screening, and the national screening programme in particular. Within four years of it being introduced in 1988, incidence had dropped by 50%, and within six it had dropped by about two thirds. In terms of the number of lives saved, it was calculated in 2012 that it had saved about 100,000 lives by that point. Early detection is critical; if cervical cancer is diagnosed in the early stages, up to 90% of women under 40 will survive.

Q3 Is there anything I can do to prevent cervical cancer?

There is general advice that holds true for all cancers, as well as overall good health: avoid smoking, limit your alcohol intake, exercise regularly and eat a healthy diet. The most important advice with regard to cervical cancer is to attend screenings. Despite a nationwide cervical cancer screening programme that has been in place in the UK since the 1980s, only 66% of younger women and 80% of older women attend screening – it’s estimated that around 900,000 eligible women do not attend smear tests. The main message is simple: if you are properly screened, you will not die of cervical cancer. I can't guarantee you won't get it, but your chances of dying from it are practically zero, because we can detect it and deal with it. Cervical cancer is an almost entirely preventable disease.

Q4 What causes cervical cancer?

We now know that the majority of cervical cancers are caused by certain strains of a sexually transmitted virus calledHPV. We can test for the presence of that virus using simple techniques that are significantly less invasive than a traditional smear test, and this is one of the key reasons we are able to pre-empt the development of cervical cancer, or catch it at an early stage. We are also now vaccinating school-age girls against some of the most high-risk strains of HPV, using a vaccine called Gardasil.

Q5 What is HPV?

HPV stand for ‘human papillomavirus’. People are sometimes alarmed to learn that this is a sexually transmitted virus, which can have a stigma attached to it, but the important thing to understand about HPV is that it is endemic in the population. Everybody who is sexually active is exposed to it – it is not a sign of promiscuity – and even condoms do not necessarily protect against it. So, we need to put that stigma aside.

Q6 How is cervical cancer treated?

This depends entirely in what stage it is at when detected. Proper testing can pick up changes in cells that indicate they are likely to turn cancerous, and these cells can be removed by relatively simple surgery or burned away using various techniques, including lasers. If the cancer is more advanced the patient will be treated with radiotherapy and/or chemotherapy and may also require more radical surgery. This can involve radical trachelectomy, where the cervix, surrounding tissue and the upper part of the vagina are removed; hysterectomy, in which the cervix and womb are removed (and potentially also the ovaries and fallopian tubes) and pelvic exenteration – a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed.

Q7 Who is most at risk? Is it only a younger woman’s cancer?

There are two peaks with cervical cancer, one in the mid-30s, then another in the mid to late 60s. This is quite unusual for cancer, because most cancers follow a pattern where the older you get, the higher the risk becomes. But because cervical cancer is related to HPV – a sexually transmitted virus – the first peak is on account of what people did in their youth, and the second peak is due to mid-life divorces, second relationships, people being back on the dating market and so on. The time delay between exposure and getting cancer is about 15-20 years. Most people have most sexual partners early in their sexual career – late teens, early 20s – which means that first peak occurs at 35-40, then second relationships in the mid to late 40s and early 50s create another peak around later. So, that second peak is directly related to women being exposed to a new raft of HPV when they enter second relationships. If they are not exposed to those – if they are not sexually active or are in a stable, monogamous relationship – the risk remains unaffected.

Q8 Who is eligible for a cervical screening on the NHS?

Eligibility varies according to which country in the UK you live in. England, Northern Ireland and Wales, Women aged 25–49 are invited every three years, and women aged 50–64 every five years. In Scotland, women aged 20–60 have until recently been invited every three years. However, in 2012 the UK National Screening Committee recommended a uniform screening age of 25 to 64 across all UK countries, and these changes are due to be implemented in Scotland from 6 June 2016.

Q9 What are alternative cervical cancer screening options?

Sometimes, women outside of the NHS testing ranges who are worried that they are at higher risk may wish to be checked for peace of mind. This is where GynaeCheck and Check4Cancer come in. Our checks are a two-stage process, with GynaeCheck or Check4Cancer providing the initial part of the test, to establish first whether the woman has the presence of the high-risk HPV virus. The advantage of this is that the test can be administered by the woman herself in the privacy her own home. She doesn’t need to make an appointment, the instrument is no bigger than a super-size tampon, and feedback on early use of it has been very positive. The sample is then sent away, and they are then told whether or not they are high-risk HPV positive. If they are, only then will they need a smear test, which they can still get under the NHS.

Q10 Are the results of cervical screening reliable?

Statistics show that cervical screening is 80–90% reliable and can prevent 60–80% of cervical cancers. This means that seven out of every 10 cases of women who would have developed cancer of the cervix can be prevented.

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