Cervical Cancer Prevention Week 2024 is an internationally targeted awareness and information campaign to educate the general public about cervical cancer, its prevention and the importance of regular screening and testing. As cervical cancer is largely preventable, this special week serves as a reminder to prioritize health and prevention to reduce the risk of this cancer.
It is an annual initiative that "runs" from January 22 to 28, with many international health care organizations participating, always with the aim of encouraging women to adhere to cervical screening (PAP test and HPV test) and to inform about HPV (human papillomavirus) vaccination. Regular screening (always in accordance with international guidelines and the advice of our gynecologist) can detect abnormal cellular changes in time, which can prevent cervical cancer.
This possibility of preventing this particular cancer led the Director General of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus, in 2018, to emphasize in his global speech that cervical cancer can potentially be eliminated if states adopt a strategy in this direction.
The human papillomavirus (HPV), which can be transmitted through sexual contact, is almost always (about 95%) the cause of cervical cancer.
Vaccination against the HPV virus
It started worldwide in 2006 and opened the perspective for a new era of prevention of cancer and precancerous conditions of the cervix, vulva and vagina.
The vaccine has been approved by all global authorities, the US Food and Drug Administration (FDA), the European Medicines Agency (EMA) and the World Health Organization (WHO) and has been included in the mandatory vaccination (of many countries) and in Greece in National Immunization Program. The initial target group to apply vaccination against HPV they are mainly girls (and boys) aged 9-18 who do not have sexual contacts. In addition, the vaccine is indicated for women aged 15-26 regardless of whether they already have sexual contacts. The protection provided by the vaccine in these cases is likely to be reduced, depending on whether and to which type of HPV there has been previous exposure. In addition, the vaccine can also be given to older women, up to 45 years old.
The vaccine is preventive – not curative for pre-existing lesions
The vaccine protects to a very large extent but does not make a woman invulnerable to either the HPV virus or cervical cancer. She must follow "healthy" sexual behavior, and regular preventive gynecological check-ups and Pap smears (according to her doctor's instructions).
Screening: The basis of the cervical cancer prevention strategy
As he points out, speaking to Greek News And Radio FL, the Oncologist-Gynecologist, Mr. Vasilios Sioulas*, Director of Clinical Gynecological Oncology, "screening for cervical cancer aims at the early diagnosis of precancerous lesions. For this purpose, the Pap test (PAP test) and, in several cases, the HPV test (HPV test) are used."
The importance of cervical cancer screening
"HPV infections, even when they do not cause symptoms, can under certain conditions develop into cervical cancer. Typically, this takes 10-15 years. The aim of the preventive check-up is to diagnose changes in the cervix that either require more frequent follow-up of the patient, or require treatment before they lead to cancer."
How is screening done?
"Preventive screening is done with the PAP test and, in some women, the HPV molecular test. The sampling procedure is the same in both cases. The newest technique for PAP test (liquid phase cytology – ThinPrep) is also applied. Among the advantages of the ThinPrep PAP test is greater diagnostic accuracy, especially in cases of inflammatory or bloody material, and the possibility of simultaneous molecular detection of HPV in the same sample."
When should HPV molecular testing be done?
"With the PAP test, possible changes in the cells of the cervix are detected, which, usually, are the result of HPV infection. On the other hand, molecular testing of HPV allows us to directly detect the virus in cervical cells. When the examination focuses on the types of the virus that are considered high risk (oncogenic types) it is called an HPV test. Conversely, when it can identify all types of the virus, it is called HPV typing. We know, however, that low-risk viruses do not have the biological potential to cause serious changes or cancer in the cervix.
Therefore, based on the guidelines of the American Society for Colposcopy and Cervical Pathology and the American Congress of Obstetricians and Gynecologists, only the determination of oncogenic HPV types should be used when making decisions about the further monitoring and treatment of the patient. Finally, the identification of HPV 16 and 18 is of particular value, given that they exhibit the most aggressive behavior."
When should the HPV test be done?
· "In women whose PAP test shows atypical squamous cells of undetermined significance (ASCUS)
· In women aged 30 and over, at the same time as the PAP test. Due to the greater diagnostic accuracy of the HPV test, the probability that a woman with both negative results will develop severe precancerous changes or cervical cancer in the next 5 years is less than 0.5%
· In the follow-up of patients after the treatment of severe precancerous lesions of the cervix.
*Vasilios D. Sioulas, Oncologist - Gynecologist,
Director of the 1st Clinic of Gynecological Oncology and President of the Scientific Council of MITERA Hospital,
Clinical Associate Professor at the Medical School of the University of Nicosia
