Have a cervix? Then cervical screening is for you
This Cervical Cancer Prevention Week 2019, DIVA spoke to Dr Nagete Boukhezra about the whats, whys and hows of cervical cancer – and how you can both help to prevent it and spot the early warning signs.
What is cervical cancer?
Cervical cancer is the cancer of the cervix, the part between the lower end of the uterus and the entrance of the vagina. The main cause for cervical cancer is the virus HPV (human papilloma virus) which is very common. There are diverse types of strains HPV and, while they are mostly harmless, a few strains are harmful as they may lead to cells alteration, potentially resulting in cervical cancer.
Source: Jo's Cervical Cancer Trust.
How to identify the symptoms of cervical cancer?
There are usually no symptoms in early stages and when symptoms are present, they are – frustratingly – wide and non-specific. They can include spotting, bleeding during/after intercourse, dyspareunia (pain during intercourse), post-menopausal bleeding and unusual vaginal discharge.
Are there any preventative measures that can be taken to eradicate the risk of HPV?
There is unfortunately no way so far to eradicate the risk of HPV; the HPV infection is very common and doesn't display any symptoms. Fortunately, most people will NOT develop cervical cancer. Although, anyone with a cervix who has started to be sexually active can catch it, the risk of developing an HPV infection increases the earlier you start having regular sex and is furthered the more sexual partners you have.
In the past 10 years, the HPV vaccine has been offered to girls aged 12 and 13 in the UK. But the vaccine does not provide a complete protection against cervical cancer as the vaccine is only able to immunise against a few strains of the virus.
Are there any preventative measures that can be taken to reduce the risk of HPV?
There are some ways to reduce the risk of HPV, yes. The vaccination reduces the risk of cervical cancer as the vaccines include the HPV 16 and HPV 18, which are responsible for most of cervical cancers. However, the vaccination does not cover all the harmful types of HPV and screening is still essential regardless of if someone is vaccinated.
Using protection during sex (which provides protection against other sexually transmitted diseases), can reduce the risk of HPV infection but not totally as the virus spreads via intimate contact as well. The virus can also be transmitted by sharing sex toys. You can reduce the risk by cleaning them properly.
You can reduce your chances of getting cervical cancer by not smoking. A Portuguese study published in 2011 showed that the acquisition of HPV infection does NOT seem to be a smoking dependent event, however, the progression of the acquired HPV infection into cervical cancer increases with smoking habits.
The best way to protect yourself from cervical cancer is by attending cervical screening for early detection and early treatment.
How regularly should people have a smear test?
In the UK, the NHS offers a screening for all women as well as those who identify as non-binary or who are trans men who have retained their cervix. Between the ages of 25 and 50 years old, the screening is every three years. Between the age of 50 to 64 years, every five years. Outsides these ranges, any concerns should be discussed with a GP.
All those with a cervix should be screened as per the national cervical cancer screening program as there is a risk for the HPV to be transmitted between partners, regardless of gender, this could be through any form of sexual contact (intimate contact, sharing sex toys, etc.)
How are trans men affected?
Trans men, who have had a total hysterectomy, do not need to have cervical cancer screening as their cervix has been removed. Trans men, who have retained their cervix and are registered with their GP as female, will receive invitation in accordance with the National cervical cancer screening.
Trans men, who have retained their cervix and registered with their GP as men however, will not receive automatic invitations. However, they are at risk and are eligible for screening. They should discuss having regular smear tests with their GP.
✊Spread the word… Knowing the symptoms of #CervicalCancer could save your life. https://t.co/ihJEKm2mVt✊ pic.twitter.com/BaOT0HglDD
— Jo's Trust (@JoTrust) January 15, 2019
What happens in these screenings?
- During the cervical screening, the nurse/doctor uses a speculum to see the cervix clearly then gently scrapes the surface of the cervix with a soft brush to get cells sample
- The sample will be then sent to the lab where they will examine it under microscopy
- This is a very simple procedure and last only a couple of minutes
What should you do if you spot any of the symptoms?
- You should seek medical advice as soon as possible if you spot any symptoms even if you've recently had a screening
What happens next if you test positive?
- An abnormal test does not mean you have cancer, but it can be early stage of alteration in cells
If the results come back positive:
- For borderline change in squamous or endocervical cells, or low-grade dyskaryosis — then the HPV tests will be performed on the same sample: if the HPV test is positive the patient will be referred for a colposcopy
- If the HPV test is negative, the abnormal cells are not harmful and will go away on their own. The patient should return to the routine screening program (every three to five years depending onage)
- For high-grade dyskaryosis (moderate), or high-grade dyskaryosis (severe), the patient will be referred for a colposcopy
What is a colposcopy?
A colposcopy, which is a more accurate examination of the cervix, is a simple procedure for diagnosis. During this procedure, the clinician may be able to immediately remove the abnormal cells or may take a biopsy to confirm the diagnosis. In some case, the tests come back inadequate for testing as not enough cervical cells were present for the microscopic examination. The patient will then get a recall and will repeat the smear test but no less than three months after the initial test (time for the cells at the surface of the cervix to regenerate after a smear test).
Testosterone and smear tests
According to a study published in 2014, trans men are more likely to have unsatisfactory smear tests results and likely to have to retest. The study showed that long-term testosterone therapy administered intramuscularly (IM) induces vaginal and cervical atrophy and can alter the smear test results. The atrophy makes also the examination more difficult due to the discomfort during the passage of the speculum.
Dr Nagete Boukhezra is a General Practitioner at the Private GP, London Doctors Clinic. To learn more, visit Jo's Trust here.
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