In the UK, there are just over 3,000 cases of cervical cancer diagnosed each year, of which it is estimated that over 99% (that’s not a typo) are preventable, although over 800 people die from it each and every year. The highest incidence is in those aged between 25 and 29 (and that ain’t a typo either) so, in other words, it is a disease of the young. It is associated with smoking and other factors, but it is caused by the Human Papillomavirus (HPV).
Men carry the virus and pass it on to their sexual partners.
HPV is everywhere. There are over a hundred different types and they’re numbered. They cause things as benign as skin warts but they also cause cancers, such as penile cancers (yes, there is such a thing), anal cancer (nasty) and cervical cancer. Some types are troublesome, but benign. Some types, though, cause the cancers. Types 16 and 18 cause cervical cancer.
Cervical screening aims to spot the changes that lead up to cancer, because HPV works slowly, over a course of years, but it isn’t easy. This much is known. The changes that lead to cervical cancer begin in the TRANSFORMATION ZONE (TZ) of the cervix. where the nature of the covering of the cervix abruptly changes from SQUAMOUS (multilayered) to GLANDULAR (single cell layer). They are known as CERVICAL INTRAEPITHELIAL NEOPLASIA, which for the sake of simplicity is known as CIN (pronounced ‘sin’ and I know not if that is a deliberate choice of pronunciation). CIN1 is mild, CIN2 and CIN3 are high grade. Progression to cancer (which is invasive and potentially spreads) is not inevitable, but you don’t want high grade CIN.
The cervical screening test is embarrassing and uncomfortable. The person taking the sample tries to scrape off cells from the TZ. They are then put into a machine that washes the cells and spreads them on a slide. A human being then has to scan that slide and look for cells that mean CIN is present. If they see them, a punch biopsy may be taken to confirm the diagnosis of precancerous changes; the punch biopsy will be looked at by a medically-qualified pathologist.
If high grade CIN is diagnosed, the usual treatment is LOOP EXCISION OF THE TZ (LETZ), which aims to cut out the abnormal area and can be done in out-patients; it is again uncomfortable and embarrassing. In the great majority, that will cure the patient and they won’t develop cancer.
HPV vaccination has been introduced, the aim being to stop HPV 16 and 18 causing the cancer. HPV testing is also undertaken on samples. Soon, everything will change, and it will be for the better. Fewer cases, fewer cervical smears, fewer deaths. But only if that letter calling patients to be tested is not ignored.
Cervical cancer is a horrible way to die.