Why Is Cervical Screening Important? Know Guidelines For Women Belonging To Different Age Groups

An estimated incidence of 604,000 cases and a death toll of approximately 342,000, makes cervical cancer a significant global health concern and the third most prevalent cancer in India.

Know Importance Of Screening for Cervical Cancer

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(By Dr Vani Ravikumar, who is a Senior Consultant and Head of Histopathology, at Metropolis Healthcare)

The cervix plays a significant role within the reproductive system, contributing immensely to woman's health. This lower part of the uterus not only facilitates childbirth but also acts as a crucial barrier against uterine infections. Maintaining a healthy cervix is vital for overall reproductive health. According to GLOBOCON 2020, cervical cancer ranks as the third most prevalent cancer in India, representing 18.3% of all reported cancer cases. The gravity of this disease is further emphasized by an estimated incidence of 604,000 cases and a death toll of approximately 342,000, making cervical cancer a significant global health concern. The recent WHO Global strategy aims to reduce the number of new cases annually to 4 or fewer per 1,00,000 women by a three- point plan to be achieved by 2030. 

• Achieve 90% HPV vaccine coverage for girls by 15 years of age.
• Attain 70% screening coverage for women by 35-45 years of age.
• Ensure 90% treatment for pre-cancerous cases and women with cancer. 

Why is cervical screening important?

Cervical cancer is a slow-growing malignancy with a long pre-invasive state that allows detection in pre-malignant stage. However, unlike many other types of cancer, cervical cancer may not exhibit any signs or symptoms until the cells become cancerous. Most patients are diagnosed at an advanced stage, when it may be too late. Thus, screening at an early stage can prevent cervical cancer. 

Evolution in Cervical Screening Techniques

Progress in cervical cancer screening has been notable over the years. The development of the PAP smear test in the early 1940s, despite its low sensitivity, was a crucial milestone. While PAP is a primary screening method, Human Papillomaviruses (HPVs) cause nearly all cases of cervical cancer, leading to the incorporation of HPV testing alongside Pap testing. This approach enables earlier interventions and improved cancer detection. The introduction of liquid-based cytology (LBC) into the screening program in the 1990s has been the second major advance in cervical cancer screening, revolutionizing the screening process. After the introduction of LBC, HPV test, screening has taken a new avatar, “the Molecular pap!!”.

In our experience, over a 12-year period, we observed a linear increase in the LBC testing over the years. Further, due to this, the detection of abnormalities has increased by 96% and the unsatisfactory cases have decreased by 45%. Molecular tests for HPV screening have also undergone significant advances, from HPV DNA-based tests to mRNA-based molecular tests that show better sensitivity as well as specificity. This has also led to the detection of more subtypes of the HPV variants which may also be potentially cancerous.  

The recent decade has seen a pivotal shift with the introduction of a combination of imaging and review methods, streamlining the screening process and enhancing specificity and sensitivity. The integration of artificial intelligence and digital image processing has brought forth a new level of precision and efficiency to cervical cancer screening, augmenting sensitivity and specificity. Recent advancements in diagnostics represent a major step towards improved and patient-friendly screening methods.

Advancements in Cervical Cancer Screening: A Comprehensive Approach

Cervical cancer screening and detection is a collaborative effort of the gynecologist, cytopathologist and the molecular biologist and is no longer limited to Conventional Pap smear examination. Liquid based cytology can be used effectively along with HPV co-testing in accordance to the USPSTF guidelines (2012), improving sensitivity and specificity and helps reduce ambiguous results.

Guidelines for cervical cancer screening, such as those from the ACS (2020), recommend different approaches based on age and risk factors. 

• Women aged 21-25 years are recommended to undergo primary HPV testing alone every five years. From the age of 25, co-testing every five years or liquid-based cytology (LBC) alone every three years is advised.
• For women between 30-65 years, options include Pap smears every three years, high-risk HPV testing every five years, or a combination of both every five years.
• After reaching the age of 65, personalized considerations become crucial. This involves taking into account individual health factors, any history of abnormal Pap smears, and the individual's HPV vaccination status.

However, moving beyond improved screening methods in cervical cancer prevention necessitates addressing a critical issue—awareness and education among women. Despite the availability of more effective screening techniques, a persistent challenge is the reluctance of women to undergo regular check-ups and tests. Bridging this gap requires a collective effort to enhance public awareness programs and wellness initiatives. The focus should extend beyond providing information about the importance of screenings to fostering a proactive attitude towards women's health.

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