Cervical cancer: The importance of screening

Doctors say that cervical cancer, which begins in the lining of the lower part of a woman’s uterus, is the most common form of cancer in Thai women, and the cancer that causes the most deaths. This form of cancer, however, is easily detected and treated if found early. In Thailand, the National Cancer Institute estimates that for 1993 to 1997, the average incidence of cervical cancer was 18.6 cases per 100,000, but this is probably a considerable underestimation, given shortcomings in reporting.

Bumrungrad Hospital gynacologist Dr Dejaphongs Bhucharoen says that the most important reason for the high incidence of cervical cancer is that women do not have regular screening tests. "Particularly after they have children, women don’t come back [to see their doctor]. Doctors should tell their patients after they’ve had a baby to make sure they come back. And it’s the culture – Thai women are very shy about their bodies, but there is still this lack of awareness."

Samitivej Hospital’s Dr Yaowaluk Rapeepattana agrees. "This is due to socioeconomic factors, also perhaps that women’s health care is not good enough, and to education."

What leads to cervical cancer?

Most cases of cervical cancer are caused by the human papilloma virus (HPV), a sexually transmitted virus also known as the wart virus. The virus usually infects women aged up to their 30s – condoms do not offer protection – but it can take 20 years for abnormalities to develop. The virus can cause abnormal cell growth, known as dysplasia, which may lead to cancer. Other terms used to describe abnormal cells are squamous intraepithelial lesion (SIL) and cervical intraepithelial neoplasia (CIN). Cigarette smoking is another reported cause of dysplasia.

Pap smears are the key to early detection

Dysplasia sufferers will show no symptoms, and in its early stages cancer will not manifest itself externally either, and this is why regular screening – in the form of quick and painless Papanicolau or "Pap" smears – is so important. The procedure involves a doctor or clinician inserting a speculum into the patient’s vagina to open it, and taking a sample of cells from in and around the cervix with a scraper or a small brush. The specimen is then placed on a glass slide and sent to a laboratory for examination.

"If we can detect the cancer in situ [before it has become invasive], we can treat it because it develops very slowly," says Dr Dejaphongs. Mild dyspasia can take up to seven years to develop into invasive cancer.

American guidelines recommend that a woman should have her first Pap smear after she has become sexually active, or after she has turned 18. The best time for the test is between 10 and 20 days after the first day of the menstrual period. Doctors generally agree that if you have a test annually for three consecutive years with no abnormalities, you can then have the test every two to three years, as this is generally the amount of time it takes for cells to go from normal to abnormal.

If your Pap smear is abnormal

Treatment options will depend on the level of dysplasia in the cervix. If it’s mild, you may simply have further Pap smears every four months as there is a good chance the cells will return to normal themselves. If this does not happen, or if the dysplasia is moderate to severe in the first instance, a colposcopy (non-invasive examination of the cervix using a microscope like instrument) may be performed, followed by a biopsy, which is the removal a small amount of cervical tissue for examination, and the only definite way of checking whether the abnormal cells indicate cancer. If these tests confirm abnormalities, the area may be removed surgically. Depending upon the stage of cancer and other factors, a hysterectomy may be advised.

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