How to prevent cervical cancer?
Currently in Portugal, around 720 new cases of cervical cancer are diagnosed every year, making it the Western European country with the highest incidence rate of this type of cancer.
Cervical cancer is always primarily caused by infection with the Human Papilloma Virus (HPV). This virus has been around for thousands of years and infects both men and women. It is one of the most common sexually transmitted infections worldwide, with 75-80% of sexually active men and women likely to be infected at some point in their lives.
To date, there are more than 200 types of HPV identified, of which around 40 preferentially infect the anogenital system: vulva, vagina, cervix, penis and perianal areas.
Cervical cancer kills one woman a day in Portugal
Dr. José Maria Moutinho, a gynecologist at CETI, tells us that in 2018 alone, cervical cancer (CC) had an incidence of 8.9 and a mortality rate of 2.3/100,000 women in Portugal. This represents around 720 new cases per year, of which 390 are fatal.
These numbers, relatively high for a developed country, mean that CC is the 7th most common cancer in women and the 2nd most common in women aged between 15 and 44.
The incidence and mortality of CC have been decreasing for 20 years (in 1995, the incidence was 18.8 and the mortality rate was 6.3/100,000 women). This decline is due to secondary screening that has been implemented in various regions of the country, where, especially in recent years, it affects an increasing number of the population.
How is HPV infection prevented?
Cervical cancer can be prevented in 2 ways:
- Primary prevention: vaccination of girls aged 9-13 before they start having sexual intercourse, preventing infection by high-risk HPVs, following the recommendations of the National Vaccination Plan (PNV). This primary prevention can be extended, with high effectiveness, to all women up to the age of 26. The risk of infection in sexually active middle-aged adult women remains high (5-15%/year). Therefore, it is now known that vaccination of this group of women is highly effective in preventing CC.
- Secondary prevention: screening, preferably organized, where through the HPV test carried out regularly (every 5 years) dysplastic lesions (which precede CC) are detected, which, once appropriately treated, prevent the onset of the disease.
Is the HPV vaccine important?
HPV infection is the most common sexually transmitted disease. The WHO currently considers this infection to be the second most important carcinogen, after tobacco, and is responsible for 5% of cancers, 10% of cancers in women and 15% of cancers in women in underdeveloped countries.
The vaccine included in the PNV provides an estimated 90% protection against cervical cancer, 95% against anal cancer, 90% against HPV-related vulvar cancer, 85% against vaginal cancer and 90% against genital warts. This high efficacy of the vaccines, verified in clinical trials, has also shown high effectiveness in clinical practice. Thus, in all countries where vaccination has been introduced, there has been a marked reduction in HPV-related diseases, even in the unvaccinated population group (group protection).
Tracking is essential
Screening allows early identification and removal of pre-cancerous lesions, reducing the incidence and mortality of cervical cancer worldwide.
Since the biggest risk factor for developing cervical cancer is HPV infection, early diagnosis is essential. A Pap smear – a gynecological exam used to detect changes and diseases in the cervix – can detect the presence of abnormal cells, allowing the woman to be treated before the cells turn into cancer.
Pap smear results can be:
- Class I: The cervix is normal and healthy;
- Class II: presence of benign changes in the cells, which are usually caused by vaginal inflammation;
- Class III: includes CIN 1, 2 or 3 or LSIL, which means that there are changes in the cells of the cervix and the doctor may prescribe new tests to look for the cause of the problem, which may be HPV;
- Class IV; CIN 3 or HSIL, which indicate a probable onset of cervical cancer;
- Class V: presence of cervical cancer.
- Unsatisfactory sample: the material collected was not suitable and the test cannot be performed.
Depending on the results, the gynecologist will say whether further tests are necessary and what the appropriate treatment is.
When should I have a Pap smear?
Your doctor will advise you on how often you should have a Pap smear, taking into account your level of risk and your specific condition.
What are the main risk factors associated with cervical cancer?
- early initiation of sexual relations;
- the number of sexual partners;
- smoking.
These factors are linked to the risk of high-risk HPV infection, a necessary, although not sufficient, factor for the development of CC.
It is worth noting that in Portugal, the group of women at greatest risk of CC is an adult woman with a history of having or having had sexual relations and who has never participated in a screening program, whether opportunistic or organized.
What are the most common symptoms of this type of cancer?
CC is a cancer that develops silently, especially in the earliest stages of the disease, when existing therapeutic methods are highly effective.
Normally, especially in more advanced stages of the disease, the main symptoms are abnormal vaginal discharge and vaginal bleeding. Therefore, it is essential that women between the ages of 25 and 70, who represent the highest risk group, have a regular (annual) gynecological examination.
How is cervical cancer treated?
Taking into account the staging – the process by which it is determined whether the cancer cells have spread from the cervix to other nearby or more distant structures – the clinical team will assess the best treatment to follow.
Treatment options may include surgery, radiation therapy, and chemotherapy.
If I suspect I have cervical cancer, who should I contact?
Based on your symptoms or a complementary diagnostic test that reveals a change, you should always go to your gynecologist. He or she will carry out an initial clinical assessment and, depending on the type of suspicion, will refer your case to the necessary specialists. necessárias.