With cervical cancer being the most common cancer in women under the age of 35, it’s understandable that many people would assume that it’s a disease that only affects the young. However, this is sadly no longer the case, with new research revealing a noticeable increase in those diagnosed with the disease in the over 40 age bracket. Due to this common misconception, it means that early detection of one of the only preventable cancers is being unnecessarily delayed.
“Cervical cancer is often considered a ‘young women’s’ disease, and many women over 40 wrongly believe they no longer need to participate in cervical screening,” explains leading UK gynaecologist Mr. Jullien Brady. “The HPV virus [one of cervical cancer’s main causes] can lay dormant for years and if women go through a divorce, start dating and have new partners in their 40s, they expose themselves to HPV again and if high risk strains are present, this can turn into cervical cancer 10 to 15 years down the line, so it is important to keep screening.”
With approximately 3,100 women diagnosed in the UK every year but 1 in 4 still shunning the opportunity to get screened (with the largest decline in attendance being among women between the ages of 40 and 54 according to NHS statistics), more needs to be done to raise awareness across the population as a whole.
We asked Jullien Brady to share his expertise and answer all of our questions on HPV and cervical cancer - from prevention to symptoms to cure. If any of this sounds at all familiar, do see your doctor as soon as possible. NHS screening starts at the age of 25 and women are invited to screen every three years until the age of 45, when they are invited every five years until the age of 64.
GTG: What are the causes of cervical cancer?
JB: HPV is the major cause, resulting in 99.7% of cervical cancers. The other 0.3% is a combination of very rare factors that can include being very immunosuppressed.
GTG: What is HPV?
JB: HPV stands for Human Papilloma Virus. HPV is an extremely common virus. 4 in 5 people will be infected with genital HPV at some point during their lives. For many, the body clears the virus naturally but in a small number of people, the virus persists which can cause changes to the cervical cells.
GTG: How does HPV lead to cervical cancer?
JB: There are over 100 strains of HPV and when some of the strains persist, it can cause changes to the cells of the cervix. This process happens over a number of years. If left untreated, these changes – or abnormalities as they are commonly referred to – can become cancerous. Attending regular cervical screening allows any changes to be monitored and treated where necessary.
GTG: How is HPV spread?
JB: Genital HPV is spread via skin-to-skin genital contact. This means you are at risk of infection from your first sexual experience and you are at risk even if you do not have penetrative sex. Safe sex practices reduce HPV spread but do not prevent it as the HPV is present in the whole genital region.
GTG: Who can cervical cancer affect?
JB: Anyone who is sexually active, no matter their age. Although it is the most common cancer in women under 35, because women in their 20s are delaying their cervical screening appointments and the HPV virus is shown to develop into cancer within 10-15 years. Women who smoke have also been shown to be at higher risk, as their bodies are less able to fight the HPV infection.
Each year in the UK, it is estimated that 3,100 women are diagnosed with cervical cancer, which accounts for two out of every 100 cancers diagnosed in women. More than 4 million women are invited for cervical screening each year in England. Around 1 in 100 women screened has a moderate or high-grade abnormality (1%). Early treatment can prevent these cervical changes developing into cancer.
GTG: What are the symptoms?
JB: HPV is very common, with most sexually active people contracting the virus at some point in their lives. The vast majority of the time, the virus infection is cleared by the body with no effects. However, it has little or no symptoms at all. The only way to pick up the presence of the virus is to specifically test for it using an at-home test such as GynaeCheck, which has been developed by expert gynaecologists. In certain circumstances, a HPV test is performed on NHS cervical smear tests, but not always. It is at present only used in low grade smear abnormalities, or in those women who have had previous treatment for abnormal cells.
On the other hand, cervical cancer in its later stages includes symptoms such as irregular bleeding following or between periods, menstrual bleeding that is longer and heavier than usual, pain during sexual intercourse, bleeding after menopause and increased vaginal discharge. If you have any of these symptoms contact your GP to request an urgent cervical screening appointment.
GTG: How can you prevent it?
JB: Cervical cancer is one of the few preventable cancers. If detected early, there is very little chance a woman will die from the disease. This is why it is so important for women to regularly attend their cervical screening appointments, so that any abnormalities in the cells of the cervix are detected early.
Make sure that your GP surgery has your up-to-date contact details, so that you continue getting screening invitations. Women who are 25-49 years of age are invited for screening every three years. Women who are 50-64 years of age are invited every five years. For women who are 65 years of age or older, only those who have not been screened since they were 50, or those who have had recent abnormal tests, are offered screening.
There is a NHS cervical cancer vaccination programme available to girls between the ages of 12 and 13 who are immunised with Gardasil, which protects against four types of HPV including the two strains responsible for more than 70% of cervical cancers in the UK (HPV16 and HPV18).
The HPV vaccine significantly reduces the risk of cervical cancer; however, it is important that women still attend their cervical screening tests, because the vaccine does not guarantee protection against cervical cancer, as it only affords protection against the 70% of cancers caused by HPV 16 and 18.
Women can also reduce their chances of getting cervical cancer by not smoking, which has been shown to impair the body’s ability to fight the disease.
GTG: What treatments are available for those who have been diagnosed with cervical cancer?
JB: Due to screening, cervical cancer remains rare. Most cases of cancer are avoided as they are identified at a pre-cancerous stage. If this is so, the abnormal area can most often be treated with a simple procedure in outpatients to remove the small areas of abnormal cells.
Later presentations of cervical cancer require much more aggressive treatment, which can include a hysterectomy, and the possible need for chemo or radiotherapy.
GTG: What in your opinion would be useful for people to know about cervical screening?
JB: Cervical screening isn't a test for cancer; it's a screening test to check the health of the cells of the cervix that may need further investigation (a hospital appointment in a Colposcopy Clinic).
It is crucial that all women partake in some form of cervical screening, either by the NHS Program or other methods such as initial HPV testing by GynaeCheck if that is the wish of the woman.
GTG: What are the biggest misconceptions about cervical cancer that you feel are important to clear up and that you wished more people knew more about?
1. Cervical cancer is almost entirely preventable due to effective screening techniques which detect and treat condition;
2. If you have ever been sexually active, cervical screening should be a regular part of your health routine, even once you have been through menopause. The risk of cervical cancer does not decrease with age and continued regular screening is very important even if you have the same sexual partner or are no longer sexually active;
3. The HPV vaccine does not protect against all the types of HPV that cause cervical cancer. Women still need cervical screening regularly even if they have been vaccinated against HPV;
4. Although condoms work well to prevent other sexually transmitted infections (STI), they offer less protection against HPV. HPV can live in areas of the skin that condoms do not cover;
5. Abnormal results very rarely mean you have cancer. It means the cells taken from your cervix look different from normal cells when seen under a microscope. These cell changes may develop into cervical cancer over many years if left untreated.
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