What is the prevention of cervical cancer? Risk factors and symptoms

Cervical cancer is a worldwide problem.
Can it be protected against?
Cancer transmission?
It's not an accurate statement, but the main suspect is...
A virus that spreads between people.

The main cause of cervical cancer is long-term infection with a human papillomavirus known as HPV.

HPV is one of the most common sexually transmitted infections today.

HPV infection and co-factors are involved in the development of cancerous changes in cervical tissue.

Today's scientific evidence suggests that, in addition to cervical cancer, HPV plays a role in the development of other malignancies such as penile, anal and skin cancers, as well as upper respiratory tract malignancies.

Cervical cancer is a common malignancy. It is one of the few cancers that is easily diagnosed and effectively treated.

Prevention and early recognition of whether it is the result of infection with HPV viruses is what matters.

Co-factors are required for malignant reversal following HPV infection.

Do you want to know more?
What types of HPV do we know?
What increases and decreases the risk?
Is there effective protection?
Do vaccinations work and are vaccines safe?

Factors that increase the risk of cervical cancer are:

• Weakening of general or local immunity (HIV, AIDS, long-term immunosuppressive treatment).
• chronic inflammation of the vaginal and cervical mucosa
• other gynaecological oncological diseases
• infectious sexually transmitted diseases
• repeated HPV infections
• persistence of HPV in cervical cells
• use of contraceptives
• smoking
• family history of cancer

You ask: How can I reduce my risk of an outbreak?

Factors that reduce risk are:

• Safe sex
  • using barrier devices such as condoms
  • knowing your partner's sex life/history
• avoiding changing sexual partners
• protect yourself from recurrent female infections
• not to smoke
• consult a gynaecologist about the risks and appropriateness of contraception
• investigate family history and plan pregnancy accordingly
• adequate hygiene

What are the symptoms of cervical cancer?

The danger with this form of cancer is that it is symptomless in the early stages. It is therefore an asymptomatic course.

It often happens that a woman arrives at the bad results by accident, after a long time at a gynecological examination. By then, the cancer may already be in an advanced stage.

That is why the importance of preventive gynaecological examinations is also high.

Cervical cancer can have symptoms such as:

• bleeding outside the menstrual cycle
• discharge
• painful intercourse - dyspareunia
• pain in the lower abdomen and pelvic area
• pain shooting up to the sacrum
• enlargement of local lymph nodes
• swelling of the lower limb
• weight loss and lack of appetite
• weakness and fatigue
• inefficiency
• abdominal swelling - ascites

What is HPV?

HPV is an abbreviation for human papillomavirus, which translates to human papillomavirus. HPVs are small DNA viruses about 55 nm in size.

The first information appeared in the early 20th century. To date, there have been significant discoveries about HPV infections.

More than 150 types of HPV are known.

Some types are responsible for the formation of warts on the hands and feet. There are about 40 types of sexually transmitted and genital warts. They are responsible for genital diseases such as condylomas and, in worse cases, cervical cancer.

HPV attacks the cells of the squamous epithelium. It then takes up residence in the infected cell.

The infected cell begins to produce altered proteins that are responsible for the changes in the epithelium. In most cases, this process is eliminated by the woman's immunity, but in a small percentage it progresses to precancerous changes.

The risk of transmission increases:
By changing sexual partners, promiscuity (risk of repeated HPV infections).
But a woman who lives with one partner can also become infected.

Other factors include:

• Smoking
• Long-term use of hormonal contraceptives
• high number of pregnancies
• other sexually transmitted diseases (e.g. chlamydia)
• immunological deficiency

HPV risk types

HPV is a highly transmissible disease that is transmitted sexually. But transmission can also be non-sexual, through body fluids, mucous membranes, skin.

The main division of HPV is into low risk LRHPV and high risk HRHPV.

• Low risk - LRHPV
  • most commonly cause warty growths, papillomas, condylomas
  • types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, 89
  • 70 % condylomata accuminata
  • 30 % other types of LRHPV
• High risk - HRHPV
  • types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82
  • but types 16 and 18 are responsible for more than 70% of cervical cancer cases
  • Types 16 and 18 are also risky for the development of cancer of the vagina, uterus, external genitalia, but also of the anus, penis and larynx

Incidence of HPV infection

Anogenital forms of HPV are considered to be sexually transmitted, but this route is not the only form of transmission (body fluids, mucous membranes, skin). It is estimated that 85% of women will come into contact with HPV during their lifetime.

The prevalence of HPV is age-dependent.

In girls who have not yet had sexual intercourse, the prevalence is almost zero. Between the ages of 15 and 18, approximately 7-9% are infected.

HPV prevalence is highest in women in their 30s. The prevalence decreases with age, with only 2-3% around age 50.

Immunity kills the virus after about 8-16 months in 80-90% of women.

In the remaining 10-20% of women, the virus persists and can ultimately cause cervical cancer.

Of these, 20% develop CIN III within 5 years and of these, 5% subsequently progress to carcinoma over 15-20 years.

What is CIN?

It is a classification of changes to the cells on the surface of the cervix. CIN is an abbreviation consisting of the initial letters:

1. C for Cervical, referring to the cervix uteri.
2. I for Intraepithelial, referring to the surface cells
3. N for Neoplasia, i.e. new formation

CIN is further subdivided into stages of precancer (a condition preceding malignant changes):

• CIN I are low grade changes, mild dysplasia (change in shape, size) - monitor progression
  • about 65% of cases resolve on their own
  • 20% persist
  • and of these, about 15% worsen.
  • follow-up every 6-9 months and if persisting for more than 2 years, conization, surgery is recommended
• CIN II is a moderate degree of dysplasia
  • conization, surgical removal of the altered portion of the neck, is recommended
• CIN III is severe dysplasia
  • when surgical removal of the affected part of the cervix, hysterectomy (removal of the uterus, upper part of the vagina), trachelectomy (removal of the cervix), robotic radical hysterectomy, pelvic exenteration, in advanced stage with overgrowth into the surrounding area is recommended
  • alternative and radical radiotherapy

There is also a classification of SIL, which is squamous intraepithelial lesion. This is divided into L-SIL and H-SIL. L-SIL means low grade (CIN I) and H-SIL means high grade lesion (CIN II, III).

Prevention of cervical cancer

No, cervical cancer is not transmissible.
But...
Long-term infection with high-risk HPV is one of the dangerous factors leading to its development.

Prevention therefore relies on preventing the spread of this virus.

The prevalence of the disease is still high, even though cervical cancer is considered a very diagnosable and treatable disease.

The main prevention methods are screening, which is a secondary form of prevention.

In the Czech Republic, approximately 25% of women undergo regular screening. The primary form of prevention of cervical cancer includes vaccination (about 1% of 12-year-old girls).

Cervical cancer occurs mainly in young women under 45 years of age.
It is the 4th most common cancer in women worldwide.
Mortality is increased by lack of access to screening, vaccines and low awareness.

Primary prevention

Primary prevention is vaccination, which is given in three doses.

It is recommended for pre-pubertal girls who have not yet had sexual intercourse. Preferably 12-year-old girls.

The effectiveness of the vaccine is highest then and girls are usually virgins. The recommended age of vaccination is from age 9 until age 45.

In Australia, for example, they have approved the bivalent vaccine for administration to women aged 27 to 45.

There are two types of vaccine available - one bivalent and one quadrivalent.

To explain it simply, the bivalent one contains substances effective against HPV 16 and 18. The quadrivalent one contains substances effective against HPV 6, 11, 16, 18.

The bivalent vaccine does not protect against HPV 6 and 11, but it is assumed to be cross-effective against other HRHPVs that are less common. Similarly, the quadrivalent vaccine protects against other types of HRHPV (31, 33, 35, 39, 45, 51, 52, 56, 58 and 59).

Vaccine safety

The safety of vaccines is very high.

The vaccines are produced synthetically and do not contain the genetic material of viruses. So there is no risk of contracting HPV infections and then years later cervical cancer.

Their effectiveness has been shown in studies to date to be for 5-7 years. Their effect is estimated to be for 10 to 15 years and, according to mathematical calculations, up to 20 years.

As with all other drugs and vaccines, side effects can occur after application. Common side effects include pain, swelling and redness at the injection site. Less commonly, headache, fever, fatigue, muscle pain are common.

Physical exertion and mental stress are not recommended after vaccination.

Secondary prevention

Preventive measures are provided by full screening, where early diagnosis occurs. In addition to routine examination, oncological cytology is used. During cytological examination, a woman has a swab of cells from the cervical epithelium.

The so-called PAP test.

A Pap test is a cytological examination of a cervical smear.

It is named after the Greek physician Georgios Nikolaou Papanikolaou. He was the first to state in 1928 that uterine cancer could be diagnosed from a vaginal swab.

This form of diagnosis is time-saving. It takes about 10 minutes to collect and is done by swabbing cells from the surface of the cervix using a tiny brush. The procedure is painless.

Every woman from the age of 18 should attend a routine gynaecological examination.

Vaccination of boys

As well as affecting the female genital tract, HPV can cause papilloma of the vocal cords, carcinomatous degeneration of the larynx, urological problems such as condylomas and various other cancers in both sexes.

Vaccination of both sexes will provide protection against HPV and also prevent transmission. Since men are also carriers of HPV.

The male sex is also at risk of developing a number of health complications caused by HPV. So why not protect boys too by vaccinating them?

Final summary

Nowadays, there is an effective diagnosis and also treatment of diseases that are caused by HPV viruses.

Awareness that HPV is a major risk factor for cervical cancer is also at a higher level than in the past.

But...

There is still a lack of support for regular preventive and screening examinations and a lack of interest among women, especially mothers, in vaccinating girls before they start having sex.