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Of all the cancers that we have to worry about, there is one that is the easiest to detect really early cervical cancer. This cancer today kills a woman every 8 minutes in India only because it is detected late on the basis of physical symptoms making treatment less effective and more expensive. Thanks to the latest advancements in screening technology cancer of the cervix can be detected in very early stages with up to 99 per cent accuracy. Giving the power back in your hands to protect yourself and your loved ones from it.
The discovery of necessary cause of cervical cancer, human papilloma virus (HPV) has led to the development of molecular tests for HPV to identify women with cervical precancerous lesions. HPV testing has proven to be more sensitive and more reliable, albeit less specific, for detection of cervical pre-cancer than cytological methods of detection. This is a simple test to keep cervical cancer away. The effectiveness of the test assures you for a stress free window of 5 years. If tested positive, this test gives an advanced window to treat cervical cancer at the earliest stage possible. It's a win-win for Indian women aged 30 65 years.
Multiple studies have established the superiority of the HPV-DNA screening test.
In spite of the knowledge that HPV-DNA testing has considerably better sensitivity compared to pap smear, the fact that major guidelines hesitancy in making HPV-DNA screening as primary modality might be the initial high cost of setting laboratory facilities for doing HPV-DNA testing. But after the COVID pandemic almost all labs have facilities to do RT-PCR testing, same mechanism used for HPV-DNA testing. Maybe henceforth HPV-DNA screening might be the primary modality for all guidelines. Even WHO recommends DNA testing as a first-choice screening method for cervical cancer prevention.
There are various screening techniques for cervical cancer.
This is the oldest screening test for cervical cancer. History of cervical cancer screening dates back to 1920 when pap smear testing was invented by Georgios Papanikolaou and Aurel Babe .
Procedure: During pap smear testing cells from cervix are collected using a wooden spatula (Ayer's spatula) and immediately it is smeared to a glass slide and slide is immersed into a bottle containing fixative which is a mix of 95% ethyl alcohol and ether. Sides were later examined by pathologist and identify any features suggestive of pre-malignant or malignant lesions.
Effectiveness: Various studies have revealed the specificity of Pap smears to be between 64.79 - 96.8%.
Factors that can cause a false-negative result during pap smear include:
This was introduced to improve the sensitivity of pap smear testing. But studies proved that it also has similar sensitivity and specificity as pap smear testing. The advantages of using a liquid-based cytology screening are that cellular morphology can be preserved well, there will be absence of air-drying, cell crowding, obscuring cells and more over the remaining fluid can be used for HPV-DNA testing.
With effective screening we can reduce the burden of cervical cancer, which is especially a disease of low-middle income countries and can actively contribute to WHOs Global Strategy to Accelerate the Elimination of Cervical Cancer. The goals of the strategy are, by 2030:
(This article is authored by Dr Aswathy G Nath, Gynaecological Oncologist, Karkinos Healthcare)
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