Almost 290 women a year in Ireland are diagnosed with cervical cancer, Joan Kelly of the Irish Cancer Society says.

“This cancer of the cells that line the cervix – the neck of the womb – is usually caused by the human papilloma virus (HPV). It is a very common virus that is passed on during sexual contact.”

She points out that the cells of the lining of the cervix are always changing due to hormonal responses and that abnormal (pre-cancerous) changes can occur over time in these cells.

CervicalCheck, and all the other screening programmes in the world, are looking for pre-cancerous changes, not for cancer as such

“What’s different about cervical cancer, compared to say breast or bowel cancer, however is that it is very amenable to screening. A lot of cancers aren’t. It is amenable because it has a distinct pre-cancerous phase.

“That’s why our national screening programme, CervicalCheck, and all the other screening programmes in the world, are looking for pre-cancerous changes, not for cancer as such. This is a really important message.”

Early detection

She outlines some detail about the cervix.

“It is a part of the neck of the womb, it is about one inch in depth and cone-shaped and it differs from the womb in that it has a different kind of cell. Cervical cancer occurs when normal cells in the lining of the cervix grow in an abnormal way to form a cluster and a tumour or a neoplasm or growth of any kind. Fortunately, this development into cancer can be prevented if smear tests are done regularly to highlight any changes in these cells.”

She explains that the abnormal, pre-cancerous, cells that can develop are called cervical intraepithelial neoplasia (CIN) cells.

“These cells are not cancerous, but if left untreated may develop into cancer. They are generally diagnosed as CIN 1, 2 or 3 depending on their stage.”

Smear tests takes about five minutes and while it can be slightly uncomfortable it is quite a straightforward test

The Papanicolaou (Pap) smear test that is done involves a sample of cells being scraped from the surface of the cervix.

The test is called after the Greek scientist George Papanicolaou who discovered this method of cervical testing in 1920.

“Smear tests takes about five minutes and while it can be slightly uncomfortable it is quite a straightforward test,” Joan says.

“The cells in the sample are then examined in a lab and that’s how any changes are identified.

“Every woman between 25 and 60 years of age should have a regular smear test and here in Ireland screening is available free of charge through CervicalCheck.”

She reiterates that most cervical cancers are caused by the HPV.

“HPV is a very common virus that is passed on during sex and most women will get this infection in their lifetime. It usually clears up by itself but if you smoke it can prevent the infection from clearing up.”

A positive smear

If after a smear test, some pre-cancerous cells are found, treatment begins. In the case of CIN 2 or 3 cells this involves a colposcopy – a procedure that involves the cervix being examined by microscope under bright light.

“A cone biopsy may also be taken which can be both the treatment and the diagnosis. The area of suspicion is then treated – the abnormal cells are burnt away – and the cervix heals over after that and there is often no further action needed apart from returning for further smear tests in the normal way or sooner, depending on the recommendation of the doctors.”

The HPV vaccination

The HPV vaccination – which prevents cervical cancer – is offered free of charge now as part of a national immunisation programme for both boys and girls who are 12 years of age. In girls, HPV infection can cause cancer of the:

In boys, HPV infection can cause cancer of the:

HPV testing of cervical smears

The next step in the fight against cervical cancer is the move to primary HPV testing of all CervicalCheck cervical smears, the cancer support manager says.

“This is expected to commence later this year and is an important development in cervical screening because it will help to avoid unnecessary smear tests for some women while ensuring earlier diagnosis and treatment where necessary. With these advances there is hope that we will see an end to cervical cancer in Ireland in the future,” Joan states.

The most common symptoms of cervical cancer relate to vaginal bleeding.

“If you experience vaginal bleeding between your periods, for example, or bleeding after the menopause or after intercourse or have an unpleasant vaginal discharge you should tell your doctor and have it investigated,”advises Joan.

“Vaginal bleeding (outside normal menstruation) is always something to be concerned about.”

If cancerous (rather than pre-cancerous) cells are discovered a wider biopsy will take place, she says. The way cervical cancer is treated mainly depends on the stage of the disease at diagnosis and on:

“Often cervical cancer is treated with a combination of chemotherapy and radiotherapy. This is sometimes called chemo-radiation. Surgery and radiotherapy are also used. Rarely, chemotherapy on its own may be used,” Joan explains.

This is the Irish Cancer Society’s advice for preventing cervical cancer:

1 Have regular smear tests, every three years from the ages of 25-44 and every five years between the ages of 45 and 60. Go for screening at the first invitation and continue for screening regardless of the result. Sometimes when people get a good result they don’t go back. It is important to go back – and go after having a baby – and to continue having the tests into your 60th year.

2 Don’t smoke. Not smoking will make it easier for our bodies to fight the HPV infection.

3 Be active and live as healthy a lifestyle as possible.

4 Have your son/daughter vaccinated against HPV. Being vaccinated before any sexual contact occurs is important in terms of the way the vaccination works. See the HSE website page www.hse.ie/eng/health/immunisation/pubinfo/schoolprog/hpv/ for more.

“While the HPV vaccination programme has had some controversial associations with other conditions, but these have now been disproven. Laura Brennan, who died last year, was a fantastic advocate for the HPV vaccination programme,”says Joan.

Helpline experience at the Irish Cancer Society

Joan says that while the HSE’s CervicalCheck programme helpline is obviously getting a lot of queries (some women received incorrect results in the past), the calls to the Irish Cancer Society’s Cancer Nurseline (1800 200 700) are frequently from women who have received an abnormal result from their screening test.

“They are worried and want to know what the results mean and what to do next. There is a heightened sense of worry and concern because of the CervicalCheck screening issues in the past but that’s to be expected.

That said, our screening programme is the best way to prevent cervical cancer,” she says, “and we need to take all the steps to go for our screening smears and make sure that our children have the HPV vaccination as young teens.”

Where are we now?

We asked the HSE for an update on the CervicalCheck programme.

They didn’t go into the testing and re-testing issues, the failure to send results to women nor the independent review of these events that took place as recently as this summer.

Audits and independent reviews are not mentioned either but the ongoing commitment to improve the screening programme and rebuild women’s confidence in it is.

They point out that cervical cancer rates have reduced since CervicalCheck was introduced in 2008 and that the new development Joan Kelly mentioned above will be happening soon.

HSE response:

A cervical screening test (also known as a smear test) looks to see if a woman might be at greater risk of developing cervical cancer in the future. It is a way of detecting abnormal cells in the cervix (neck of the womb).

It is estimated that regular cervical screening can help prevent 75% of cervical cancer cases.

Since CervicalCheck started in 2008, more than 3 million screening tests have been carried out. Over 100,000 cases of abnormal cervical cells have been detected and treated. The number of women who develop cervical cancer has fallen by 4.2% per year since 2010.

CervicalCheck is progressing plans to introduce HPV cervical screening in the coming months. In this new way of cervical screening, a woman’s screening sample is first checked for human papillomavirus (HPV) – a virus that can cause cervical cancer. If HPV is found, the same test sample is checked to see if there are any abnormal cells in the cervix.

Once HPV cervical screening is introduced, all eligible individuals will be invited when they are due.

Call the Cancer Nurseline freefone on 1800 200 700 for confidential advice, support and information. Monday-Friday, 9am-5pm.

Also see www.cancer.ie

CervicalCheck

Freephone 1800 45 45 55 (+353 21 421 612 if calling from outside Ireland). The phone line is open from 9am-6pm, from Monday to Friday.

www.cervical check.ie