Cervical Cancer Awareness Month: Screening Changes May Mean More Deaths

January is Cervical Health Awareness MonthAlmost every woman in the progressive world may have heard of Breast Cancer Awareness Month, with is ubiquitous pink ribbons and a virtual army of women and celebrities touting awareness towards it. As the number one cancer against women, that is understandable. The second runner-up, Cervical Cancer, however, is also no laughing matter either.

What is Cervical Cancer?

Cervical cancer develops in a woman’s cervix, which is the entrance to the womb from the vagina. The cancer starts to line the cells of the cervix, with two different cell types: the glandular cells and exocervix cells. These cells meet at the transformation zone of a woman’s reproductive system, which is where it most often starts.

In its earliest stages, cervical cancer has no real symptoms, which may make it difficult to detect. However, it most commonly causes unusual vaginal bleeding, which occurs after sexual intercourse, after menopause, or (for women still of the age) between monthly menstrual periods. The cells go from pre-cancerous stages until it becomes cancerous.

Cervical cancer was the most common cause of cancer death in American women for some time, until the recent developments in medicine and treatment have caused the mortality rate to drop by a staggering 50 percent.  All of this can be attributed to two things: awareness, and screening.

How screening works

As with all cancers, early detection is the true key to the most successful treatment or cure for the cancer. This is why screenings have become so important. According to the Centers for Disease Control and Prevention (CDC), women need to begin getting tested for cervical cancer from age 21. The cancer is highly preventable given these regular screenings and appropriate treatment.

There are two tests that help detect cervical cancer: the HPV (Human papillomavirus) test which looks for the specific virus that might cause the cells to become cancerous, or the more popular and often-recommended Pap test, otherwise known as the Pap smear or the smear test. This test looks for precancerous cells which would later on turn into cancer cells if not treated correctly.

What is a pap smear?

Smear tests are, by far, the most highly-recommended means of screening for a majority of women around the world. It is recommended for women anywhere between 21 and 65, and it can be done easily at a doctor’s office or a clinic.

This is often done during a pelvic exam. With the use of a speculum to widen the vaginal opening, the cervix and the vagina are examined. Through this, a plastic spatula and a brush are used to collect cells from the cervix and then placed into a solution to be stored and studied for markers that indicate that they could or could not be pre-cancerous cells that indicate the beginnings of cervical cancer. This should not cause any discomfort for the rest of the day and a woman can proceed as she normally does.

The pap smear has been generally seen as an excellent and harmless way for women everywhere to make sure that they are safe from cervical cancer, or as a means to detect it early. Being completely treatable, early detection could mean a woman getting her lifesaving treatment immediately.

New Zealand makes an allegedly fatal change

New Zealand had recently launched changes to its cervical screening program, pressing some limitations to the screening with regards to age and time, as well as the procedure on how it’s meant to be done. However, a leading cancer specialist, Associate Professor Brian Cox of Otago University, has suggested that these changes may in fact, prove fatal to even more women instead of helping them to detect the disease early.

The previous recommendation for a pap smear for women between the ages of 20-65 is that they can be taken regularly every three years. This is the same recommendation found virtually anywhere in the world, including distinguished establishments such as the Mayo Clinic, the CDC, and the American Cancer Society.

However, New Zealand’s government has begun to impose restrictions on these pap smears. From 2018 onward, the age range of the requirement for pap smears has been narrowed to 25-69, and the time in between the regular testing has increased from three years to five years instead. And instead of getting a pap smear the first time, the first laboratory test will be an HPV test. Any positive samples from this test would then be re-tested by current cell analysis. In this end, New Zealand uses liquid-based cytology to determine the presence of the virus.

It’s true that most cervical cancers are indeed caused by HPV. It’s a sexually transmitted infection, and some people get it at some point within their lifetime. There is an HPV vaccine that is available now, and it protects against the types of HPV that are the most common causes of cervical, vaginal, and vulvar cancers. Anyone within the age group recommended for it may take this vaccine, even males, and New Zealand funds this vaccination.

However, Dr. Cox has suggested that the risks of this new testing regime are ultimately too dangerous and could lead to more deaths instead. By limiting the recommended age range and by increasing the gap between tests, there is the very real possibility that the pre-cancerous cells would be given more time to develop into actual cancer cells. There could be 20% increase in cases of cervical cancer due to this lack of immediate screening, and therefore, treatment. The mortality would, by the same proportion, also increase.

Is it better after all?

However, both the government and the National Screening Unit do not share Cox’s fears. They believe that the new regime could actually reduce the incidence by 12-15 percent, and reduce mortality at the same percentage. Instead of over-referral and over-treatment, the cell-testing would save more time and instead be more directly focused on the real cause of cervical cancer. Around 160 women in New Zealand are diagnosed with this cancer, and 60 of them die from the disease.

Cox nevertheless remains stubborn in his beliefs that this is too much of a risk to take especially for the women of New Zealand. Citing studies in Finland that prove that HPV actually leads to more over-diagnoses that don’t even lead to cancer. It would lead to more testing such as colonoscopies, the departments of which are already stressed as they are.

The Ministry nevertheless continues to stand by their own findings and their own studies that prove that this new change could in fact be more beneficial to New Zealand women. European trials have concluded that this method offers a substantially better level of protection against the cancer, and that it is the overwhelming international opinion that HPV tests will reduce cancer rates.

In the end, it must be left to the women of New Zealand to decide. The early detection is the key to a truly successful, curable treatment of cervical cancer. Whichever method they choose, it must be carefully considered, for the best protection of their own bodies.