How to prevent cervical cancer?

Cervical cancer is a disease linked to an infection caused by one or more strands of the human papilloma virus (also known as HPV). The most frequent types are 16 and 18, present in more than 70% of cervical cancer cases.
These viruses are sexually transmitted. Generally speaking, the body manages to eliminate them but in some cases infections may subsist and cause lesions on the cervix which are likely to ultimately develop into cancer.
Yet most deaths from this type of cancer can be prevented. A pap smear test is used for the early detection of premalignant lesions which can then be treated.

Vaccination is recommended for girls aged between 11 and 15 years and as a catch-up solution for girls aged from 15 up to but not including the age of 20. Vaccination is more effective if the young girl has not yet been exposed to the risk of HPV infection.
Two vaccines are available:

• The Gardasil vaccine is quadrivalent, which means it protects against 4 viruses: cancer-causing genotypes 16 and 18 and genotypes 6 and 11, which do not cause cancer but can result in benign lesions known as condylomas (or genital warts).
• The Cervarix vaccine is bivalent and protects against two 2 viruses: cancer-causing genotypes 16 and 18.

3 injections are required for the vaccination to be effective:

• a succession of 3 injections at 0, 2 and 6 months for the quadrivalent vaccine (Gardasil),
• or a succession of 3 injections at 0, 1 and 6 months for the bivalent vaccine (Cervarix).

The two vaccines are not interchangeable. If vaccination begins with one type, the same vaccine must be administered for each of the three injections.

The pap smear is a simple and effective gynecological test. It is recommended for all women aged between 25 and 65 years (regardless of vaccination against the HPV virus), and even after the menopause.
Lesions caused by the HPV virus develop slowly. That is why screening every three years is sufficient following two initial pap smear tests with normal results conducted one year apart, except in special cases (discuss this with your doctor). Naturally, even women who have been vaccinated must be screened with pap smears.
An abnormal smear test result means that cells with anomalies have been detected.
It is then possible to distinguish between infection by the HPV (papilloma virus), dysplasia (premalignant state) to different degrees or a squamous cell (affecting the skin or mucus membranes) or glandular cancer.
Patients receiving abnormal pap smear results will be asked to undergo a colposcopy.

A colposcopy is a painless examination conducted by a gynecologist, usually in their office. It allows the specialist to view the cervix directly through the vagina.
The aim is to look for any premalignant lesions present on the cervix and, where necessary, to take biopsies of the abnormal areas.
A biopsy is the removal of one or more fragments of the mucus membrane of the cervix which are then sent to a laboratory for analysis. The biopsy is used for the exact diagnosis of the detected abnormality. In the event of an anomaly, a cervical conization is required to remove the premalignant lesions.

Cervical conization is a surgical procedure which involves removing the section of tissue around the orifice of the cervix. The sample removed is shaped like a cone, hence the name of the procedure. Depending on the country, the procedure is conducted in an operating theater or during a consultation under anesthetic, often loco-regional (technique used to numb a specific part of the body) or local anesthetic. 

Cervical conization is recommended in the following two cases:

• In cases of dysplasia (premalignant states) confirmed by biopsy. Dysplasia is classified as CIN (Cervical Intraepithelial Neoplasia) grade 1, 2, 3 according to its growth potential. Conization aims to remove CIN 2 and 3. Mild dysplasia (CIN 1), which has been recently detected, is not treated and will be monitored by your gynecologist.
• In the event of an inconsistency between the pap smear and the biopsy results, conization may be conducted to confirm the diagnosis. Under all circumstances, the tissue sample removed will be analyzed to eliminate the existence of a source of cancer and to assess the spread of the lesions.

Your gynecologist will see you for a consultation 2 or 3 weeks following the procedure to discuss the results. 
If the analysis shows that all lesions have been removed, your gynecologist will set up a simple monitoring protocol to prevent any recurrence of HPV.
A more aggressive treatment is necessary solely where the analysis shows more advanced lesions (micro-invasive or invasive cancer).

• Less than 25 years

The risk of cervical cancer is quite rare before the age of 25. This is why screening by pap smear is not yet recommended, except in specific cases. However, if you have a daughter aged between 11 and 14 and, under certain conditions, as a catch-up program up to but not including the age of 20, you can arrange for her to be vaccinated. Please discuss this with your doctor.

• Over 65 years

The natural development and spread of cervical cancer are such that it is less frequent to contract this disease after the age of 65. Regular gynecological monitoring is however recommended, in particular depending on your medical history and/or previous pap smear results.

• If your are pregnant

Being pregnant does not prevent you from having a pap smear. You should know that this procedure is not dangerous at all for you or your baby. If you haven’t been screened in the last three years, your doctor or midwife may suggest you have a pap smear during your first compulsory prenatal examination, which generally takes place during the first three months of pregnancy.