The conventional pap smear has been used in South Africa since the early 1960’s but the incidence and mortality of cervical cancer in the country has changed very little. The reason being is majority of women do not present themselves for screening tests.
Women should ideally avail themselves for annual pap smears starting a year after sexual debut. The advent of liquid based cytology has improved smear quality and adjuvant testing for the Human Papilloma Virus (HPV) done at the same time and on the same sample significantly improves sensitivity. Thus allows for a more precise and thorough result.
The risk factors for cervical cancer are mainly the HPV virus 16 and 18.
HPV is predominantly but not exclusively a sexually transmitted virus thus making sexual intercourse the single most important risk factor. The other risk factor for exposure to HPV is age at first sexual encounter. Women who have commenced sexual activities during adolescence appear to have the highest risk. Coitus with multiple partners poses an increased risk independent of other risk factors.
Other high risk factors include patients with HIV infection. An increased prevalence of cervical cancer is seen in HIV positive patients.
The smoking of cigarettes doubles the patients risk to develop pre-cancer and cancerous lesions of the cervix.
Persistence of the HPV virus in the cervix is known to cause cancer. The advent of HPV testing on the pap smear allows us to more accurately triage woman with abnormal pap smears to more rapid colposcopy.
Colposcopy allows the clinician with the use of a colposcope to examine the cervix under magnification. Biopsies can then be taken from the most abnormal areas. The precise diagnosis of a pre- cancer lesion is made histologically on a cervical biopsy. The predictive value of directed biopsies as to the final diagnosis is excellent.
This improved screening process can result in fewer pap smears needed, early detection of disease and cancer and thus leading to earlier successful treatment.