cervical screening for cervial cancer

1. CERVICAL CANCER
SCREENING
Dr. M.
Mwanahamunt
u

2. Screening. The meaning!
 Intervention upon the susceptible* population
aimed at preventing the occurrence of a disease*.
* Susceptible is not the same as at risk or at
increased risk
* What the intervention tests in not the disease but
the pre-disease manifestation since in screening,
the actual disease has not yet occurred.

3. Screening. The test itself!
 A disease that is screened must be significantly
prevalent and must have significant mortality or
morbidity
 The disease must have a detectable preclinical
stage
 The disease must be treatable
 The test must be sufficient specificity, sensitivity
and positive predictive value
 The test must be cost effective
 The test must be tolarable

4. Facts about pre-cancer of the cervix
-The causes
 Associated with oncogenic types of Human
Pappiloma Virus (HPV) infection. E.g.
type 16, 18, 31, and 32
 Immunosupressive disorders such as
HIV/AIDS the risk of cancer because HPV will be persistent
 Other carcinogenic substances involved in
other cancers may also have a role

5. Facts about pre-cancer of the cervix
-The histology and course
 According to dyskaryosis(dyskaryosis is the early change in cells undergoing
carcinogenesis characterized by increased activity seen as increase in the nuclei)
CIN1 (mild)
CIN 2 (moderate)
CIN 3 (severe)
 changes begin in the transformation Zone
 CIN takes any time between 6 months to several
years to become cancer of the cx
 Majority CIN may persist for life

6. Facts about pre-cancer of the
cervix-methods of screening
 Papanicolaou (Pap) smear(is cytology based, most popular, oldest. It
remains the method of choice.)
 Thin prep Pap
 HPV-DNA testing
 Visual Inspection with Acetic Acid (VIA)
(Still being investigated for its suitability esp in poor countries since it does not require cytology services)

7. Facts about pre-cancer of the
cervix-methods of screening
 All Reproductive health workers must
know how to do a Pap smear. This includes
you! When in the field, you must learn how to use an Ayre spatula to do a cervical scrape, to
fix the smear on to a glass slide, preserve it and send it for cytological assessment.

8. Facts about pre-cancer of the
cervix-methods of screening
 WHO SHOULD BE SCREENED:
By definition of a screening test, all women
are susceptible to cancer of the cervix.
HPV is sexually transmitted therefore all
sexually active women are recommended
for screening at least once in 3 years. After
menopause, the likelihood of developing
pre-cancer lesions is very slim hence this
upper limit of screening.

9. Facts about pre-cancer of the
cervix-methods of management
 When a screening methods reports
dyskaryosis of the cervix, there should be
interventions as follows:-
1. CIN1 Repeat after 6 months or after treating any infections. If this continues, do local destructive
therapy
2. CIN2/3 Do local destructive therapy of the cervix.

10. Facts about pre-cancer of the
cervix-methods of management
 Local destructive techniques of the cervix are
aimed at completely removing the transformation
zone (TZ) up to the squamocolumnar junction
(SCJ). These include:-
1. Large loop excision procedure (LLEP) (most recommended
in units that can afford the equipment and expertise)
2. Cryotherapy (‘cold treatment’ is also recommended as above)
3. Cone biopsy (It is possible to do this in ordinary theatre and there recommended in many
Zambian hospitals.)
4. Cauterization / Vaporization (Not a very good method because dissue is
destroyed and not available for further histological analysis)

11. Facts about pre-cancer of the
cervix-methods of management
 Methods of cervical destruction mentioned
above should not be used where there is
cancer of the cervix. They are only for the
treatment of pre-cancer lesions termed as
CIN. All women treated by local
destructive methods must continue to
receive frequent screening services i.e. Pap
smear.