By: Adebowale Bello, Freelance Health Writer. With medical review and editorial support by the Datelinehealth Africa Team
A gathering of African women
In 2020, there were an estimated 604,000 new cases of cervical cancer and it ranked as the fourth most common cancer in women, hence highlighting cervical cancer as a significant global health concern.
As medical advancements and awareness campaigns gain momentum, the emphasis on cervical cancer screening becomes increasingly important.
This article focuses attention on the urgency of cervical cancer screening in African women and sheds more light on the various screening methods.
Cervical screening is a preventive measure that scans the cervix for signs of cancer. Its main goal is to identify precancerous cells early enough so that appropriate treatment can begin.
Undergoing periodic cervical cancer screening is important because these abnormal cells can be present in the cervix for a long time thereby making it difficult to treat.
The WHO global strategy encourages a minimum of two lifetime screens with a high-performance HPV test by age 35 and again by age 45 years. More specifically, women should be screened for cervical cancer every 5–10 years starting at age 30 and those living with HIV should be screened every 3 years starting at age 25. [1]
There are different ways by which cervical cancer can be screened with the most common ones being the Pap smear and Human Papilloma Virus (HPV) test. Other methods include visual inspection either with acetic acid or Lugol's iodine and it is also possible to self screen yourself for cervical cancer.
Here's a brief look at each of these methods.
The Greek scientist George N. Papanicolaou studied the vaginal smear and was able to accurately distinguish between normal cervical cells and precancerous cells by viewing such cells under a microscope and this simple test has become the go-to test when screening for cervical cancer.
“A Pap smear is by far the most reliable and effective screening tool for cervical cancer and Pap smear screenings have prevented death from cervical cancer by 93 - 95%”, says Dr. Anne Alaniz, a gynecologic oncologist at the Houston Methodist Willowbrook Hospital, Houston, Texas, USA.
To begin a pap smear, a clean medical device known as a speculum is inserted into the vagina to pull the walls apart for a clear view of the cervix. A soft brush and wooden spatula are then used to collect cell samples from the cervix. The samples are smeared on a glass slide then stained with dyes which allow them to be visible under a microscope. [2]
Some limitations of the Pap smear include the time taken for the test and the possibility of a false result due to the presence of blood or mucus.
Over the years though, several improvements have been made to the Pap smear test ensuring a faster and more economical test. [3,4,5]
HPV testing is carried out to identify high risk HPV types which can potentially cause cervical cancer. This test aims to identify traces of the DNA or mRNA of the HPV virus in the cervical cells.
Depending on your doctor, HPV testing can either be carried out alone or with a Pap smear test. The American Cancer Society recommends HPV tests for people within the ages of 25-65 while the World Health Organization (WHO) recommends the HPV DNA detection method as the primary screening test for cervical cancer.
This method is extremely valuable in areas such as developing countries where there are limited resources available for cervical cancer screening.
For the first method, acetic acid is applied to the uterine cervix and inspected with the naked eyes and if there are precancerous cells there, these cells turn white and can be easily identified.
Visual inspection with Lugol's iodine test is similar to the first test and the only exceptions are the use of Lugol's iodine instead of acetic acid and the yellow colouration of precancerous cells instead of white.
These tests can be performed by trained primary care healthcare professionals and though they might be less specific than the Pap smear, they make up for that by being more sensitive to precancerous cells.
Globally, there is a shortage of health professionals especially in low and middle income countries and this has led to self-care interventions.
These interventions are evidence-based and could include medicines, devices or even diagnostic tests which can be provided outside formal healthcare with or without the supervision of a health care professional.
HPV self-sampling is a widely accepted screening method as it affords privacy and convenience and this option has increased the amount of women who are willing to get screened for cervical cancer. [6]
If you want to self screen, here are the steps you should take:
Cervical cancer screening guidelines are recommendations on when and how often women should undergo screenings to detect early signs of cervical cancer or abnormalities. The guidelines may vary slightly among different health organizations but they generally share common principles.
The most recent guideline by the American Cancer Society recommends an HPV test every five years for women within the ages of 25-65, however a Pap test every three years or an HPV and Pap test every five years is acceptable.
For women who are aged 65 and above, no further screening tests are necessary if previous tests showed no signs of cancer.
You do not need to go through any special preparations before your scheduled screening appointment. You also do not need to worry if you're on your period because the screening tests can still be carried out.
Ensure that you wear comfortable clothing and avoid intercourse or using vaginal pills two days before the test. However, if you do have sexual intercourse, tell your doctor about it.
“You can take some over-the-counter pain medicine such as ibuprofen, acetaminophen or panadol to decrease the pain if a biopsy is performed”, adds Dr Alaniz.
Your screening results depend on the type of test carried out. For HPV tests, the result could either be negative signifying that no HPV type was found or positive indicating the presence of HPV.
For Pap smear, the result could come out as normal showing that there are no abnormal cervical cells or the results could come out as unsatisfactory or abnormal. An unsatisfactory result might be due to contamination of the sample or the presence of blood or in some cases, the sample cells collected are insufficient.
An abnormal Pap test result shows that there are abnormal cervical cells present, however it is important to note that this does NOT mean that you have cervical cancer. These abnormal cells could be caused by an HPV infection and you may need to undergo further tests to be sure if they are precancerous cells or not. [7]
If testing reveals precancerous changes in your cervix, your doctor may suggest further evaluation and tests such as colposcopy and a biopsy.
A colposcopy is a procedure in which the doctor examines your cervix more closely using a tool called colposcope, which is a specialized magnifying instrument. If abnormal areas are identified, a small sample (biopsy) might be taken for evaluation in order to determine the extent of the changes.
“A biopsy helps to identify if the cells are pre-cancer cells or cancer cells. If it’s pre-cancer, potential treatments include freezing the abnormal cells, thermal ablation, laser treatment and resection of the abnormal cells. If cancer cells are found, treatment such as surgery or radiation therapy would depend on the stage of the disease, explains Dr. Alaniz.
Potential causes include HPV infection, inflammation or infection, recent vaginal surgeries, menstrual blood, technical factors, cervical dysplasia (CIN) and smoking. Abnormal results don't necessarily mean cancer. However further evaluation is needed.
To reduce the risk of cervical cancer, get vaccinated against HPV, practice safe sex, quit smoking, attend regular screenings and discuss risk factors with your healthcare provider.
The need for more frequent screenings depends on individual factors. Follow your doctor's recommendations for the most suitable schedule based on your health and history.
Yes, you can still get vaccinated against HPV even if you haven't done so previously. It's recommended for prevention, especially if you're within the eligible age range.
Abnormal results may indicate cell changes that need extra treatments. Prompt follow-up is crucial and the impact on future health and fertility depends on the underlying cause and subsequent treatment, if necessary.
The benefits of cervical cancer screening cannot be overemphasized as it is a proactive measure that saves lives and also gives you a sense of responsibility and control over your health status.
Increased awareness and accessibility of screening services is crucial in ensuring a future where cervical cancer is not as deadly as it currently is.
If you haven't, book an appointment with your doctor and get screened today.
1. World Health Organization. Cervical cancer. [Internet]. November 17 2023. Accessed January 30 2024. Available from here.
2. Chantziantoniou N, Donnelly AD, Mukherjee M, Boon ME, Austin RM. Inception and Development of the Papanicolaou Stain Method. Acta Cytol. 2017;61(4-5):266-280. doi: 10.1159/000457827. Available from here.
3. Prasaad PR. Short-duration Papanicolaou stain (SPS)—an alternative to conventional Papanicolaou stain in routine cytopathology?. Comp Clin Pathol 2017;26, 1285–1288. Abstract available from here.
4. Izhar S, Kaur R, Masih K. Efficacy of rapid, economical, acetic acid, Papanicolaou stain in cervical smears as an alternative to conventional Papanicolaou stain. J Cytol. 2014; 31(3):154-7. doi: 10.4103/0970-9371.145648. Available from here.
5. Thakur M, Guttikonda VR. Modified ultrafast Papanicolaou staining technique: A comparative study. J Cytol; 2017;34(3):149-153. doi: 10.4103/JOC.JOC_23_16. Available from here.
6. World Health Organization. WHO recommendations on self-care interventions. [Internet]. April 17, 2023. Accessed January 22, 2024. Available from here.
7. National Cancer Institute. HPV and Pap Test Results. [Internet]. Updated May 5, 2023 Accessed January 22, 2024. Available from here.
Published: January 30, 2024
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