The NHS recently announced that thanks to improved rates of cervical screening and HPV vaccination uptake, there is hope for cervical cancer to be practically non-existent in the UK by 2040.
However, as NHS England boss Amanda Pritchard noted, more still needs to be done to encourage women to get their screenings and get the HPV vaccine.
So, despite the good news that cervical cancer may be eliminated, it remains crucial for women to attend their cervical screenings. “HPV infections do not usually cause any symptoms, and most people will not know they’re infected,” says Dr. Hana Patel, NHS GP and GP Medico-Legal Expert Witness to GLAMOUR. “Having your regular smear test when your GP or the NHS invites you to get one done every 3 years lowers your chances of getting cervical cancer. Screenings finds abnormal cells so they can be removed before they become cancer.”
The human papillomavirus, or HPV, vaccine has reduced cervical cancer rates in women by 87%, according to research conducted by King’s College London.
A great deal of unnecessary shame surrounds HPV and smear test results. Research by Jo’s Cervical Cancer Trust for Cervical Cancer Awareness Week this week (17-23 January) found that over 70% of women surveyed had a HPV diagnosis, many of which expressed feelings of guilt, confusion, and anger or concerns about relationships and infidelity as a result.
A third (34%) reported feeling anxious or worried and 35% spoke of shame, embarrassment or feeling dirty.
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The King’s College London study found that the HPV vaccination programme “prevented around 450 cervical cancers and around 17,200 pre-cancers by the middle of 2019,” with Dr Vanessa Saliba, Consultant Epidemiologist in Immunisations at Public Health England, saying:
“These remarkable findings confirm that the HPV vaccine saves lives by dramatically reducing cervical cancer rates among women. This reminds us that vaccines are one of the most important tools we have to help us live longer, healthier lives.”
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Human Papillomavirus (HPV) causes cell changes. Cervical screening has been found to help prevent cervical cancer by identifying infection and abnormal cells, which can be monitored or treated to stop cancer developing.
With more than half a million smear tests delayed or missed during the pandemic, recognising the symptoms yourself is absolutely pivotal.
Under normal circumstances, 1.5 million appointments (!!!) are skipped each year due to fear, body consciousness, embarrassment or ‘packed schedules’, but anxiety around catching coronavirus has seen attendance plummet even further. Only half of eligible patients are attending their smear test in some parts of the UK.
Around 220,000 women are diagnosed every year following cervical screening, according to Jo’s Cervical Cancer Trust, however over a quarter (26%) of those surveyed said they felt ashamed when diagnosed.
“Over 21,000 women in the UK are diagnosed with a gynaecological cancer (ovarian, cervical, womb, vaginal and vulval) every year, but awareness of their signs and symptoms is low,” explains Dr John Butler, gynaecological surgeon at the Royal College of Obstetricians and Gynaecologists (RCOG). “It’s vital women of all ages get to know their bodies and what to look for as the earlier a cancer is found, the easier it is to treat and the higher the chance of successful treatment.”
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Every single day, 58 women in the UK receive a life-changing gynaecological cancer diagnosis. Out of those 58 women, 21 of them will die. That’s why it’s never been so important to understand the first symptoms of cancer and why we need to start talking about gynaecological health a lot more openly.
Leading gynaecological cancer awareness brands have been searching for ways of ensuring the information we need reaches us, to ensure we’re armed with the signs and symptoms that can aid the detection and treatment of gynaecological cancers early.
The good news is up to 93% of cervical cancers are preventable through proper screening, so health professionals are desperate to make us all aware of just how life-saving cervical screenings can be.
“It is estimated that the smear test program, with proper treatment of the pre-cancerous changes that are sometimes found, saves the lives of up to 5,000 women per year, who would otherwise have died of future cervical cancer,” explains Andrew Pooley, Gynaecologist at New Victoria Hospital.
“The smear test does not prevent pre-cancerous changes, but it does find them at an early and simply treatable stage in nearly all cases,” he added. So it’s vital we make them a priority.
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We asked Andrew to talk us through everything we should know about cervical cancer, from what causes it, to preventing it. Here’s what he had to say:
What is cervical cancer?
“Cervical cancer is when cells in the lining of the cervix (which is the lower part of the uterus, also called the neck or the opening of the womb), grow abnormally in an uncontrolled way. The main symptom is unusual bleeding from the vagina. Finding pre- cancerous changes in the cells through screening can help to prevent cancer developing.”
What are the symptoms of cervical cancer, and warning signs to look out for?
“Cervical cancer may not cause any symptoms or the symptoms may not be obvious. However, the most common symptoms of cervical cancer include:
- vaginal bleeding that is unusual for you, including after the menopause, after sex, or between regular periods
- changes to vaginal discharge
- pain or discomfort during sex
- unexplained pain in your lower back or between your hip bones
It is important to remember that these symptoms often happen for reasons other than cervical cancer. But it is also important to contact your GP straight away if you notice these symptoms, so they can give you reassurance and support.”
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What are the causes of cervical cancer?
“The main cause of cervical cancer is a virus called high-risk human papillomavirus (HPV). High-risk HPV sometimes causes changes in the cells of the cervix, which can develop into cervical cancer.
“On average this happens slowly, between about five and 20 years. Knowing about risks can be helpful, as it can help you understand more about what you can and can’t control. But it is important to remember that having any or all of the risks we talk about on this page does not mean you will definitely develop cervical cancer.”
How can I prevent cervical cancer?
“Virtually all cervical cancers are associated with human papilloma viruses (HPV). However, the majority of women with HPV do not develop cervical cancer. Women become susceptible to developing cervical cancer following HPV infection, but other environmental factors are required for the cancer to develop. These include lifestyle risk factors such as smoking, or having reduced immunity from medical conditions or medicines.
“The most important step is to attend your regular smear tests when invited. The smear test does not prevent pre-cancerous changes, but it does find them early and at a simply treatable stage in nearly all cases. Being armed with the correct facts is vital when it comes to health, so it’s important for people to understand exactly why smear tests are so important and what the process of going for one really involves.”
Now that the first recipients of the HPV vaccine are of an age to have smear tests, can you comment on its success in reducing cervical cancer?
“Since the NHS started offering HPV vaccination to teenage girls in 2008, and boys from 2019, more than 11 million have been vaccinated. Recent studies have shown that rates of infection with HPV 16 and 18 (the highest risk types) are down from 15% to 2% in those vaccinated. Pre-cancerous cervical changes have so far been shown to be reduced by 51% in teenage girls, and by 31% in women aged 20-24. An added benefit is that rates of infection with HPV types 6 and 11, that cause genital warts have also halved, to 4%.
It usually takes at least 10 years to develop cervical cancer after HPV infection, and in many cases much longer. This means that it is too soon to yet see a significant drop in rates of clinical cancer, but with very high levels of reduction in the prevalence of the high risk HPV types that cause nearly all cervical cancers, a fall in rates of cancer is highly likely to show itself soon.”
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How can you find out if you have cervical cancer?
“If you have symptoms, you should ring your GP surgery and ask for an appointment. Your GP may want to assess you over the phone to help decide the next steps. Once they know more about your individual situation, they will decide on the next steps. This is likely to involve a visit to see your doctor face to face for an examination. If your GP is concerned, then a prompt visit to see a hospital specialist would be arranged.”
What are the cervical cancer grades and stages?
“With a cancer, the individual cells are graded into 3 groups depending on how similar or different the cells are compared to healthy cells.
These cells look similar to healthy cells. They tend to grow more slowly than higher grades.
These cells look a bit like healthy cells and may grow a bit quicker.
These cells look very different to healthy cells. They tend to grow more quickly which means they are more likely to spread. Grade 3 cancers might need more intensive treatment than lower grades.
Cases of cervical cancer are grouped into 4 stages, depending on how large the growth is, and if there are any signs that it has spread outside the cervix to nearby organs or around the body [stage 1 means the growth is small and hasn’t spread, stage four means the growth is larger and has spread].”
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What are the treatments for pre-cancerous changes, and for cervical cancer?
“When attended regularly, smear tests help with the monitoring of any change in cells and the detection of pre-cancerous cells – something that is easily treatable and helps stop the development of cervical cancer.
The modern screening test is looking for possible presence of certain higher risk strains of the Human Papilloma Virus (HPV), not for cervical cancer itself. If HPV is found, then the cells in the test are examined for possible signs of pre-cancerous cells, which, if found are very simply treatable in nearly all cases.
It is just as important to have routine smear testing even if you have had the HPV vaccine. It is likely that the chance of ever having cervical cancer will be much lower in those who have had the vaccine, but some types of cervical precancerous changes will not be prevented by the vaccines and are just as treatable if detected.
Cervical cancer is treated differently depending on what grade and stage it’s at. If cells are found in your cervix that are abnormal but haven’t turned cancerous, doctors can use different treatments to kill or get rid of them. This doesn’t usually hurt, and is sometimes done by a laser or small electric current being applied to the affected area.
If cells have become cancerous but the cancer is found early on, it may be possible to remove part or all of the cervix, but keeping the uterus, so that there may be the possibility of future pregnancies. Depending on the stage of the cancer, a hysterectomy may be the recommended treatment, with possible radiotherapy to kill any cancerous cells that may have started to spread. If the cancer is more advanced then you will be offered radiotherapy, and maybe a combination of chemotherapy and surgery.”
What are the cervical cancer survival rates?
“Survival statistics are available for each stage of cervical cancer in England according to Cancer Research UK. These figures are for people diagnosed between 2013 and 2017.
Almost 95 out of 100 people (around 95%) will survive their cancer for 5 years or more after diagnosis.
Almost 70 out of 100 people (almost 70%) will survive their cancer for 5 years or more after diagnosis.
Around 15 out of 100 people (around 15%) will survive their cancer for 5 years or more after being diagnosed.
Around 15 out of 100 people (around 15%) will survive their cancer for 5 years or more after being diagnosed.”
Can you get the HPV vaccine later in life?
If you haven’t yet received the HPV vaccine you may be wondering: is it too late?
“Some adults ages 27 through 45 years who missed the vaccination might choose to get the HPV vaccine after speaking with their GP about their risk for new HPV infections and possible benefits of vaccination for them,” says Patel.
Additionally, if you haven’t received the vaccine, it’s vital to attend your regular cervical screenings. In fact, even if you have had the vaccine, screenings remain essential.
“Because the HPV vaccine does not protect against all types of HPV that can cause cervical cancer, it’s important that all girls who receive the HPV vaccine also have regular cervical screening once they reach the age of 25,” she says.
Can you get rid of HPV?
As Patel explains, most people are infected with one of the hundreds of types of HPV at some point in their life.
“There is no treatment for the virus itself,” she says. “However, there are treatments for the health problems that HPV can cause.”
Has the way they test for HPV and cervical cancer changed?
Yes, the test has changed in the last three years.
“The new test is known as HPV primary screening and is more accurate at detecting who is at higher risk of developing cervical cancer,” says Patel. “This means the intervals for those not at high risk can be safely extended from 3 to 5 years.”
Can you test for HPV at home?
“There are at home test kits available and NHS England carried out a trial where they offered women who were overdue their smear tests kits to carry out smear tests in the privacy and convenience of their own homes,” says Patel.
However, it is advised that you attend in-person screenings with your GP wherever possible as the trial is a new one.
If you have questions, concerns or are affected by cervical cancer or cell changes, contact Jo’s Cervical Cancer Trust for support.
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