Cervical Cancer: Changing Early Detection | Knowledge

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  ofPamela Dörhöfer

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Since January 1, women aged 35 and over have been offered a screening that combines the Pap test with an HPV examination / There is also criticism

The early detection of cervical cancer is one of the routine examinations by a gynecologist. Women of all ages know it: The doctor painlessly removes cells from the cervix with a small spatula – their subsequent analysis under the microscope then provides information about possible inflammatory changes, precursors to cancer or an existing tumor.

Since the beginning of the 1970s, this so-called Pap test has been part of early cancer detection in addition to a gynecological examination, which every health-insured woman from the age of 20 can use free of charge once a year. The benefits of the Pap test are undisputed, the error rate is very low. Figures from the German Cancer Registry show that before the Pap test was launched, twice as many women died of cervical cancer as they do today. One of the advantages of the test is that it can detect precursors to cancer.

Since January 1st, gynecological preventive care in Germany is no longer managed in a uniform manner, but divided into two age groups: women between 20 and 34 can, as before, have their abdomen examined and a cell smear taken once a year, nothing will change for them. Women over 35 will be offered a screening for cervical cancer in the future: For them, the Pap smear will in future be combined with a test for human papilloma viruses (HPV). If the result is normal, the double test is repeated every three years. As before, the gynecological examination of the lower abdomen can be performed free of charge once a year.

Human papilloma viruses are widespread pathogens that can cause genital warts, inflammation and also malignant changes. There are more than 200 different types of HPV, around 40 of which cause infections and are sexually transmitted. Most women and men become infected with an HP virus once or several times in the course of their lives. The infections often go unnoticed and heal without any consequences on their own, even without treatment, because most human papilloma viruses are harmless. However, some types increase the risk of cervical cancer.

Cervical carcinoma, as the medical term is known, is one of the most common cancers in women worldwide and is triggered in most cases by an infection with viruses. The cancer often arises many years after infection from diseased skin areas. Girls and boys between the ages of 18 and 18 can be vaccinated against high-risk papilloma viruses; some health insurance companies also pay for vaccinations up to their 26th birthday.

Back to the screening: If the Pap smear and / or the HPV test show any abnormalities, the findings must be clarified. To do this, the patient’s cervix is ​​examined under a special microscope, a colposcope. Gynecologists who work with it must acquire a special qualification.

According to the professional association of gynecologists, there are currently “far too few gynecologists in Germany” who can offer these examinations with the colposcope ”. They therefore see a “chaos in their practices” approaching their colleagues and even wrote an open letter to Federal Minister Jens Spahn (CDU) at the end of November last year demanding that the start of the program be postponed.

The gynecologists fear that there will be waiting times “that can quickly grow over many months until the system collapses completely”. In addition, “fundamental questions” of data protection and documentation are still unresolved. The latter is mainly due to the fact that the necessary software for the practices could not be made available by January 1, 2020. That is why the start of the new early detection “was made possible initially without fulfilling the documentation requirements,” says a press release from the Federal Joint Committee. So far, it has been planned that the experiences with the screening program should be evaluated after six years and that one wants to check whether it has proven itself.

In a few years, there could be an even more drastic change or additional option in the early detection of cervical cancer: At a major cancer conference last year, a team of researchers led by Belinda Nejai from Queen Mary University in London presented a rapid home test, where Women themselves can take vaginal secretions and urine samples. The study involved 600 women who had already been examined with a colposcope due to an abnormal screening or a positive HPV test. Some only took a smear from the vagina, some also took a urine sample. As the researchers reported, the test worked well in both variants and provided reliable information about advanced stages of cancer.

The test called “S 5” looks for epigenetic changes in the genome of human cells and HP viruses. Epigenetic changes say something about the activity of certain genes.

The test could be particularly interesting for women who shy away from seeing a gynecologist because they find the examination uncomfortable and therefore do not take part in early detection. In these patients, cancer is often only recognized when it is already causing symptoms and is therefore often advanced.

Such a self-test could also help women who live in remote regions or countries without early cancer detection to detect pathological changes in the cervix at an early stage.

However, there are also critical voices that such a self-test contradicts the proven previous cancer screening.

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