Cervical cancer symptoms?

Fortunately I don’t see them often…..

and great news…cervical cancer is now potentially a preventable disease!

Cervical cancer causes a smelly blood stained vaginal discharge. Every gynaecologist would recognise the rotten meat smell which can only mean one of two things. The relief and embarrassment which a woman expresses as I remove a fetid old tampon (which the patient is incredulous that she could have forgotten), is entirely mutual. The only other cause of this symptom is cervical cancer. When I examine my patients, I’m praying to find the former.

The incidence of cervical cancer in the UK fell steadily following the introduction of the national cervical screening programme in the mid-1970s, and hit its lowest point in 2003-2005. Next there was a small rise and a specific peak in 2009, likely due to increased awareness after the tragic death of Jade Goody at only 27 years of age. The small gradual rise was greatest in the 25-34 year old age group, and probably reflected an increase in smoking and an increase in the prevalence of infection with Human Papilloma Virus (HPV), which is now known beyond a shadow of doubt to be the cause of this cancer. The significance of smoking as a risk factor for cervical cancer cannot be over-stated.

So what has changed? Well the introduction of HPV vaccination has been a huge success. The vaccine was introduced across the UK in 2008 and the effectiveness data initially came from Scotland where women start having their smear tests aged 20 years (cf 25 in the rest of the UK). Initially just effective against types 16 and 18 HPV (causing 70% of cervical cancers) the vaccine used in schools is now effective in providing protection against genital warts which are largely caused by types 6 and 11. Gardasil 9 is a newly launched improved vaccine that protects against five more subtypes of cancer-causing HPV, making it effective in preventing over 90% of cervical cancers. The doses were previously given three times over six months, and it is now reduced to twice, with the same effectiveness, as long as given before the age of 15years.

So do I need a Smear test

You most certainly do! Cervical cancer is the twelfth most common type of cancer in women in the UK, with over 3000 new cases per year. It is, however, the second most common cancer in women under 35 years of age. Worldwide it is the fourth most common cancer in women, with over half a million new cases per year. The only way to know whether you have cervical cancer is to get a smear test and once you know your smear test results, you can take it from there. Even if you have an abnormal smear test, it is very unlikely that you have cervical cancer. It is much more likely that it is a precancerous cell change. This will be investigated following referral to a gynaecologist at a hospital where a further examination called a colposcopy will be done. The cervix will be looked at with bright illumination and magnification, and the application of a solution which has the ability to highlight any abnormal tissue. Samples (biopsies) may be taken.

The Eve Appeal is constantly raising awareness of this disease and its latest campaign has done a lot to make women realise the importance of getting advice if the have symptoms and of having smear tests

All in all, through prevention and early detection of precancerous cells, cervical cancer is a preventable disease.