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Importance of  PAP smear, HPV test and  Gardasil vaccination in prevention of cervical cancer

Cervical cancer develops in a woman's cervix -the entrance to the uterus from the vagina. 

In 2020, more than half a million women contracted cervical cancer, and about 342 000 women died as a result – most in the poorest countries. Quick and accurate screening programmes are critical so that every woman with cervical disease gets the treatment she needs, and avoidable deaths are prevented.

Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.

Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.

Effective primary HPV vaccination and secondary prevention approaches -screening for, and treating precancerous lesions ,will prevent most cervical cancer cases.

When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.

With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation.

The main step- is PAP smear test and HPV test

A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women- collecting cells from the cervix

Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. A Pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. Detecting these abnormal cells early with a Pap smear is your first step in halting the possible development of cervical cancer.

Pap test should be combined with a test for human papillomavirus  HPV — a common sexually transmitted infection that can cause cervical cancer

The new guideline include some important shifts in World Health Organization’s recommended approaches to cervical screening. 

In particular, it recommends an HPV DNA based test as the preferred method, rather than visual inspection with acetic acid  or Pap smear ,currently the most commonly used methods globally to detect pre-cancer lesions.

HPV-DNA testing detects high-risk strains of HPV which cause almost all cervical cancers.

Recommend beginning Pap testing at age 21.

Women age 30 and older can consider Pap testing every five years if the procedure is combined with testing for HPV. Or they might consider HPV testing instead of the Pap test.

If you have certain risk factors, your doctor may recommend more-frequent Pap smears, regardless of your age.

Although the process for a healthcare provider obtaining a cervical sample is similar with both cytology or HPV DNA testing, HPV DNA testing is simpler, prevents more pre-cancers and cancer, and saves more lives than VIA or cytology.

WHO suggests using either of the following strategies for cervical cancer prevention:

  • HPV DNA detection as a primary screening test
  • starting at the age of 30 years
  • with regular screening every 5 to 10 years.

HPV infection is a viral infection that commonly causes skin or mucous membrane growths -warts. There are more than 100 varieties of human papillomavirus HPV. Some types of HPV infection cause warts, and some can cause different types of cancer.

Most HPV infections don't lead to cancer. But some types of genital HPV can cause cervical cancer . Other types of cancers, including cancers of the anus, penis, vagina, vulva and back of the throat , have been linked to HPV infection.

These infections are often transmitted sexually or through other skin-to-skin contact. Vaccines can help protect against the strains of HPV most likely to cause genital warts or cervical cancer.

In most cases, your body's immune system defeats an HPV infection before it creates warts. When warts do appear, they vary in appearance depending on which kind of HPV is involved:

Genital warts: These appear as flat lesions, small cauliflower-like bumps or tiny stemlike protrusions. In women, genital warts appear mostly on the vulva but can also occur near the anus, on the cervix or in the vagina.

In men, genital warts appear on the penis and scrotum or around the anus. Genital warts rarely cause discomfort or pain, though they may itch or feel tender.

Cervical cancer :Nearly all cervical cancers are caused by HPV infections, but cervical cancer may take 20 years or longer to develop after an HPV infection. The HPV infection and early cervical cancer typically don't cause noticeable symptoms. Getting vaccinated against HPV infection is your best protection from cervical cancer.

Because early cervical cancer doesn't cause symptoms, it's vital that women have regular screening tests to detect any precancerous changes in the cervix that might lead to cancer. Current guidelines recommend that women ages 21 to 29 have a Pap test every three years.

Women ages 30 to 65 are advised to continue having a Pap test every three years, or every five years if they also get the HPV DNA test at the same time. Women over 65 can stop testing if they've had three normal Pap tests in a row, or two HPV DNA and Pap tests with no abnormal results.

Causes

HPV infection occurs when the virus enters your body, usually through a cut, abrasion or small tear in your skin. The virus is transferred primarily by skin-to-skin contact.

Genital HPV infections are contracted through sexual intercourse, anal sex and other skin-to-skin contact in the genital region. Some HPV infections that result in oral or upper respiratory lesions are contracted through oral sex.

Warts are contagious. They can spread through direct contact with a wart. Warts can also spread when someone touches something that already touched a wart.

HPV infections are common. Risk factors for HPV infection include :number of sexual partners- more sexual partners you have, the more likely you are to contract a genital HPV infection. Having sex with a partner who has had multiple sex partners also increases your risk ; young age, weakened immune systems, damaged skin, personal contact.

Gardasil 9 HPV vaccine

Gardasil 9  Human Papillomavirus 9-valent Vaccine Types 16, 18, 31, 33, 45, 52, 58, 6, 11  helps protect individuals ages 9 to 45 against the following diseases caused by 9 types of HPV: cervical, vaginal, and vulvar cancers in females, anal cancer, certain head and neck cancers, such as throat and back of mouth cancers and genital warts in both males and females.

HPV is  vaccine approved by the U.S. Food and Drug Administration and can be used for males and females to protect against cervical cancer and genital warts.

The Centers for Disease Control and Prevention  recommends routine HPV vaccination for girls and boys ages 11 and 12, although it can be given as early as age 9. It's ideal for girls and boys to receive the vaccine before they have sexual contact and are exposed to HPV. Research has shown that receiving the vaccine at a young age isn't linked to an earlier start of sexual activity.

Once someone is infected with HPV, the vaccine might not be as effective or might not work at all. Also, response to the vaccine is better at younger ages than older ones. But, if given before someone is infected, the vaccine can prevent most cases of cervical cancer.

The U.S. Food and Drug Administration  approved the use of Gardasil 9 for males and females ages 9 to 45.

For persons 9 through 14 years of age, GARDASIL 9 can be given using a 2-dose or 3-dose schedule.

For persons 15 through 45 years of age, GARDASIL 9 is given using a 3-dose schedule; the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot.

The appropriate dosing schedule will be determined by your Doctor and according to updated guidelines

Treatment for abnormal PAP smear and positive HPV in the cervix- Colposcopy

If you have an abnormal HPV or Pap test, your gynecologist will perform a procedure called a colposcopy. Using an instrument that provides a magnified view of the cervix (colposcope), your doctor will look closely at the cervix and take samples (biopsy) of any areas that look abnormal.

Any precancerous lesions need to be removed. Options include freezing (cryosurgery), laser, surgical removal, loop electrosurgical excision procedure (LEEP) and cold knife conization. LEEP uses a thin looped wire charged with an electric current to remove a thin layer of a section of the cervix and cold knife conization is a surgical procedure that removes a cone-shaped piece of the cervix.

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