An Overview of Cervical Cancers and Screening Guidelines in the UK
« Back to ArticlesCervical cancer is a type of cancer that affects the cells of the cervix, which is the lower part of the uterus that connects to the vagina. The cervix is the only part of the female reproductive system that can be seen from outside. Cervical cancer can cause symptoms such as abnormal vaginal bleeding, pelvic pain, discharge, and difficulty in having sex or passing urine.
There are two main types of cervical cancer: squamous cell carcinoma (SCC) and adenocarcinoma. SCC is the most common type, accounting for about 70% to 90% of all cases1. SCC starts in the squamous cells, which are flat and thin cells that cover the surface of the cervix. Adenocarcinoma is a less common type, accounting for about 10% to 20% of all cases1. Adenocarcinoma starts in the glandular cells, which are cuboidal and produce mucus and other substances.
The main cause of cervical cancer is infection with certain types of human papillomavirus (HPV), which is a very common sexually transmitted infection (STI). HPV can infect any part of the body where there are skin cells, including the cervix. There are more than 100 types of HPV, but only some types can cause cervical cancer. These are called high-risk HPV types2. The most common high-risk HPV types are HPV16 and HPV183.
Other risk factors for cervical cancer include smoking, having a weakened immune system, being exposed to diethylstilbestrol (DES), an artificial hormone used during pregnancy in some countries between 1939 and 19714, and having multiple sexual partners or having sex at an early age.
The diagnosis of cervical cancer usually involves a combination of tests, such as:
• A Pap smear test: This is a screening test that involves taking a sample of cells from the cervix using a small brush or spatula. The sample is then examined under a microscope to look for any abnormal changes or signs of cancer.
• A colposcopy: This is an examination that involves using a magnifying device to look at the cervix more closely. A small amount of tissue may be taken from areas that look suspicious for biopsy.
• A biopsy: This is a procedure that involves taking a small piece of tissue from the cervix for further testing in a laboratory.
• A HPV test: This is a test that detects whether there are high-risk HPV types in the cervix. It can be done as part of a Pap smear test or as an alternative screening method.
The treatment options for cervical cancer depend on several factors, such as:
• The stage and grade of the cancer
• The size and location of the tumour
• The presence or absence of lymph node involvement
• The patient’s age and general health
• The patient’s preferences and goals
The main treatment options for cervical cancer include:
• Surgery: This involves removing part or all of the cervix (hysterectomy) or nearby organs (lymphadenectomy). Surgery may also be combined with radiation therapy or chemotherapy to kill any remaining cancer cells.
• Radiation therapy: This involves using high-energy rays or particles to destroy abnormal cells in specific areas. Radiation therapy may be given before surgery (neoadjuvant) to shrink tumours or after surgery (adjuvant) to prevent recurrence.
• Chemotherapy: This involves using drugs to kill rapidly dividing cells throughout the body. Chemotherapy may be given before surgery (neoadjuvant) to shrink tumours or after surgery (adjuvant) to prevent recurrence.
The prognosis for cervical cancer depends on several factors, such as:
• The stage and grade of the cancer
• The response to treatment
• The patient’s age and general health
Cervical cancer can be prevented by:
• Getting vaccinated against HPV before becoming sexually active
• Having regular Pap smear tests starting from age 25
• Using condoms during sexual intercourse
• Limiting number of sexual partners
• Avoiding smoking
Cervical screening guidelines – There are some differences in the screening guidelines for cervical cancer between England, Scotland, Northern Ireland, and Wales. They are as follows:
England - Cervical screening is available to anyone with a cervix aged 25–64 years in England. All eligible people who are registered with a GP (as female) automatically receive an invitation by mail. People aged 25 to 49 receive invitations every 3 years. People aged 50 to 64 receive invitations every 5 years.
• Trans men (assigned female at birth) do not receive invitations if registered as male with their GP, but are still entitled to screening if they have a cervix
• The screening test uses HPV testing as the primary method.
Scotland- Cervical screening is offered to anyone with a cervix aged between 25 and 64. The frequency of screening has recently changed from every 5 years to every 3 years for women aged 25-49 and every 5 years for women aged 50-643. The screening test now uses HPV testing as the primary method, which means that if high-risk HPV is found, the sample will also be checked for abnormal cell changes.
Northern Ireland- Cervical screening is also offered to anyone with a cervix aged between 25 and 64. The frequency of screening has recently changed from every 3 years to every 3 years for women aged 25-49 and every 5 years for women aged 50-64. The screening test also uses HPV testing as the primary method, but if high-risk HPV is detected, the sample will be checked for abnormal cell changes under a microscope.
Wales- Cervical screening is also offered to anyone with a cervix aged between 25 and 64. The frequency of screening remains at every 5 years for both groups. The screening test still uses HPV testing as the primary method.
In conclusion, cervical cancer is a significant health issue that can be effectively managed with early detection and appropriate treatment. Regular cervical screening is crucial in identifying precancerous changes in the cervix that could potentially develop into cervical cancer. By understanding the types of cervical cancer and adhering to the screening guidelines in their respective regions, healthcare professionals can play a pivotal role in preventing cervical cancer and improving women’s health outcomes. It’s important to continue research and education in this field to further enhance our ability to prevent, detect, and treat cervical cancer.
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References
- BMJ Best Practice, 2023. Cervical cancer - References. [online] Available at: [BMJ Best Practice website] [Accessed 26 Dec 2023].
- MSD Manuals, 2023. Cervical Cancer Screening and Prevention. [online] Available at: [MSD Manuals website] [Accessed 26 Dec 2023].
- NHS, 2021. Cervical screening. [online] Available at: [NHS website] [Accessed 26 Dec 2023].
- Cancer Research UK, 2021. Cervical cancer statistics. [online] Available at: [Cancer Research UK website] [Accessed 26 Dec 2023].
- World Health Organization, 2021. Human papillomavirus (HPV) and cervical cancer. [online] Available at: [WHO website] [Accessed 26 Dec 2023].