When and why should you get cervical cancer screening?

The cervix is the lower part of the uterus and cancerous growth can occur in the area. It is the second most common cancer of women in Ethiopia following breast cancer, but it is completely preventable. 90% of cervical cancer is associated with a high-risk Human Papillomavirus infection (HPV 16 and/or 18). Some of the risk factors include early onset of sexual activity, multiple sexual partners, history of STDs, immunosuppression (HIV infection, post-transplantation), and cigarette smoking and/or exposure to second-hand smoke. 

Affected women typically don’t have any symptoms during the early stages of the disease, but advanced cervical cancer typically manifests with vaginal bleeding especially postcoital spotting, pelvic pain, and/or lower back pain and if it has spread, it can even lead to death. So given most patients are asymptomatic at early stages, primary (i.e., vaccination) and secondary (i.e., screening) prevention are essential. 

Cervical cancer screening tests consisting of Pap smear and/or HPV DNA testing are performed regularly to identify cancer precursors and early-stage cervical cancer. The incidence is higher in countries without screening programs so regular screening can help prevent cervical cancers or find and manage them early before it’s too late.

For patients with no risk factors meaning immunocompetent women with normal cervical cancer screening history, there are three screening strategies depending on the age of the woman: 

• Primary HPV testing is recommended for individuals between the ages of 21–65 years every 5 years.
• If this type of testing is not available, individuals within 30–65 years of age should be screened with co-testing (HPV testing combined with a Pap smear) every 5 years or,
• With a Pap smear every 3 years from age 21-65. 

If the results are normal, continue screening in the appropriate timeline but if results are abnormal, further workup is required and follow-up testing is performed at a shorter interval either using HPV primary testing or co-testing.

Important details to remember:

• • If older than 65 years of age, screening is no more required if the previous tests were all negative.
  • If high-risk (immunocompromised or HIV positive) but there is average life expectancy, continue screening per the protocol stated above.

• Patients with HIV diagnosis should start screening at the start of sexual contact and not wait until the age of 21 years. And the Pap smear should be done twice in the first year after HIV diagnosis with an annual follow-up and not every 5 years.