In March of last year, the CeramicCheck screening program began using the HPV first test instead of the cytological smear test.
The free cancer screening program has been asked many questions about why this change happened. To commemorate this week’s Cervical Cancer Prevention Week, we aim to answer some of them with answers from Dr. Nóirín Russell, Clinical Director of Cervical Check.
You can enroll in the free Ceramic Check program here..
During the Level 5 Covid-19 time limit, you may have to wait longer than usual to book a smear test, but it is recommended that you book at a later date. Some colposcopy clinics prioritize advanced anomalies during the current time limit.
First: Some general points about the Ceramic Check program
CervicalCheck is a free program that screens women aged 25-65 years in Ireland for cancer (formerly smear test, now HPV test) and classifies them into low-risk and high-risk groups.
Women who receive a negative result belong to the low-risk group and return to the test after 3-5 years. High-risk groups, on the other hand, are referred to the Colposcopy Clinic for further testing, and about 80% of women do not need treatment, but may need another test after 6 months or 1 year.
If you have symptoms of cervical cancer, such as pelvic pain. In case of bleeding during menstruation; vaginal bleeding or secretions; or pain / bleeding during sex, the specialist’s advice is to consult your GP and not wait until a regular Cervical Check appointment comes.
From March 30th to July 6th, the Cervical Check program was suspended as Ireland worked on the Covid-19 pandemic. In November and December, 6,000 samples were received in the month when about 4,000 were expected.
In 2020, 117,000 women were screened. About 50% of what we expected to show earlier this year.
Why does CervicalCheck no longer test abnormal cells?
CervicalCheck continues to screen for abnormal cells that can cause cervical cancer, but the method has changed.
Previously, cytological smear tests were done to look for abnormalities in cervical cells, and if the tests found abnormalities, the woman was referred to a colposcopy clinic to see if those abnormalities were low-grade or high-grade. Was inspecting.
However, studies have shown that if you first test your cervical cells for HPV and if you find it, ask a woman for more tests and the results will improve.
If you want to look at science, in countries that first use the HPV test for a long time, screening 1,000 people shows that about 20 people have abnormal (precancerous) cervical cells. I will. Studies show that:
- In screening by cytological smear test, 15 out of these 20 You will find these cells – Five People will not develop cervical cancer, and they can. This makes the old cervical smear test 75% accurate.
- In screening by HPV first test, 18 out of these 20 You will find these cells – two People will not develop cervical cancer, and they can. This gives the old cervical smear test an accuracy of 85-90%.
“The primary HPV test is a much better test,” said Dr. Russell. Cytology or smear tests have a false negative rate of 1/200. Therefore, 1 in 200 women is given normal results and is actually anomalous but undetectable. The HPV test is 1 in 500. Therefore, it is a much better test. “
“So you are very likely to be in 980 women who get negative results, and you will be one of the two women who get negative results out of the 20. Very unlikely [when there is an abnormality].. “
Do you remind me what HPV is again?
HPV, or human papillomavirus, is a very common virus and is the most common sexually transmitted disease in the world.
Most HPV infections have no noticeable symptoms, with over 90% being cleared by the body’s immune system after 2 years. However, in some cases, HPV can develop into cancer in both men and women.
There are more than 200 types of HPV, 40 of which can infect the reproductive tract. Of these 40, 13 are thought to be at high risk or have the potential to cause cancer.
Not all cervical cancers are caused by HPV. It can catch all types of cervical cancer, so it might be better to test for abnormal cells.
“This is a more accurate prediction of who will develop cervical cancer,” said Dr. Russell, who says the smear test is still a very good test, but limited.
“We know that there are many transient abnormalities and transient cellular changes in the cervix. Most of the mild changes, most of the changes in the female cervix, she You’ll handle them yourself, nature will organize them, solve them, and everything will work. This is what happens with most of the cell changes.
“But the problem is that if the HPV infection is persistent, the cells will continue to tickle or become abnormal, or the combination of abnormal cells and persistent HPV infection will cause the cancer to become persistently abnormal. What are the risk factors for continuing to develop?
“Therefore, if there is a combination of persistent HPV infections that keeps cells abnormal and refuses to return to normal, that is a risk factor for cancer.”
She says this is the reason smoking It is a risk factor for cervical cancer.
“What smoking predisposes to maintaining HPV? It makes it more difficult for the immune system to clear HPV,” says Dr. Russell.
Why is this a better test for women who have previously undergone a precancerous / high-grade precancerous cell procedure and were negative for the HPV virus?
Dr. Russell said that women who tested negative for HPV but were treated for precancerous cells were more likely to develop HPV, but their bodies cleared up HPV before the test was done. I am.
“In the old program, when I had a cytological examination [a high-grade abnormality], We weren’t looking for HPV on a regular basis. You were referred to and treated by Colposcopy, and you were only tested for HPV as part of your follow-up.
“Therefore, the vast majority of women who were treated for abnormal cells were actually infected with HPV before that, but did not know about it.”
Dr. Russell said UK and Australian evidence of women who had previously been treated for abnormal cells shows that the new test method is “just as good, safe, and actually better.” I did.
Almost all cervical cancers (> 92%) are caused by HPV. Women are warned to be aware of cervical cancer symptoms, including menstrual bleeding, because some types of cervical cancer are not detected by either the old smear test or the new HPV test. Abnormal vaginal discharge; or pain during sex.
If you experience any of these symptoms, you should be checked outside of Cervical Check.
Is this a cost-cutting measure for HSE?
“No, it’s not a cost-cutting measure,” Dr. Russell said.
“Part of the Hiqa report [into switching to primary HPV testing] Did they have to be cost effective as you had to do anything in healthcare? However, this is definitely not a cost savings measure. “
“If a better test comes online, I will be the first to advocate a better test for Irish women. This is to get the best test, not the cheapest one. “
Over time, as more studies were published, the cases became stronger and stronger in support of HPV’s first cervical cancer screening, Dr. Russell said.
A 2017 report by Irish health monitoring agency Hiqa recommends HPV cervical screening in combination with an HPV vaccination program to reduce the incidence of cervical cancer and the prevalence of abnormal cells. I will.
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This type of cervical screening has been introduced in Australia, the United Kingdom, the Netherlands and Wales.
Australia aims to be the first country in the world to eradicate cervical cancer by combining high uptake rates of both HPV-led cervical cancer screening and HPV vaccines (which is 98% uptake) It is said.
Better test of the entire cervix
“The problem with cytology is just brushing the woman’s cervix and brushing some cells in the cervix that are visible in the vagina,” Dr. Russell adds.
“The average length of the cervix is 3,3.5 centimeters, but we are still sampling only the cells below, perhaps 0.5 centimeters.
“If there is an abnormality above the cervix, we will not pick it up in the smear test. [the old way of testing].. “
There are two types of cervical cancer: flat cancer and adenocarcinoma.
“We know that screening is much better because squamous cell carcinomas tend to be superficial, but adenocarcinomas are even more elevated and screened by cytology. [the old way of screening] Not as good as detecting them. “
You can check whether it is registered in the CervicalCheck register. hereRead more about the Cervical Check screening program here..
