Various Choices of Cervical Cancer Screening Methods

GBS - Cervical or cervical cancer is often touted as a silent killer because there are no symptoms in the early stages of cervical cancer. Symptoms of cervical cancer only appear after entering an advanced stage. However, the more advanced the stage of cervical cancer is, the lower the life expectancy. Therefore, it is important to take preventive measures against cervical cancer.

(source:ACOG)

One of the main preventive measures that is important to do is cervical cancer screening. The World Health Organization (WHO) recommends women of childbearing age (WUS) aged 30-50 to carry out routine cervical cancer screening. This examination really needs to be done to detect HPV infection or detect early changes in cervical cells, so that treatment can be given early to prevent cancer development.

There are several methods available for cervical cancer screening. Some of them are IVA tests, Pap smears, and HPV DNA. Examination IVA test and Pap smear aims to find pre-cancerous lesions so that patients immediately get treatment to prevent cancer development. While HPV DNA aims to identify the presence/absence of HPV infection either before or after this infection develops into pre-cancer or cervical cancer.

1. IVA Test (Visual Acetate Infection)

This examination is intended for all women who have had sexual intercourse, especially Women of Reproductive Age (WUS). This examination can be done at any time, but it is not recommended to have an IVA examination during pregnancy, it is better to postpone it until 12 weeks after delivery.

The IVA test procedure to be carried out is as follows:

1. Before starting the IVA test, you will be asked to lie down with your legs wide apart or astride.
2. The doctor or midwife inserts a speculum into the vagina. The speculum tool aims to make the vagina wide open, making it easier to observe the cervix or cervix.
3. Acetic acid or acetic acid with a concentration of about 3-5% is rubbed on the walls of the cervix.
4. The results can be seen immediately after the examination takes place. Usually, normal cervical wall cells will not experience any change (color) when acetic acid is applied. Conversely, if there is a problem with the cervical wall cells, for example, precancerous cells or cancer cells, the color of the cervix will automatically turn white.

2. Pap smears

Pap smear is a procedure to detect cancer of the cervix (cervical) in women. Pap smears can also find abnormal cells (precancerous cells) in the cervix that can develop into cancer.

Pap smear is done by taking a sample of cells in the cervix. After that, the cell sample will be examined in the laboratory to find out whether the sample contains precancerous cells or cancer cells. Pap smears can also be used to detect infection or inflammation of the cervix.

Pap smears are recommended to be done every 3 years in women aged 21 years and over. For women aged 30 to 65 years, Pap smears can be done every 5 years, but it needs to be combined with an HPV test.

Pap smears should not be done during menstruation, because the results can be inaccurate. If you want to do a pap smear, it is advisable to wait at least 5 days after menstruation is over. Pap smears should also not be done at 25 weeks of gestation and above, because they can cause severe pain during examination. Instead, wait until 12 weeks after giving birth if you want to undergo a pap smear.

During the 2 days before the pap smear procedure, the doctor will advise the patient not to do the following:

• Have sex
• Cleaning the inside of the vagina (douching) with water, vinegar, or other fluids
• Inserting anything into the vagina, including tampons, vaginal creams, or vaginal medications

Pap smears are usually performed by obstetricians and gynecologists. The process only lasts about 10–20 minutes. The following are the steps that doctors carry out in pap smears:

• The patient will be asked to remove lower clothing. After that, the doctor will ask the patient to lie down on the table with the knees bent and thighs open.
• The doctor will insert a speculum (cocor duck) into the vagina. This tool serves to open the vaginal wall so that the cervix can be seen. In this process, the patient may feel uncomfortable.
• The doctor will take tissue samples in the cervix using a spatula, special soft brush, or both. When finished, the doctor will store the sample in a special container and examine it in the laboratory.
• After the procedure is complete, the patient can rest for a few minutes before being allowed to go home. The patient may experience pain or some bleeding after the procedure.
• If the patient does not experience worsening symptoms, the patient can go home immediately after the Pap smear procedure is finished. The doctor will make an appointment with the patient to discuss the pap smear results on another day.
• If the results of the Pap smear examination do not find abnormal cells or the results of the examination are negative, the patient can be said not to have cervical cancer. Patients who get negative results do not need to undergo further tests until the next pap smear schedule. Pap smear results are said to be positive if the patient has abnormal cells, both cancer and precancerous lesions. Patients who get positive pap smear results will be advised to undergo further examinations for confirmation.

3.HPV DNA

HPV DNA examination is a screening procedure performed on women to detect high-risk types of HPV (human papilloma virus) infection. HPV DNA testing is done by examining the genetic material (DNA) of HPV in cervical cells.

Currently, the World Health Organization (WHO) recommends HPV DNA testing as a screening and treatment approach for cervical cancer for the general population of women aged from 30 years, which is carried out every 5 to 10 years. As for the female population with HIV, it is recommended for women from the age of 25 every 3 to 5 years.

HPV DNA examination is considered as the gold standard test for detection of HPV infection. The advantage is that HPV DNA can detect the risk of cervical cancer even before the development of pre-cancerous lesions in cervical cells. If a positive result is found, there is about a 70% risk of developing cervical cancer. Meanwhile, if a negative result is found, no further examination is needed.

Sampling for HPV DNA testing is more or less the same as Pap smear testing. However, recently a domestic product has been developed that can detect HPV DNA from decayed cervical cells found in urine. So that the inspection method is much easier, more convenient, and faster.

Reference :

1. World Health Organization. Cervical Cancer. 2022.
2. Ministry of Health of the Republic of Indonesia. Prevent Early Cervical Cancer. 2022.
3. Kasper, Dennis L, et al. Cervical Cancer. In : Harrison's Manual of Medicine. 19th McGraw Hill Inc. 2017.
4. Centers for Disease Control and Prevention. What Can I Do to Reduce My Risk of Cervical Cancer? 2022.
5. Ministry of Health of the Republic of Indonesia. Cervical Cancer Screening and Early Detection. 2021.
6. Hello Sehat. IVA Test, Examination to Detect Cervical Cancer. Accessed in 2023.
7. Pap Smear, This Is What You Need to Know. 2022.
8. Kitchen FL, Cox CM. Papanicolaou Smear. 2022. https://www.ncbi.nlm.nih.gov/books/NBK470165/
9. HPV DNA testing. 2020.
10. World Health Organization. Guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition. 2021. https://www.who.int/publications/i/item/9789240030824
11. HPV DNA Test Is More Recommended For Cervical Cancer Screening. Accessed in 2023.

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