The role of preventive examinations in health care

The preventive treatment of cervical cancer – cytological screening

Cervical cancer is called a 'treacherous killer'. The disease might have been developing hardly ever giving symptoms for many years. When first symptoms such as abnormal bleeding, profuse vaginal discharge, pain in lower abdomen or during sex often even specialised therapy will not lead to full recovery.

Therefore apart from primary prevention of the cervical cancer (education, vaccination against HPV), a secondary prevention is playing a huge role that is cytological screening (col. "pap smear"). The pap smear allows to detect already existing epithelial (cancerous) changes within the cervix in order to treat them. The cervix is easily accessible in the gynecological examination. Deepened visual examination (colposcopy) and/or taking samples from the surface of cervix (biopsy) should be performed if the situation is doubtful. Preventive examinations are simple, painless and are sufficient enough to detect early "cancerous" changes therefore it is very important that women systematically undergo them. It is proven that the earlier cancerous changes are detected the greater chances (up to 95%) for total recovery from cancer.

Free-of-charge National Programme of Cervical Cancer Prevention financed by National Health Fund is currently conducted in Poland. It aims at women between the ages 25-59 who have not pap smears done within last three years.

Cytological examination
The examination requires taking a sample from extocervix and endocervix with a professional disposable brush, marking to separate special microscope glass and strengthened with appropriate reagents. Further examinations are made in cytological laboratory and consist in colouring the preparation according to Papanicolau method and subsequently according to Bethesda anatomical pathology classification. This classification allows to multilayered evaluation of the changes within the cervix as well as indicating factor type which evokes these changes. Further proceedings such as: check-up, colposcopy, biopsy are dependent on cytological results. If the result is abnormal (cancer?) then it always requires confirmation through histopathological examination. Only then appropriate treatment may be applied.

It is a method of thorough examination of lower part of women reproductive organs (perineum, vulva, vaginal portion of the cervix with external orifice of the uterus) through a colposcope inducted to vagina.
It enables to see the changes on the surface of cervix which cannot be seen during ordinary gynaecological examination.

If certain indications to the verification of the acquired colposcopic image or cytological examination occur then it is advised to collect targeted samples from the cervical surface to histopathological examination under the microscope).
This examination determines the stage of Cervical Intraepithelial Neoplasia advancement (CIN) so the abnormality of cells.
There are three degrees:

CIN 1 – mild-degree changes, CIN 1 changes remit spontaneously very often without treatment and it is unusual to observe their progression within 2 years of observation, further treatment proceedings can be limited to control and the determination of HPV type and pap tests every 6 months,

CIN 2 – moderate-degree changes,

CIN 3 – severe-degree changes, CIN2 and CIN3 are determined altogether as CIN 2+ are direct precursors of cervical cancer changes and are recommendation to extreme proceedings; It s recommended to cut the alteration out (cold-knife conisation, LLERZ/LEEP procedure, laser conisation) surgically with histopathological examination of postoperative material. The lack of extreme of the operation performed determined in histopathological examination causes the necessity of repeated diagnostics after 4 to 6 months,

Why there are still so many deaths from cervical cancer in Poland since pap smear is the easiest way to detect early cancerous changes and even up to 95% effectively treat them?
It is estimated that the death rate in the USA decreased by 70% after implementing pap smear in 1950's! However in Poland compared to 1960's the number almost doubled! The reply is unfortunately banal - only 1 / 3 of Poles is subjected to screening examination. We do not make examinations!
And is it worthwhile being examined? Let every woman answer this question for herself.


Elaborated by: Agnieszka Wrzesińska, MD