Cervical cancer – a cancer that can be prevented Cervical cancer, or cervical cancer for short, is a malignant tumor that occurs in the area of a woman’s cervix. There are about 500,000 new cases of cervical cancer worldwide each year, of which China accounts for 1/5, and it is the second most threatening malignancy to women’s health besides breast cancer. In recent years, it has been reported in some regions that the incidence of cervical cancer has increased and there is a trend of younger age. Therefore, it poses a serious threat to women and their families. Cervical cancer is currently the only cancer with a clear etiology, and high-risk HPV infection is necessary for the development of more than 90% of cervical cancers. Systematic and effective screening can significantly reduce the incidence and mortality of cervical cancer by as much as 60-90%. What is HPV? HPV, or human papillomavirus, is an epitheliophilic virus. Genital HPV infection is transmitted mainly through sexual contact, with sexual intercourse being the primary mode of transmission. There are more than 100 types of HPV viruses, more than 30 of which are associated with reproductive tract diseases such as warts and cervical cancer. HPV is highly transmissible and most active women will become infected with HPV at some point in their lives. for most women, HPV infection is temporary, and persistent or recurrent HPV (especially high-risk) infections are common. especially high-risk types) infection may lead to abnormal cellular changes that may continue to progress toward cancer if not detected and treated in a timely manner. Screening methods 1. Cytological examination Currently, liquid-based cytology (TCT/LCT) method with higher accuracy than traditional Pap smear is mainly used. The specimen is washed into a container with special cell preservation solution immediately after removal, and after filming, the cells are evaluated by cytologists. 2, HPV DNA detection Hybridization capture method (HC2) is a new technique for detecting HPV DNA, which has been approved by the U.S. Food and Drug Administration (FDA) for marketing. It can detect 13 high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) simultaneously. The method has gained worldwide acceptance and is widely used for screening and follow-up of cervical cancer. There are no special requirements for the test, and sampling is similar to cytology methods, as only cervical exfoliated cells are collected through a special sampler and then analyzed in the laboratory to obtain the results. Colposcopy Colposcopy can directly observe the lesions of cervical, vaginal and vulvar epithelium with stereo magnification or electronic monitor under strong light source, and is an important auxiliary method for early diagnosis of cervical cancer and precancerous lesions (CIN). Colposcopy is often recommended when there is clinical suspicion or an abnormal cytologic examination. Colposcopy in combination with HPV testing or cytology can reduce the incidence of false negatives and significantly improve the early diagnosis of CIN and cervical cancer. The greatest advantage of colposcopy is the ability to detect subclinical lesions that are invisible to the naked eye and to locate biopsies at suspicious lesions, thereby increasing the accuracy of diagnosis. Screening recommendations 1. Screening targets Any woman who has had sex for more than three years or who is 21 years of age or older who has had sex is a candidate for screening. (Because cervical cancer is extremely rare in patients under 21 years of age and it takes at least 3-5 years to go from HPV infection to CIN). Cervical cancer screening is not required in some cases, such as women who have had their uterus removed for other benign diseases. For the general population, the age of screening initiation can be considered as 25-30 years. For high-risk women (women with multiple sexual partners, early sexual life, HIV/HPV infection, low immune function, poor hygiene/low knowledge of sexual health), the age of onset of screening should be appropriately advanced. Cervical cancer screening is generally not recommended for women over 65 years of age. 3. Screening interval If cytology screening is performed once a year and the second consecutive screening is normal, the screening interval can be extended to once every three years. If HPV and cytology screening are normal for two consecutive times, the screening interval can be extended to 5-8 years. 4. Screening regimen The best screening regimen is currently a combination of HPV testing and liquid-based cytology, and in 2003 the FDA approved the use of a combination of cytology and HPV DNA testing (HC2) for primary screening in women over 30 years of age. The combination of the two has resulted in advanced screening techniques with almost no missed cases and a specificity of more than 80%. (1) For women with normal menstruation, 10-18 days after menstruation is the best time for examination; (2) Do not do vaginal douching or use intravaginal drugs such as contraceptive creams within 48 hours before examination; (3) Do not have sexual intercourse within 48 hours before examination.