How to understand cervical screening scientifically

  First, about 100,000 new cases of cervical cancer occur in China every year, accounting for 20% of the new cases in the world. Among these new cases, 50% have never been screened for cervical cancer, and 10% have not been screened for cancer within five years. More than 30,000 women die from cervical cancer in China every year. Secondly, cervical precancerous lesions are usually asymptomatic, and once there is abnormal bleeding, it may be advanced. In addition, a smooth cervical lesion may be a precancerous lesion or early cervical cancer, so it is not feasible to see it with the naked eye.  Definition of cervical precancerous lesions: Cervical intraepithelial neoplasia (CIN2 and CIN3) is diagnosed by colposcopy and biopsy, which is a precursor of invasive cervical cancer. The purpose of cervical cancer screening: To detect CIN2 and CIN3 lesions at an early stage and give conization treatment to stop their development into cervical cancer. If CIN2 and CIN3 are found without treatment, 30% of cases will become cancerous within 30 years.  In 2012, the American Society for Colposcopy and Cervical Pathology (ASCCP) pointed out, based on a large amount of evidence-based medical evidence, that cytology combined with HPV testing is the best option for women aged 30-60 years. This means annual cervical cytology (TCT) and human papillomavirus (HPV) typing tests. This is because numerous epidemiological studies have found that 99.7% of cervical cancers are related to HPV infection. The 14 high-risk types associated with cervical cancer are: 16,18,31,33,35,39,45,51,52,56,58,59,66,68. The risk of developing ≥CIN2 lesions after HPV infection varies among high-risk types. For example, the risk of developing lesions above CIN2 in cytology-negative but HPV16-positive women was 13.6%, or an average of 1 in 8 cytology-negative women with a high level of lesions ≥CIN2. Women infected with HPV 16 or 18 have a much higher risk of progression to high cervical lesions in the near and distant future than women positive for other types of HPV.  V. The importance of combined screening: The sensitivity of TCT alone is about 65-70%, and the accuracy may reach 99.5% if HPV screening is added. Therefore, combined screening improves the sensitivity and specificity and greatly reduces the rate of missed diagnosis. To eradicate cervical cancer, a three-step standardized screening and treatment is required: TCT and HPV in the first step, colposcopy in the second step if indicated, and conization in the third step if histological CIN2 or CIN3 is detected. Regular post-operative TCT and HPV follow-up for early detection of recurrent cases.  VI. How to look at viral infections: There is no need to panic when HPV infection is detected because 80% of sexually active women are likely to be infected with this virus during their lifetime. About 90% of people will clear it from their bodies within 12 to 15 months of infection. Poor immunity may lead to persistent infection, while normal young women will clear the virus on their own. A healthy lifestyle, such as reducing smoking and alcohol consumption, getting enough sleep and exercising, will definitely help a woman’s immune system to clear the virus from her body well. There is no specific drug to clear HPV. the virus will be cleared while the cervical lesion is being treated by conization.