What is cervical cancer?

Cervical cancer affects cells in the lining of the cervix which is the lower part of the uterus (womb) and situated at the connection to the vagina ^[1]. There are several forms of cervical cancer, the greatest proportion are squamous cell carcinomas and adenocarcinomas or combinations of both. The disease can spread to other parts of the body. Cervical cancer can take 10 years or more to develop, but cells may show pre-cancerous changes before this time. Symptoms are not obvious in the early stages of cervical cancer, those that may occur are unusual bleeding from the vagina and sometimes an unusual vaginal discharge, but these symptoms may not always be due to cancer. There is an increasing risk of the disease with age, it is very rare before the age of 25 years.

Risk factors

Cervical cancer is preventable in most cases - internationally it has been demonstrated that 90% of squamous cervical cancer can be prevented through early screening and treatment ^[2]. Risk factors for cervical cancer include human papilloma virus (HPV) infection, sexual behaviour and cigarette smoking ^[3]. In Australia HPV infections are among the most common types of sexually transmitted infections (STIs), but it is difficult to monitor the incidence as they are not notifiable diseases ^[4]. HPV often does not cause symptoms as the immune system suppresses the infection. It is only some strains of HPV that lead to abnormal cell changes.

Screening for cervical cancer

The Papanicolaou (Pap) smear test is the usual means of screening and can detect changes in the cells before they develop into cancer. Pre-cancerous lesions are treatable. Currently the Australian recommendation is for all women who have been sexually active at any stage in their lives to have a Pap smear every 2 years until the age of 70 years ^[1]. Pap smears may cease at age 70 years for women who have had two normal Pap smears within the previous five years. Women aged 70 years or older who have never had a Pap smear, or who request a Pap smear, should be screened. Women who have had a hysterectomy should seek advice on their individual needs regarding screening.

Cervical cancer screening for Australian women began in the 1960s ^[2]. The National Cervical Screening Program (NCSP) was introduced in response to the report Cervical Screening in Australia in 1990. The program has been widely accepted by women, service providers and other stakeholders and there has been increasing participation in the program.

References

1. Australian Institute of Health and Welfare, Commonwealth Department of Health and Aged Care National Cervical Screening Program (2000) Cervical screening in Australia 1997-1998 Canberra: Australian Institute of Health and Welfare and the Commonwealth Department of Health and Aged Care National Cervical Screening Program
2. Commonwealth Department of Health and Aged Care (2001) The national cervical screening program Canberra: Commonwealth Department of Health and Aged Care
3. O'Brien E, Bailie RS, Jelfs PL (2000) Cervical cancer mortality in Australia: contrasting risk by Aboriginality, age and rurality International Journal of Epidemiology; 29(5): 813-816
4. Australian Institute of Health and Welfare (2002) Australia's health 2002: the eighth biennial report of the Australian Institute of Health and Welfare Canberra: Australian Institute of Health and Welfare