Cervix is also called the neck of the womb. Cervical cancer is the third most common cancer affecting women, after breast and ovarian cancer (Saslow et al., 2012). It progresses slowly over the years. Cervical cell dysplasia is an early signs of cervical cancer. Though, not all cervical cell dysplasia terminates in cancer, it is still an important screening tool. Pap smear can detect cervical dysplasia and enables treatment of the condition at an early stage, even before it progresses to cancer. While dysplasia is a non-malignant condition, cervical cancer is a malignant disease that originates from cervical cancer cells. The NCI guidelines also recommend the use of Pap test to screen for cervical cancer in the population. (Saslow et al., 2012)
Lack of effective screening program is the reason for high mortality associated with cervical cancer in developing countries. The Pap smear screening protocol is applicable to women population and ideally suggested for women above 35 years of age. Lack of knowledge about cancer and its screening, prevent detection at an early stage and presentation of disease at an advanced stage. This screening method is suitable for application in a clinical setting and can be done with minimum resources. Lack of primary preventive measures is an important problem in areas where there are poor resources and Pap test can be adapted to such regions. Pap test should be recommended as a routine screening procedure to detect early cancerous conditions and other treatable cervical abnormalities in women who are sexual active. The Pap test begins with the taking of a Pap smear. Pap smear is prepared from the cells scrapped from the cervical epithelium. The smear is then examined under the microscope to detect abnormalities. (Saslow et al., 2012)
The Human papilloma DNA test is a more advanced way to screen for cervical cancer and gives a definite diagnosis. This test also requires cells scrapped from the cervix. A negative Pap smear test does not guarantee the absence of cervical cancer for a life time. The test needs to be repeated at regular intervals (2-3 years) in a sexually active population of women, to identify early stages of cervical cancer. ("Cancer Control P.L.A.N.E.T. - Cervical Cancer", 2016)
The success of a screening program is not solely dependent on the technique used, rather it depends on how the program is managed. The NCI guidelines provide a list of factors that have to be considered while developing a screening program for cervical cancer. The factors that need to be considered while developing a screening test are: service delivery, information systems, program evaluation and down staging in places where screening is possible. (Simon, 2016)
Not all cervical dysplasia develops into cancer. A majority of them may spontaneously regress. Cervical cancer develops very slowly and most cases of cervical cancer are noticed in females after 35 years of age. Human papilloma virus prevalence is reported in 99.7% of cervical cancers. Smoking, use of contraceptives, vitamin deficiency, the presence of other STD, etc., can act as a confounding risk to cervical cancer. (Saslow et al., 2012)
The decision to implement cervical cancer screening program is done after examining evidences that support cervical cancer as the major health problem in the region. Data from hospitals and pathological labs can help to provide rough estimates of cervical cancer prevalence, and to identify the need of implementing a screening program. Identifying the age of the population at risk of high mortality is important in deciding priority groups. There is also an inverse relationship between socioeconomic status and risk for cervical cancer. These factors are taken into consideration while deciding on the population that are to be screened. In order to execute Pap smear screening test, there is a need to have the appropriate health care infrastructure, and technical resources to collect cervical smear and access it in a lab. Cervical cancer screening does not require high-cost sophisticated equipment and is thus easy to implement. (Simon, 2016)
References
Cancer Control P.L.A.N.E.T. - Cervical Cancer. (2016). Cancercontrolplanet.cancer.gov. Retrieved 18 July 2016, from http://cancercontrolplanet.cancer.gov/cervical_cancer.html
Saslow, D., Solomon, D., Lawson, H., Killackey, M., Kulasingam, S., & Cain, J. et al. (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. American Journal of Clinical Pathology, 137(4), 516-542. http://dx.doi.org/10.1309/ajcptgd94evrsjcg
Simon, S. (2016). New Screening Guidelines for Cervical Cancer. Cancer.org. Retrieved 18 July 2016, from http://www.cancer.org/cancer/news/new-screening-guidelines-for-cervical-cancer
