Screening Tests for Gynecologic Cancers
CANCER IS A PREVENTABLE DISEASE TO A LARGE DEGREE.
What is Cancer Screening?
Cancer screening includes the tests applied for early diagnosis in people who do not have any complaints yet. Screening tests and their timing differ depending on the type of cancer. The age group at risk differs for each type of cancer.
In our clinical practice, we can divide the screenings into two as a public screening program under the state health policy, which can vary from country to country, and in accordance with the guidelines prepared according to the conditions of the developed country. The cancer screening program recommended by the Turkish Ministry of Health is available at https://hsgm.saglik.gov.tr/tr/kanser-tarama-standartlari. In this article, international guides are discussed.
Why Should I Get Cancer Screening?
Early diagnosed tumors are generally easily treatable diseases. With early diagnosis and treatment, patients often regain their normal life expectancy, allowing them to live a healthy life for many years. Even if cancer is not found as a result of screening, pre- cancerous lesions may be detected. In this case, the lesions that may progress to cancer in the future are easily treated.
Does an Abnormal Screening Test Result Mean I Have Cancer?
Most of the time, no! This only means that compared to the normal population, you have a slightly increased risk of cancer. If you have an abnormal result, it will be appropriate to consult with your physician regarding further examination-treatment or close follow-up.
Which Cancers Can Be Screened In Women?
Screening can be done for these types of cancer: Cervical (neck of the uterus) cancer, ovarian cancer, breast cancer, colon and rectum cancer.
Cervical Cancer Screening
Infection by the human papillomavirus (HPV) is the most important risk factor for cervical cancer. There are more than 100 different types of HPV. While HPV types 16 and 18 cause 70% of cervical cancers worldwide; Types 31, 33, 45, 52 and 58 additionally account for in 20% of cervical cancers. HPV 6 and 11 are responsible for 90% of genital warts. HPV is usually spread during sexual contact. It has been estimated that 75 to 80 percent of sexually active adults will get at least one genital HPV infection before the age of 50. In many cases, the immune system clears the virus.
In addition to the annual gynecologic examination, we have two important tests to screen for cervical cancer: HPV test and Pap smear test. These two tests can be done at the same time. During the test, a swab sample is taken from the cervix. The sample taken is put into the tube containing liquid preservative.
Who Should be Screened for Cervical Cancer?
Cervical cancer screening is recommended for women aged 21 and over who are sexually active. Unless there is an abnormal finding in the history and gynecologic examination of the woman, if the test results are normal, it will be sufficient to conduct a smear test every 3 years between 21-29 years, and both vaginal smear and HPV DNA test every 5 years after age of 30. In women without clinical background that indicates otherwise special status, screening can be terminated at the age of 65-70.
How do I Prepare for HPV Test or Smear Test?
Previously, it used to be recommended to postpone the smear test in a woman when having her period. Of course, smear and/or HPV testing will be more comfortable during the non-bleeding period. With the introduction of liquid-based methods, smear/HPV test can be done in a woman with vaginal bleeding. The ideal timing, however, is in the second and third weeks after the first menstrual day.
According to the result of the single study in few patients, having a sexual intercourse before the HPV test or vaginal douching, which we do not normally recommend, does not affect the test result. Preferably, we do not recommend sexual intercourse for at least 24 hours before the smear/HPV test.
Smear and/or HPV Test Result
If abnormal cells are detected in the smear or your HPV test is positive, your physician may recommend a colposcopic examination or close follow-up, depending on the degree of the test result.
Ovarian Cancer Screening
Ovarian cancer screening is especially recommended in patients with a family history of ovarian cancer or BRCA gene mutation or Lynch Syndrome. Screening includes routine gynecologic examination, ultrasound and CA 125 test in blood.
Breast Cancer Screening
Initiation of breast screening is recommended at age 40 in people who do not have an increased risk (e.g. BRCA gene mutation). It is recommended to continue breast cancer screening until at least 75 years of age. Screening frequency is planned to be each year or every two years depending on the age and risk factors of the patient. Your doctor will inform you according to individual risk factors.
Breast cancer screening is done with an annual breast examination and mammography. In mammography, each breast is scanned from right to left and top to bottom throughly.
The benefit of self-examination of the person is not a proven practice. However, you can create self-awareness for the breast with concise recommendations from your physician.
Colon and Rectal Cancer Screening
The aim of colorectal cancer screening is to find polyps that are likely to progress to cancer. In women without an increased risk factor (e.g. Chron’s disease, ulcerative colitis, Lynch Syndrome) compared to the normal population, colonoscopy every 10 years or sigmoidoscopy every 5-10 years and occult blood test in stool every year is recommended, starting at the age of 50.
As a result, cancer screening touches lives significantly, either by providing early diagnosis of cancer or by diagnosing lesions that may progress to cancer. In addition, we also make several suggestions to all of our patients such as quitting smoking, avoiding excessive sun exposure and alcohol consumption, keeping red meat consumption within the recommended limits, paying attention to weight and engaging in regular physical activity.
CANCER IS A PREVENTABLE DISEASE TO A LARGE DEGREE.