Cervical cancer screening: Diseases and Various Testing Methods.

     Cervical Cancer  (Cervical Cancer) is the most common cancer found in Thai women, with approximately 7,000 new cases diagnosed each year. It is most frequently detected in women over the age of 35. The major issue with cervical cancer is that there are usually no early symptoms until it reaches an advanced stage, which is difficult to cure. However, this disease can be detected and investigated right from the initial cell abnormalities. Because the progression of the disease is gradual, it takes a relatively long period of time.

The cervix is located in a position that is much easier to examine and diagnose compared to other organs, allowing physicians to diagnose and provide treatment from the earliest stages of pre-cancer or before it advances to an invasive stage. Cervical cancer screening therefore significantly helps reduce the incidence of this disease.

Risk Factors for Cervical Cancer

• Having sexual intercourse at an early age
• Having multiple sexual partners
• A history of sexually transmitted infections
• Smoking
• Immunodeficiency disorders or the use of immunosuppressive drugs
• Infection with the Human Papilloma Virus (HPV)

Cervical Cancer Screening

1.  Pap Smear Method

     In 1992, the World Health Organization gathered statistics showing that cervical cancer screening using the Pap smear method among female populations aged 35-60 years every 5 years could reduce the incidence of cervical cancer by up to 44%.  Therefore, the Pap smear is a highly beneficial, cost-effective method that has been widely accepted and used for a long time up to the present day.

Recommendations for Women

• Women should receive their first Pap smear between the ages of 30-35 and should be screened regularly every 1-3 years.
• The frequency of screening depends on each woman's individual risk factors for developing cervical cancer. An obstetrician-gynecologist will recommend how often you should be tested.

The Pap Smear Procedure

     The patient will undergo a pelvic examination by an obstetrician-gynecologist in a private room for only 1-2 minutes. The physician will collect cell samples from the cervical epithelial tissue and the inner vagina, smear them onto a glass slide, and then send the slide for specific staining. A specialized pathologist will then examine the cells for abnormalities under a microscope.

Reporting Pap Smear Results

     Patients who undergo a Pap smear will receive their results within 2-3 days. The most widely popular reporting systems today are the Papanicolaou classification (Class I-V) and the Bethesda system (a report that includes detailed characteristics of the detected cells). Once the results are released, the obstetrician-gynecologist will interpret the report and inform the patient.

Treatment for Patients with Cervical Abnormalities

     When a Pap smear result reports abnormalities, the obstetrician-gynecologist will interpret the report and formulate a treatment plan or recommend additional testing as appropriate. Since there are various types of cervical abnormalities, recommendations may vary; for instance, some patients may be prescribed antibiotics or vaginal suppositories and scheduled for a follow-up test, while others may need an additional evaluation using a colposcope

2.  Examination with a Colposcope 

     A colposcope, or a cervical examination microscope, is an instrument used to examine and inspect the detailed lesions on the cervix. Colposcopic examination is considered a highly efficient procedure because it features lenses with 6 to 40 times magnification to observe abnormal tissue coloration. This provides a sharp view of the lesions around the blood vessels on the surface of the cervix and vagina, allowing obstetrician-gynecologists to accurately and specifically diagnose the underlying abnormalities.

3.  Liquid-Based Cytology Screening

     Liquid-based cytology is a laboratory method for cervical cancer screening. Specialized equipment is used to collect samples by smearing the epithelial lining of the cervix in the same manner as a Pap smear. The physician will place all the collected cell samples into a vial of preservative solution before sending it to an automated machine to prepare the epithelial cells, removing contaminants such as mucus or blood cells. It also helps reduce the overlapping of overly dense cells. Once prepared, the cells are transferred onto a glass slide.

Advantages of the Screening

• It increases the likelihood for pathologists to detect existing abnormalities more effectively.
• Data from global research reports indicate that cervical screening using the liquid-based method (such as ThinPrep) yields more accurate results than the traditional Pap smear. However, this method is significantly more expensive than the conventional technique.
• It is suitable for specific use in women who have a high risk of developing cervical cancer, and it is also used to follow up on the results of treatment for certain types of cervical diseases.

Read more: HPV Testing and the Development of Cervical Cancer

Patients with cervical cancer usually exhibit no symptoms until the disease has advanced to an invasive stage, which is difficult to cure completely. Therefore, regular cervical cancer screening can significantly help reduce the incidence rate of the disease.