Preventing Cervical Cancer with Mr Christian Barnick
23rd January 2020
While there are an average of 3,000 cases of cervical cancer each year, with over 800 deaths, the fact is 98% of cervical cancer cases are preventable.1
For Cervical Cancer Prevention Week we spoke to our Gynaecology and Obstetrics Consultant, Mr Christian Barnick, about the disease, what can be done to prevent it, and the positive signs that preventative measures are leading to a steady decline in the UK.
Cervical cancer explained
The cervix is the cylindrical neck of tissue connecting the uterus and the vagina. Abnormal cells in the cervix can turn cancerous and while cervical cancer early on is often symptomless, as it develops one may notice abnormal vaginal bleeding, pain during sex and pain in the pelvis. If left untreated the cancer can spread to different parts of the body including vital organs which is when it can become very serious.
According to Cancer Research, however, incident rates of cervical cancer have dropped by nearly a quarter since the early 1990s.
The importance of the HPV vaccine?
The human papillomavirus, of which there are several subtypes, is very common and is transmitted through sexual intercourse – though it is not regarded as a sexually transmitted disease. And while the majority of those with the virus won’t get cervical cancer, 90% of cases of cervical cancer are related to HPV.
Mr Barnick says, “Somewhere around 40% of women carry HPV of some type. The thing about HPV is that it sits in the cervix and it has clever ways of hiding itself from the immune system. And when the virus hangs around there, its genetic material can insert itself into the genetics of the cell which causes the cancer.”
By taking the HPV vaccination then, you are significantly reducing your risk of getting cervical cancer.
Mr Barnick says, “It works extremely effectively. We have a multivalent vaccine now that vaccinates for a number of HPV viruses. Gardasil gives you specific protection against nine different HPV subtypes and, because HPV strains are fairly similar, it gives a broader defence against a wider number of HPV subtypes.”
It is best to get vaccinated at a young age to prevent colonisation happening in the first place as well as the fact your immune system reacts more effectively when you are young.
It is important to note there are also lifestyle factors that can affect your chances of developing cervical cancer including smoking which reduces your cells’ ability to repair their DNA.
The importance of regular screening (smear tests)?
In addition to the vaccine, screening is an incredibly effective way of protecting yourself from cervical cancer.
Mr Barnick says, “Screening will pick up the presence of HPV. If this is present we will then look at the cells of the cervix. If this comes back normal, then it’s just a matter of continuing with regular screening, say, once a year. If we pick up an abnormality in the cells as well, even if it’s minor and there’s HPV present we might need to do a colposcopy, which looks at the cervix more closely. If there’s an area that looks at all suspicious we take a small biopsy.
“If it comes back saying there’s nothing very much we say great, we’ll see you in another six months and keep you under more regular observation. If it comes back saying there is a potential precursor of cervical cancer then we might remove that superficial area of the cervix which obviously treats the problem now and also removes that area as an HPV reservoir leading to a long term solution to the problem unless you get reinfected.
“Unfortunately, around three quarters of those diagnosed with cervical cancer haven’t been screened. Some women are put off by the procedure which can be a bit uncomfortable while others simply don’t have good access to healthcare,” says Mr Barnick.
The common type of cervical cancer that is related to HPV is squamous cell cancer which infiltrates locally and can spread out into the surrounding tissue.
Mr Barnick says, “It can spread into the bladder and the bowel and sideways towards the pelvic sidewall and as it gets bigger, as it starts to spread, it is more likely to get into the lymphatics which is where it can become very serious.”
Prevention vs Cure
Preventative measures in the UK, namely the HPV vaccine and regular screening, have been highly successful in tackling the disease. The sad fact that in countries without these measures in place cervical cancer remains a big killer, further illustrates this. Ultimately, prevention will always be more effective than treating the disease once it occurs.