In a few weeks, the screening of cervical cancer of the uterus will be generalized to the 17 million women aged 25 to 65 years
They will receive a letter inviting them to participate all three years, after the first two screening tests normal spaced a year. This generalization, which was included in the cancer plan 2014-2019, is primarily intended to improve screening existing, woefully inadequate. Currently, only six in ten women have actually produced a sampling cervico-uterine cancer (pap) screening in the past three years. The national cancer Institute (Inca) estimates that 90% of cancers of the cervix could be prevented with a screening test every three years. “Let us not forget the smear, it is for the women who do complain of nothing,” Pr Xavier Carcopino, secretary general of the SFCPCV and obstetrician gynecologist at university hospital North of Marseille. “The first wave of invitation to the screening should be for women over the age of 50, especially those who have never done a pap test,” explained Thursday the Dr Christine Bergeron, anatomo-cyto-pathologist and vice-president of the French Society of colposcopy and pathology of cervico-vaginal (SFCPCV), meeting in congress at Montrouge.
“We are very happy, it’s been twenty years expected that. ” In fact, as early as 1990, the French departments began to test screening. Although this cancer is rare, its mortality rate is high. Lack of obvious symptoms, it is often detected late, unless one makes a smear on a regular basis. The purpose of these levies is not to detect cervical cancer, but precancerous lesions, ten to fifteen years before the cancerous.
“Let us not forget the smear, it is for the women who do complain of nothing,” says professor Xavier Carcopino, secretary general of the SFCPCV and obstetrician gynecologist at university hospital North of Marseille.
Each year, approximately 3,000 women are diagnosed with cancer of the cervix, uterus, and nearly 1 in 100 die from the disease. “Among the women who each year have an invasive cancer of the cervix, 70 % have not had a pap test”, said Dr. Bergeron.
In contrast, among women who undergo screening are discovered each year 35.
. 000 pre-cancerous lesions or cancer, says the Inca.
The smear is a simple test, quick and painless. It is based on a sample of cells at the level of the neck of the uterus, by doctors, gynaecologists or midwives, with a swab.
The sample is immediately placed in a container containing a liquid, which will allow possible research of DNA of human papillomavirus (hpv) by a “test ” HPV”. “HPV is responsible for the vast majority of cancers of the cervix,” says the Pr Jean Gondry, surgeon, and obstetrician gynecologist, president of the SFCPCV.
It also underlines the interest of vaccination of youth against human papillomavirus (hpv): “today, we observe a very significant decrease in precancerous lesions of the cervix in young women in the countries where vaccination against HPV is well-made.
” “The announcement of an abnormal smear is always a concern for women, often young, because the risk of abnormal result is increased between 25 and 30 years,” Dr. . Jean-Luc Mergui, surgeon, obstetrician gynecologist in Paris The blood sample is then analyzed by a doctor, anatomo-cyto-pathologist. The result is normal in 96% of cases. If it is abnormal, additional tests will be performed to check for the presence of pre-cancerous lesions, for example, a new smear, a test for HPV or colposcopy (a visual examination of the cervix by a doctor).
“The announcement of an abnormal smear is always a concern for women, often young, because the risk of abnormal result is increased between 25 and 30 years old,” explains Dr. . Jean-Luc Mergui, surgeon, obstetrician gynecologist in Paris (see box below).
Everything is covered at 100 % without upfront costs, in the context of organized screening. “With the exception of the research of human papillomavirus (hpv) when smear is mildly abnormal, regrets Dr. . Bernard Huynh, obstetrician gynecologist (Paris and Neuilly-sur-Seine, france). It is, however, what advocating the recommendations of the High Authority of health since December of 2016, to distinguish the women truly at risk of the other, but the act is still not registered in the nomenclature (list of acts to be reimbursed by the social Security, editor’s NOTE). “Two years ago, the Bulletin épidémiologique hebdomadaire (BEH) published the results of an experiment, conducted over three years (2010-2012) in thirteen departments, which showed a significant increase in the participation of women in the screening thanks to the device which will now be extended to the whole of France. .A little more than 1. .3 million women who had not completed a pap test within the past three years, about 2. .4 million of the relevant age (25-65 years) in these departments, had been invited by mail to be tested.
What were in fact 230. . 000 of them. A stimulus had been needed for about 450. 000, for adding 48 000 women in the screening.
“By bringing all of these 278 767 women in the total target population, the increase in the screening participation (at national level) would be 12 percentage points”, read it in the BEH.
Misconceptions about cervical cancer and screening by smear test (sampling cervico-uterine)Some women think that there is no interest to be tested after the menopause until the age of 65.
.In reality, if it is true that more than a third of new cases of cancer of the cervix diagnosed in 2015, were before 50 years, more than four out of five deaths occurring after this age. In addition, the cancers are still possible after the age of 65 and, based on history or the results of the last smear, the doctor may recommend a follow-up gynecological adapted. Even women who have had a hysterectomy subtotal (remove the uterus, but with preservation of the cervix) should continue to perform pap smears regularly after the operation. Because the contamination by the human papillomavirus (HPV) during sexual contact may have occurred ten or fifteen years earlier, including without penetration. This is why lesbians, or women without sexual activity should also participate in the screening.
It is also the case of young women vaccinated against HPV, since some strains of the virus are not in the combination vaccines.
The contamination by the HPV is so frequent (4 out of five people), which could almost be considered as a marker of sexual activity. In practice, most of the girls eliminated naturally HPV before age 25-30 years, and only 10 % are not. “When women have an abnormal smear they are afraid of a cancer,loss of fertility, radical surgery (removal of the uterus, ED)”, adds Dr. . Jean-Luc Mergui.
Fears unfounded in the vast majority of cases.