Cervical cancer screening

Cervical cancer is the fourth most common cancer in the world and, among young women aged 15 to 44, it is the second most common globally. However, thanks to advances in vaccination and screening techniques, it is a predictable and treatable disease, if diagnosed early and treated appropriately.

In November 2020, the World Health Organization (WHO) set a goal to eliminate cervical cancer by 2030. This objective is based on three main pillars:

Vaccination: Vaccinate 70% of adolescents by the age of 15;
Screening: Reach 90% of the world's population with screening programs;
Treatment: Ensure that 70% of women with invasive diseases receive adequate treatment.

Early screening is essential. Traditionally it is based on the execution of the Pap test, introduced by Papanicolau in the 40s. Thanks to this test, millions of lives have been saved, as it allows for early detection of cellular abnormalities. Today, screening programs have evolved with the introduction of the HPV DNA Test. It is a molecular biology test that detects the presence of viral DNA. This test is now used as the primary screening for women over 30 years of age and has been adopted by 18 Italian regions.

The screening and diagnosis process includes:

HPV DNA Test: Detects the presence of the virus. If positive and associated with an altered Pap smear, the patient is sent to undergo a colposcopy;
Pap test: If the HPV DNA test is positive but the Pap test is negative, the HPV test is repeated after one year. The persistence of high-risk viral genotypes requires further investigation with colposcopy;
Colposcopy: It is a second-level examination that, through a biopsy, confirms the histological diagnosis.

The HPV DNA test is very sensitive and has a high negative predictive value, which means that a negative test indicates a very low probability of developing diseases in the coming years, allowing the screening interval to be extended to five years, while the Pap test must be repeated every three years.

Colposcopy is essential not only for the diagnosis, but also for the conservative treatment of precancerous lesions of the cervix (CIN 2 and CIN 3), which can evolve into invasive tumors, if left untreated. The radiofrequency excision technique (LEEP conization) allows curative and conservative treatments, maintaining the functional and anatomical integrity of the uterine cervix. This is especially important for women between the ages of 32 and 35, many of whom are nulliparous and eager to have children.

The combination of HPV vaccine, HPV DNA Test and Pap Test represents a winning strategy for the future of women's health. These tools, when used correctly, can save countless lives and improve the quality of life for women around the world.

However, despite the availability of these effective tools, vaccination coverage still remains low. It is essential to increase social, economic and cultural efforts to improve vaccination coverage and raise public awareness of the importance of prevention.