GYN CHRONICLES
Prevention And Screening For Cervical Cancer
Dr . Maureen Owiti
The editor in chief at Marketing Africa Limited is at it again and requires an article . Fortunately , as I pen this article , we are still in January , which is the Cervical Cancer Awareness Month so of course this would be the perfect time to discuss this particular topic . I will take it from the stand-point of prevention strategies and if words allow may go into treatment as well .
No Woman Should Die From Cervical Cancer !! I strongly believe this , as Cervical Cancer is one of the rare cancers that can be detected before actual cancer sets in and therefore can be prevented . Our intellectual discourse here-in will discuss this .
Bettina ( not her real name ) has been a long standing client of mine , very polite , affable and it has always been a pleasure communing with her during consultations . Sorry to say but some patients are just energy zapping , while others are just a breath of fresh air and bring back peace and balance after some sessions have just drained every ounce of patience , energy and used up all your brain cells to calm down . Anyway I was very happy to see Bettina and she had come for her scheduled routine screening . She is a 35 years old mother of 3 , and I had the pleasure of delivering the last two .
After all the pleasantries , we got down to business . As is customary for me during the annual screening we did a Breast exam which , fortunately was normal and the proverbial pap . But as I am a selfprofessed pap-smear whisperer ( I try to ensure the least discomfort during the examination ), the pap-smear went down without too much ado about nothing .
At the end of the visit I informed her she could come in 3 days to a week to review her results . I personally prefer in-person review of results and fortunately this story is prior to the onset of the dreaded coronavirus pandemic . No masks , social distancing etc … what a wonderful dream , can ’ t wait to get back . We now email results and if necessary follow up with a phone call . How life has changed . Vaccine please come quickly to Africa , so we can go back to normal ASAP .
Bettina was a bit busy and could only make it in two weeks and on the appointed day , she showed up for her results . This was not a very easy consultation as the pap-smear indicated she had a high grade squamous intra-epithelial lesion ( HSIL ) i . e . she tested positive for a pre-cancerous lesion .
From a pap-smear the options for results are : Normal : no changes suggestive of pre-cancer or cancer ; Atypical squamous cells of undetermined significance ( ASC- US ): ASC-US means that changes in the cervical cells have been found . The changes are almost always a sign of an HPV infection . ASC-US is the most common abnormal Pap test result ; Low-grade squamous intraepithelial lesion ( LSIL ): This means that the cervical cells show changes that are mildly abnormal . LSIL usually is caused by an HPV infection that often goes away on its own .
Other options are : High-grade squamous intraepithelial lesion ( HSIL ): which suggests more serious changes in the cervix than LSIL . It is more likely than HSIL to be associated with pre-cancer and cancer ; Atypical squamous cells , cannot exclude HSIL ( ASC-H ): ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL ; and Atypical glandular cells ( AGC ): Glandular cells are another type of cell that make up the thin layer of tissue that covers the inner canal of the cervix . Glandular cells also are present inside the uterus . An AGC result means that changes have been found in glandular cells that raise concern for the presence of precancer or cancer .
No Woman Should Die From Cervical Cancer !! I strongly believe this , as Cervical Cancer is one of the rare cancers that can be detected before actual cancer sets in and therefore can be prevented .
After explaining in detail the significance of the results we planned for a colposcopy . During that visit we used a special light and magnifying machine , pretty much like a pap-smear but takes a while longer . Bettina had to lie down on the examination couch and her cervix was visualized using a speculum . We then proceed to apply acetic acid . After a few minutes the typical white patches of a pre-cancerous lesion appeared .
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