With the vinegar the areas affected by HPV turn white and under the iodine the same areas will not turn dark brown but remain a yellow color . This offers the opportunity to fairly accurate targeted biopisies . These are then taken to the pathologist who will tell us the extent of the damage .
In nature most people are exposed to the Human papilloma virus . Most exchange of the strains which are responsible for cervical cancer such as HPV 16 or 18 is through sexual contact , however even just skin to skin contact is enough to cause transmission and even use of intimate items from an affected person may cause transmission and even condom use will not prevent transmission . This is why almost 75 % of the population if tested would be positive for HPV .
Once infected the period between infection and development of overt cancer can be up to 10 years . Due to differences in physiology and immune defences some people will get changes on the cervix and some will not be affected at all . We presently do not understand the mechanism by which some people do not get affected .
As the topic is on cancer we focus on those who will develop cancer . The virus affects the cervical epithelium which is in several layers of cells . The more the layers affected the more severe the disease . We generally divide the epithelium into thirds and this is the basis on which we say CIN I , II or III . CIN stands for Cervical Intraepithelial Neoplasia as the cells will get changes based on the infection .
The interesting thing is that the severity can progress from I to III but it can also regress to normal . If the body is not able to fight the disease to regress to normal over time , the changes will progress to cancer . This is where the basement membrane is breached .
Fortunately , this time we are concentrating on prevention . We had mentioned the pap smear and a high-grade lesion . On pap smear we collect cells from the cervix but we can also see certain changes and classify them into 2 groups : low grade and highgrade lesions .
A low-grade lesion would correspond to the biopsy CIN I or II , and a high-grade lesion would be the grade II and III . There is a bit of overlap but we cannot get a clear distinction like on biopsy . Had Sienna had a low-grade lesion we would have just reassured her and asked her to repeat the pap-smear in 6 months .
Following the procedure , she had follow-up and one year down the line , Sienna was able to conceive . She still undergoes frequent check-ups but to date the pap-smears are normal .
Other ways of screening are by use of what is known as visual inspection with acetic acid and / or visual inspection with Lugol ’ s iodine ( VIA / VILLI ) which is similar to what I described in the colposcopy where we apply the acetic acid and Lugol ’ s iodine . The difference with VIA / VILLI is we don ’ t use the colposcope which like a microscope to see the changes . This is cheaper but with similar effectiveness as the pap . In countries where pathologists or cytologists are few this helps to ensure more women are screened for cervical cancer .
There are also tests which can check for HPV itself and some of these are selfadministered . Presence of oncogenic ( those that cause cancer ) strains of HPV usually 16 or 18 will necessitate a colposcopy as mentioned above .
Based on the biopsy a treatment plan will be instituted like in Sienna ’ s case . Had she not received the treatment there is a great possibility we could be discussing a further case of cervical cancer .
We must remember that even if we have been vaccinated against cervical cancer , we still need to come in for regular screening . Vaccination and screening saves lives , and so we encourage all of you to get tested and vaccinated .
Hoping I have inspired you to marshal the courage do both i . e . get vaccinated and get screened and thanking God for yet another year .
Dr . Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi . You can commune with her on this or related matters via email at : Drmaureenowiti @ gmail . com .