Your gynaecologist has informed you about an abnormal Pap smear result or you are HPV positive? Or possibly both? Suddenly you are at risk of getting cervical cancer. You start to reconsider. Together with your gynaecologist, you now have to find the method of clarification that suits you best.
Good news first: although cervical cancer is caused by human papillomavirus (HPV) infection, only few infections actually develop into cervical cancer. In Germany, about 200,000 women are diagnosed with a suspicious Pap smear every year, but only few are serious.
The cervix is the lower, narrow part of the uterus, which connects it to the vagina. Accordingly, cancer of the cervix is called cervical cancer or cervical carcinoma.
More than 500,000 women worldwide are diagnosed with cervical cancer every year, but if detected early, there are very good chances of recovery.
Human papillomaviruses (HPV) are almost always responsible for the development of cervical cancer. Almost every woman becomes infected with HPV once in her life. These viruses are transmitted during sexual intercourse.
The infection often remains undetected because there are no symptoms. In most cases, HPV infections heal on their own after one or two years. However, in some women, the infection lasts longer. This can lead to cellular changes in the cervix. But even these changes can reverse themselves. Cervical cancer actually develops in less than 1 in 100 cases.
Since cervical cancer develops over a period of several years, and you have regular cervical checks, there are good chances that it is detected in its preliminary stages.
A precancerous stage can be present if the surface cells of the cervix are degenerated, but have not yet proliferated into deeper cell groups. These changes do not yet cause any symptoms. These changes are also called dysplasias. Dysplasia is not yet cervical cancer, but may develop over years.
Cervical cancer only causes symptoms in an advanced stage. Discharge, intercourse bleeding, postcoital bleeding, or unexplained weight loss may indicate a serious disease.
From a certain age, women are entitled to a screening examination by their gynaecologist, in order to detect cervical cancer early.
At the beginning of 2020, the new early detection of cervical cancer programme started in Germany. Here, women between the ages of 20 and 35 can still have a Pap test performed annually. Women aged 35 years and older are then entitled to a Pap smear in combination with an HPV test every three years. The extended examination period results from the fact that cervical cancer caused by HPV infection develops very slowly. Therefore, if both, Pap smear and HPV test are negative, the examination does not need to be repeated annually.
Other countries are also about to change or have already changed cervical cancer screening to primary HPV screening for women above a certain age and using the Pap smear as a primary screening test alone only in the younger patient group.
Your gynaecologist has informed you that you have an abnormal smear? This refers to a very abnormal test result. The Pap test is performed by taking a smear from the cervix and examining it microscopically to detect cellular changes. Five different groups indicate how severe the degree of change is. Pap I and II are harmless. From Pap III onwards, results are considered abnormal. However, a Pap test is prone to errors. It can be a false positive. This means that sometimes even healthy women receive abnormal Pap smear results. They then needlessly have to undergo further examinations.
Cervical cancer develops through an infection with human papillomaviruses, or HPV for short. In some countries, the HPV test is already part of the primary cervical check. For the detection of HPV, a smear sample has to be taken by the gynaecologist. An HPV infection heals on its own in most cases. Cervical cancer can only develop from a long-lasting, chronic infection with HPV.
Women with abnormal findings should undergo a colposcopy. Simply put, a gynaecologist performs a colposcopy by examining the surface of the cervix with a special magnifying glass. If a tissue sample is also taken during a colposcopy, this is called a colposcopy-guided biopsy.
Not all gynaecologists have a colposcope or the corresponding additional qualification, which is why affected women may have to wait longer for a specialist consultation.
If abnormal cellular changes or precancerous stages have been detected in a woman, a conisation will be the next step. A conisation is also performed if a colposcopy-guided biopsy could not provide a clear diagnosis. When performing a conisation, the opening of the cervix into the vagina is cut out in a conical shape.
However, conisation is associated with considerable risks. Changes in the shape and width of the cervix or birthing cervix are possible, as is scarring. Conisations increase the risk of premature birth or miscarriage in later pregnancies. In rare cases, conised women have difficulty falling pregnant.
Watchful Waiting describes the strategy of monitoring the course of the disease. An HPV infection can heal on its own with no consequences. Slight cellular changes at the cervix can also be reduced. Doctor and patient have time to monitor a cervical disease as it develops over years. Of course, this strategy depends on the severity of the cellular changes.
The watchful waiting strategy is psychologically very stressful for many women. However, at regular intervals, affected women have to go for check-ups fearing their results may have changed for the worse.
in early detection of cervical cancer
GynTect® is a test for the diagnosis of cervical cancer that offers three main advantages:
GynTect® is a molecular biological test that examines cell DNA for cancer-typical changes. These changes occur especially in cervical cancer or its preliminary stages.
Myriam von M – Two questions for the anti-cancer activist
With all her strength, Myriam von M has declared war on cancer. Her motto: FUCK Cancer! The campaign of the same name was launched in 2014 and has since gone far beyond educational activities: FUCK Cancer is a meeting point for those affected and their relatives who are looking for answers and a sympathetic ear. But FUCK Cancer is also there for people who are dying of cancer. Myriam von M and her team accompany those who are losing the fight against cancer and who have lived life to the fullest and now want to let go. The work of Myriam von M came to light and grew in prominence through the TV series ‘Voller Leben – Meine letzte Liste’ (‘Full of Life: My Final List’) (RTL ZWEI, German TV channel).
With great passion, Myriam von M discusses cancer screening. And so, many advice-seekers who receive abnormal test results turn to the anti-cancer activist. The fear of cancer is nerve-wracking. Those affected seek information and support, and the waiting for a diagnosis or an all-clear can be long.
Myriam von M became an anti-cancer activist through her own life story: in her early twenties she fell ill with vulva cancer, and was later diagnosed with cervical cancer. She had to endure countless surgeries. She is now sharing her experience and knowledge to other cancer patients. She is also a trained alternative psychotherapy practitioner.
Myriam von M: ‘People often come to me with abnormal findings. Most of the time they are totally insecure and don’t understand what it all means. Some immediately think they have cancer because they just haven’t been properly informed or advised. They are scared to death and often think that they are going to die. I try to calm them down and explain that abnormal results don’t necessarily mean cancer, and that they still have several options.
But the worst thing for those affected is not knowing where the journey will end. The psychological pressure to be examined every few months is immense. At each examination, the abnormalities could still be there, or even worsened. This feels like a ticking time bomb to many people. Some go as far as to think that they would like to have the whole organ removed. That way life could be so much easier for the affected person. In the field of cervical cancer, for example, there is a simple diagnostic smear, and the results are quickly available. This means that the pressure of suffering is taken away, and a woman can act or wait in peace until her body heals on its own. That’s why my educational work is so important to me.’
Myriam von M: ‘I believe you can never really take away people’s fear after a cancer diagnosis. Experience has shown that the longer the timepoint of diagnosis goes back in the past and the longer a person is in a healthy phase, the more anxiety manifests itself. People become fearful that the health and normality they are enjoying will disappear. You learn to live with it in a certain way and you come to terms with it. But you are never really free in your life again. What helps these people most is normality, sensitivity and also solidarity—the feeling of not being alone with your fears is very important. That is why I give my patients the opportunity to exchange information with each other. They all have the same ultimate goal: To survive as long and happily as possible.’
Many thanks to Myriam von M for taking the time to answer our questions!
This page is intended to give patients a summary overview of the topic. Reading this page does not replace a medical consultation or a discussion with your doctor.