January has been declared International Cervical Cancer Awareness Month.

The risk of cervical cancer increases significantly in women over 30 years of age, but it can be prevented and cured if it is detected early and treated effectively.

According to the World Health Organization (WHO), cervical cancer is the fourth most common cancer in women worldwide, with about 604,000 new cases in 2020. Of the approximately 342,000 cervical cancer deaths in 2020, middle-income countries, while 80% of cases worldwide are in developing countries. This difference is mainly due to women’s limited access to medical and preventive services, which leads to late diagnosis and untimely intervention.

In the WHO European Region and Greece in particular, the World Health Organization’s Global Cancer Observatory and the International Agency for Research on Cancer estimate that cervical cancer is the 10th most common malignancy in 2020. women, while for women aged 15 to 44 years, this is the 3rd place in terms of the frequency of malignant neoplasms.

Human papillomavirus (HPV) is almost always (about 95%) the cause of cervical cancer. HPV is a virus that can be transmitted sexually. There are many types of HPV. Certain types of HPV can cause changes in a woman’s cervix that, over time, can lead to cervical cancer.

Risk factors

• Beginning sexual activity at an early age. Starting sexual activity at a young age increases the chance of contracting HPV.
• Multiple sexual partners. The likelihood of contracting HPV increases with the number of sexual partners, and in particular, the greater the number of sexual partners a couple has, the higher the risk of HPV infection.
• Smoking. Smoking has been associated with an increased risk of cervical cancer.
  Weakened immune system. Women who have a weakened immune system for another reason or because of chronic drug use and HPV infection are at greater risk of developing cervical cancer.
• Other venereal diseases. Sexually transmitted diseases (such as chlamydia, gonorrhea, syphilis, and HIV/AIDS) increase the risk of contracting HPV.

The Global Strategy to End Cervical Cancer as a Major Public Health Problem, adopted by the World Health Assembly in 2020, is a comprehensive approach to cervical cancer prevention and control in the population. The plan focuses on primary prevention through scaling up human papillomavirus (HPV) vaccination, secondary prevention through screening, and tertiary prevention through treatment of all women diagnosed with the disease worldwide.

The proposed actions include interventions throughout people’s lives.

For children it is recommended:

• Vaccinate girls 9-14 years of age against HPV, ideally before sexual activity – In our country, the National Committee on Immunization recommends that both sexes be vaccinated from the age of 9 years.
• Informing the public about the health risks of smoking
• Sex education adapted to the age and needs of different population groups
• Information and promotion of condom use among the sexually active population

For women in the general population from 30 years of age and for women with HIV from 25 years of age, it is recommended:

Regular screening with highly reliable laboratory tests (HPV DNA and HPV mRNA analysis) every 5 to 10 years, followed by immediate or as prompt treatment as possible in patients diagnosed with HPV.

Women living with HIV should be tested more frequently, every 3–5 years.

Regardless of age, for invasive cancer it is recommended:

•  Surgery
• Radiation therapy
• Chemotherapy
• Palliative care

According to guidelines Instructions from the Hellenic Society of Obstetrics and Gynecology:

Cervical cancer screening should begin when a woman turns 21, except in immunocompromised patients, where screening is recommended earlier.

Women aged 21-30 years are recommended follow-up with a cytological examination of a smear from the cervix (Pap smear) every three years. In the age group over 30, screening of women every three years with a combination of cytology and HPV DNA testing is recommended.

“Cervical cancer is preventable. No woman should die from this disease. A future without cervical cancer is in our hands. We have the knowledge and the tools,” says Dr Nino Berzuli, Director of Country Programs for Health at WHO/Europe.