Healthcare

Vaccination is there, but no one does it: why is cervical cancer one of the leaders in cancer

– Until the age of 30, we take a smear for oncocytology every three years, if the previous result was normal, – says obstetrician-gynecologist, ultrasound doctor W Clinic Anna Barkovskaya. – We do not conduct co-testing at this age, as it is associated with frequent changes of sexual partners and high HPV infection, which then most often goes away on its own and does not lead to any consequences. Determination of HPV at this age is recognized as overdiagnosis.

After 30 years, the analysis for oncocytology is taken every five years, but it is supplemented by a test for HPV. The goal is to identify a risk group of all women that needs to be monitored more closely.

– If there is an abnormal result of oncocytology, or 16 and 18 types of HPV are found, then we perform colposcopy, – continues Anna Barkovskaya. – Unfortunately, not all doctors know why she is needed. First and foremost, it is the choice of location for the biopsy to accurately diagnose. Neither the results of oncocytology nor HPV analysis allow a diagnosis – it is made only by histology after biopsy.

Experts say that without the results of oncocytology, everyone does not need to do a colposcopy. This is overdiagnosis.

Anna Barkovskaya recommends to hand over liquid oncocytology since it gives more exact result.

“Liquid cytology has certain advantages,” he confirms Olga Malinovskaya. – If the smear is taken by an experienced doctor who has been working for a long time, he has beautiful glasses, has all the devices to take a smear and he correctly applies a thin layer of biomaterial to the glass so that the cytologist can see each cell, then routine cytology and fluid can be comparable. But there is a human factor everywhere – if we take a smear by liquid cytology, then all the cells are immersed in a special liquid medium. It allows you to wash the cells that cover what should be assessed by a cytologist: for example, if the smear is taken against the background of inflammation, it will contain leukocytes, lymphocytes, erythrocytes. At the same time from the material for liquid cytology it is possible to make the analysis on HPV.

Daria Burmakina agrees: if the analysis is taken qualitatively, the cytologist will look equally well both a usual smear, and liquid. But it happens that the analysis is given by the flow. A variety of, not always appropriate, tools can be used during professional examinations.

– In this case, with a negative analysis, the woman will relax, but due to the violation of the procedure, the result may be false, – she emphasizes.

Olga Smirnova notes that clinically the methods of fluid and conventional oncocytology are absolutely comparable in effectiveness. But the liquid has a definite plus: it can be used to assess cellular markers – ie, to see if the cell has embarked on the path of proliferation and whether it is transformed.

“There is an important point that doctors often do not take into account – this is the so-called Koss phenomenon: you can not take repeated smears if there is less than one and a half, and ideally up to three months,” she said. Olga Smirnova. – Very often the patient comes to the clinic with a smear already taken, and the doctor does it again with a difference of even a couple of days. The result, of course, is negative, but, unfortunately, this is a false-negative smear.

She also noted that fluid cytology is not included in the MHI, but is quite expensive, especially if co-testing is performed. Therefore, not every patient can afford it. It is better to do a normal cytology than not to do any. After all, cervical cancer does not cause symptoms – they appear when the tumor has already spread beyond the cervix, and this is a common stage of the disease.

“The only thing women can complain about, and it’s rare, is watery or bloody discharge, dragging pain, discomfort,” she says. Anna Belukhina. – But at least it can make a woman go to the gynecologist.

Until recently, doctors actively diagnosed “cervical erosion” and burned it, citing the risk of tumor. Today, doctors say this is not true.

Yes, according to Anna Barkovskaya, true erosion occurs if the cervix is ​​injured by something – but this small damage to the mucosa passes itself. What has been actively cauterized in the past is ectopia of the cervix, when there is a cylindrical red epithelium around the cervical canal.

“This is a feature of the structure of the cervix that does not carry the additional risk of oncology,” she says Барковская. – On the contrary, I believe that it gives a diagnostic advantage, and cauterization just prevents diagnosis.

– Many women experience a feeling of awkwardness and embarrassment during the procedure of examination by a gynecologist or they simply do not have enough time for this, – says Anna Belukhina.

In this situation, in her opinion, special devices for self-capture of biomaterial for HPV infection will come to the rescue. In order to pass the examination, you need to take a swab with the supplied sterile device, then transfer it to the medical office. Such testing for HPV has been successfully used abroad, where it is one of the stages of cancer screening, and has already begun to gain popularity in Russia.

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