1 What is cervical cancer?
Almost all cancers of the cervix are linked to human papillomavirus infections (HPV-Human papillomavirus at high risk). This virus is transmitted by contact with the skin and mucous membranes, often during sexual intercourse. It should be noted that the condom, if it makes it possible to limit contact with the virus (70% efficiency if used systematically), cannot however provide complete protection since HPV (considered as sexually transmitted infections) transmit through skin contact (not through blood or sexual fluids). This means that contamination can occur even without penetration, and that depending on sexual practices, other anatomical regions are involved (genital, anal and ENT). Therefore, all people carrying HPV can transmit the virus to their partner(s) during sexual relations.
There are several types of HPV: those responsible for skin lesions (warts) those with low carcinogenic risk (responsible for the development of genital warts) and those attacking the mucous membranes, some of which are at high carcinogenic risk, the most common and dangerous are HPV-16 and HPV-18 (which can cause pre-cancerous lesions and the development of several types of cancer, including those of the cervix). Contracting the virus therefore does not necessarily mean developing cancer, but indicates that the patient is a carrier of the cancer risk factor and must be monitored.
It is a particularly common virus since “80% of the population will be in contact with this high-risk virus at least once in their life”, indicates Professor Jean Levêque, from the Department of Obstetrics Gynecology and Human Reproduction of the Civil Hospices of reindeer. Most women infected with HPV will naturally shed the virus. But, in 20% of cases, it will persist in the mucous membrane of the cervix, which can then cause changes in the epithelium, called precancerous lesions, likely to evolve into cancer.
2 A cancer that mainly affects young women
“Cervical cancer is not a big killer compared to the figures for breast cancer, for example, but what is very disappointing is that it is a cancer that is perfectly detectable, and that over 90% of it can be prevented by vaccination. And it remains, despite everything, the second cancer of young women. We have cancers of the cervix that we should no longer have, ”regrets Professor Levêque. “The average age of onset of this cancer is 41 years old”, underlines Professor Christopher Payan, virologist at the University Hospital of Brest.
And like any cancer, the earlier it is detected, the better! And even better if we can detect precancerous lesions, we can treat them before they progress to cancer at the cost of surgery to preserve the possibility of giving birth. And even better if we can prevent precancerous lesions and therefore cancers, genital, anal and ENT related to the HPV virus through vaccination.
3 Get vaccinated before first sexual intercourse
Vaccination against HPV is strongly recommended for girls and boys aged 11 to 14 years. For 15-19 year olds, there is a three-dose vaccination schedule. If it is carried out before the first sexual intercourse, the effectiveness of the vaccination is close to 100%. “It is important to vaccinate early, before the first sexual intercourse, because the earlier you vaccinate, the more effective and lasting the immune reaction and the lower the risk that the patient has been infected with the virus, the vaccine being only preventive and not therapy,” says Prof. Levêque. As for the question of whether it is still useful to get vaccinated afterwards? “This is the subject of a vast debate: a probable individual benefit exists, but the public health benefit remains highly debated”, continues Professor Levêque.
Not to mention that according to Professor Payan, “the vaccine also helps to reduce the circulation of this virus if the population is widely vaccinated with the disappearance of the lesions associated with this cancer in this population, which is observed in Australia or Great Britain who have been applying systematic vaccination in schools for more than ten years. This also protects against other cancers associated with this virus: ENT cancers and anogenital cancers”.
However, in France, only about 30% of women are vaccinated.
Please note, vaccination does not exempt women from having regular gynecological follow-up and screening every three years for those aged 25-30 and every 5 years for those over 30.
4 Why get tested?
For Pr Levêque and Pr Payan, “the absence of screening is the first factor in cervical cancer”. In France, just under 60% of the population is screened. “The lesions associated with human papillomaviruses causing the lesions are painless, they can develop for several years without identifiable signs, vaginal bleeding is observed by the woman at the invasive cancer stage and leads to consultation but it is too late. … This is why it must be identified before the arrival of cancer by screening,” assures Professor Payan.
Screening can be carried out by a general practitioner, a gynecologist, a midwife, or even sometimes directly by laboratories or in screening centres.
“40% of women seen in gynecology consultation for cancer at Brest University Hospital have never been screened, screening for precancerous lesions allows simple and effective treatment to avoid cancer (method of physical destruction by conization or electro-resection or even hysterectomy). This screening can be facilitated with the proposal of a urinary or vaginal self-sampling carried out at home”, indicates Professor Payan.
Since 2019, organized screening has been set up in France with a summons by mail intended for all women of age to benefit from it.
– Between 25 and 30 years: smear every three years to analyze the cells of the cervix in search of any abnormalities (cytological examination). If the test is positive, rapid support will be carried out to carry out additional examinations.
– From 30 to 65 years old, testing for the HPV virus every five years. If it is positive, a cell analysis is carried out on the same sample. “That doesn’t mean that you have to stop getting tested from the age of 65! adds Professor Levêque.
To further facilitate access to screening, self-sampling is being set up (a buffer that women apply in the vagina and then send in a bottle to the laboratory).
5 Innovative screening in Brest
In Brest, Professor Payan’s teams set up a urine papillomavirus screening campaign: “This study, PapU Access, is part of improving access to screening. The advantage is to be able to benefit from the test with a simple sample (first urine stream) taken at home and sent by post to the laboratory to do the test. We have identified a number of areas, such as Central Brittany, that are under-medicalized, the objective is to improve access to screening in these areas. Since the launch of this study in 2021, we have received nearly 2,000 samples in the laboratory, the analyzes have been completed since the end of 2022 and the statistical and medico-economic analysis is in progress for publication in 2023. We still have to validate this approach to the Ministry of Health”. The aim is for this approach to be included in the next national recommendations.