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On the occasion of World Cervical Cancer Prevention Day O Cervix – which is celebrated this Saturday, March 26 – from the Spanish Society of Gynecology and Obstetrics (SEGO) a call is made to insist on the use of available prevention measures against this tumor, one of the most frequent in women at the level worldwide, with more than 500,000 new cases per year. In Spain it is a rare tumor, with an estimate of slightly more than 2,300 new cases per yearand about 700 patients died in 2020.
It is a cancer that is diagnosed mostly in young women between the ages of 35 and 50 years and whose main cause is infection by the Human Papilloma Virus (HPV)which is transmitted through sexual contact.
Other risk factors for developing the disease are smoking, immunosuppression (patients affected by the HIV virus or who require immunosuppressive treatment), co-infection with other sexually transmitted diseases (STIs), and long-term use of oral contraceptives.
In recent decades, knowledge of the natural history of this tumor and the development of prevention strategies through the inclusion of vaccination against HPV in the vaccination schedule, and screening and early diagnosis through cytology and molecular detection of HPV DNA They have made it possible to stop and cure the disease when its diagnosis and treatment is carried out early and in the early stages of the disease.
These advances, together with surgical and oncological treatments, have translated in recent years into a decrease of more than 70% in mortality from cervical cancer in our setting. In fact, the survival rate for cervical cancer is between the higher in tumors that affect women in Spain, with a slight rise in recent years, reaching around 65%.
For this reason, the SEGO insists on prevention, even more so when it comes to a tumor that is avoidable in most cases and with the possibility of early diagnosis. Vaccination against HPV is currently considered the most effective strategy to significantly reduce the risk of cervical cancer, even more so when chronic HPV infection is the fundamental cause in more than 99% of cervical cancer cases.
Along with vaccination against HPV, cervical cancer screening is an effective and efficient prevention strategy to prevent tumor development. Cervical cytology using the Papanicolaou technique has a low sensitivity for the diagnosis of high-grade lesions, but it compensates with a high specificity. The combination of HPV molecular detection and cytology reaches a sensitivity to detect these lesions of up to 96%.
The incidence of cervical cancer has decreased in recent decades in Spain, mainly due to an increase in the diagnosis of Precursor lesions and their timely treatmentpopulation growth and immigration, population aging, and exposure to risk factors linked to lifestyle.
The Spanish Network of Cancer Registries (REDECAN) estimates that in 2022 around 2,480 cases of this cancer will be diagnosed in Spain. However, experts warn that this estimate is conditioned by the outbreak of the pandemic, since it decreased the number of cervical cancer diagnoses in 2020. In 2020, the actual number of cancers diagnosed was lower than that estimated by REDECAN for Spain. and by the IARC-WHO worldwide. Consequently, it is not clear how the pandemic will have affected the number of cancer diagnoses in 2021 and 2022, given that the delay in invitation and participation in screening may determine that more advanced lesions are diagnosed in the medium term.
The inclusion of the HPV vaccine in the vaccination schedule for girls is expected to produce a decrease in the diagnosis of lesions associated with the virus and, logically, in the incidence of cervical cancer.
HPV infection should be considered as a disease of possible sexual transmission of prevention through timely vaccination of the young or at-risk population. It not only affects women, but also men, who, in addition to being considered as a transmitter, can suffer the consequences of their infection (cancer of the oropharynx and penis). That is why the SEGO and other scientific societies recommend that health institutions also consider the inclusion of the HPV vaccine in men.
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