Frequently asked questions

1. How common is cervical cancer?
   After breast cancer, cervical cancer is the second most common cancer in women. In many EU countries and the developed countries (US, Canada, Australia, New Zeland…) the disease is almost eradicated and is belonging to the history of medicine. This is achieved by population-based screening programs, massive organized programs of primary and secondary prevention.
   In Serbia, unfortunately, 300 to 900 women die from cervical cancer every year.
   The incidence rate of this disease is from 12/100 000 to up to 35/100 000.
2. What are the methods for cervical cancer prevention?
   There are primary and secondary prevention methods. Primary prevention aims to stop disease from occurring (e.g. vaccination), and the secondary prevention is early detection (e.g. colposcopy or PAP smear). It aims to detect disease as early as possible thus saving life and enabling cure.  For many malignant diseases we do not have primary prevention methods since we still do not know what causes them (unlike infectious diseases or HPV related malignancies).
3. Is the cervical cancer curable?
   If cervical cancer is detected on time, in the premalignant stage, it should be 100% curable.
4. Is the procedure painful and how is it performed?
   Swab is completely painless and safe. You take position for gynecological examination; swab is taken under speculum with the special brush. Desquamated cells lining the cervix are taken, stained and prepared for examination. 
5. Is the procedure expensive? Is there anything I should pay?
   With a certified health card or in the organized screening programme, the procedure is completely free of charge.
6. What are the risk factors for cervical cancer?
   • Early entry into sexual-intercourse
   • Frequent change of sexual partners
   • Insufficient use of condoms when dealing with new or unfamiliar partner.
   • Poor socio-economic status
7. What is Human Papilloma Virus (HPV)?
   Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 80 types of HPV that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat.
   HPV can cause serious health problems, including genital warts and certain cancers. There is no certain way to tell who will develop health problems from HPV and who will not. In most cases HPV goes away by itself before it causes any health problems, and most people who become infected with HPV do not even know they have it.
   HPV is not the same as herpes or HIV (the virus that causes AIDS). Both viruses can be passed on during sex, but they have different symptoms and cause different health problems.
8. Who is at risk for HPV? 
   Anyone who is having (or has ever had) sex can get HPV. HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.
   HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected person has no signs or symptoms.
   What is the difference between viruses and what is happening from infection with HPV to the development of malignant disease?
   All viruses differ
   • By virulence:
     Strong oncogenic potential (easy to obtain, such as viruses of children diseases) and week oncogenic potential (hard to get, such as the HIV virus)
   • by the tissues they are targeting (the tissues virus has an affinity for). HPV populates the cell-plate-stratified epithelium that lines the vagina, the cervix, urethral tube, perianal and anal mucous membranes and throat
   • by the way of transmission (water, air, body fluids ...). HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected person has no signs or symptoms.
9. What period is from the infection with HPV to the development of malignant disease?
   The period from infection with HPV to cancer development is 8 to 10 years. During this time, the infected cells undergo premalignant changes. During this period cancer cells may be identified with simple Pap test. Greek gynecologist, Dr. Papanicolau devised a way of painting  smears with desquamated cells from the cervix to slides about 100 years ago. With this method, we extract hormonal phase cells and cell nuclei become available for visualizing under the microscope.
10. What is the screening for cervical cancer?
    Screening is the programme of prevention of cervical cancer by testing non- symptomatic target population, aiming to identify individuals with high risk for developing cancer followed by quality control and reporting. Screening allows not only the detection of cervical cancer at an early stage, but also detection of precancerous changes, whose removal prevents the development of malignant change.  Countries, mostly developed, where organized screening programs are successfully used for several decades have seen a dramatic decline in mortality from cervical cancer. For example in the Republic of Finland, decline of mortality from cervical cancer was around 80%.
11. What types of screening exist?
    • Opportune screening (every woman who comes to a gynecologist in the primary health center, can have the Pap smear). This method is in applied since 1968.
    • Organized (greater coverage of population achieved by calls to the personal address or phone number at specified terms for appointments with selected gynecologist).
12. I'm trying to get pregnant. Am I supposed to take part in screening?
    It is not recommended that women undergo cervical screening in the pregnancy, but it depends on her previous history. If one has abnormal smear findings in the past, for example, or never worked Pap smear before pregnancy, one should consult  a  gynecologist for advice.
13. So far I've been doing regular Pap test and I've always had good results. Now I am pregnant. Should I accept the invitation and participate in screening?
    No. Pregnant women during the first gynecological examination have Pap test and testing the degree of clearness of secretion. For the next test, you should wait at least three months after the delivery.
14. When is the best time for testing within organized screening during the menstrual cycle?
    It is important that you are not at the stage of bleeding when you go to testing. In addition, several days before the test you should not have sex and you should not use suppositories.
15. Could some other infection be detected during cervical cancer screening ?
    Yes. For example, mycoses, Trichomonas vaginalis, Actinomyces spec., Human papilloma virus, herpes simplex virus
16. My screening test result is labeled as inadequate. What should I do and how long will I wait until my next testing?
    You should get precise instructions for your further testing or information required in accordance with your results on time together with the unsatisfying results.
17. I have not had sex yet. Do I have to participate in the screening?
    No. Let only service in the health center know that, so they can your appointment term transfer to another woman.
18. I'm not sexually active anymore and am 70 years old. Do I need to get the test?  
    Not any longer.
    Older than 65 years are excluded from organized screening if she has had no pathological findings.
    Women with mild or high risk results in previous screening procedures should be monitored as recommended in the guidelines.
    Overall, women older than 65 years have slight chances for cancer development.
    If you have never before done a Pap smear, you need to do the testing anyway.
19. I had a hysterectomy. Should I now do testing and get involved in screening?
    No. Pregnant women, women who have never had sex and women with no uterus do not participate in the testing.
20. I am disabled and require assistance from another person, what I should do in terms of inclusion in screening?
    It is necessary to consult your gynecologist to find out exactly what is the best way to be included in the screening for you.
21. I am a looking after a person with severe disabilities. What should I do when she gets a call?
    If possible, you should first talk to the person about her earlier gynecologist visits. You should find out what is her opinion of examinations; what is her opinion about her own health and does she want to know more about cervical cancer or risk for developing the disease.
    If the person you are caring for cannot independently make a decision, you have to do what is the best for that person, the principle of which you may have already practiced in making other decisions.
    Maybe it could help if you contact her general practitioner for more details about the risks for getting or developing cervical cancer. Perhaps a discussion with her relatives or friends can help you making the decision.
22. I have abnormal vaginal bleeding lasting longer than 25 days. Can I participate in the screening?
    Organized screening program is for women who have no symptoms. If you have any symptoms that worry you, just as bleeding that is not related to the menstrual cycle, pain, or any other annoyance, you should go to your gynecologist as soon as possible.
23. I have sex with someone of the same sex. Do I need to get the test?
    Yes.