Frequently Asked Questions About Cervical Cancer

Cervical Cancer is the second most common cancer worldwide and affects women of all ages. Frequently asked questions about cervical cancer, screening, vaccination and prevention are below, which should answer any questions you may have. If there is a question you have which you can't find the answer for here, call or visit one of our clinics, or visit your local GP or nurse for more information.

What is cervical cancer?
Cervical cancer develops in a woman’s cervix, which is the opening to the uterus at the top of the vagina. It occurs when cells in the cervix become abnormal and grow at an uncontrolled rate.

How long does cervical cancer take to develop?
At the time that mild abnormalities are detected on the cervix, it usually takes 10 to 20 years for cervical cancer to develop.

How common is cervical cancer?
Cervical cancer is the second most common cancer in women under 44 worldwide. Each year, approximately 500 000 new cases of invasive cervical cancer are diagnosed globally and more than 250 000 women die. In Ireland, cervical cancer is also the second most common cancer in women under 44 and approximately 180 women are newly diagnosed and 73 women die annually.

What causes cervical cancer?
99% of cervical cancer is caused by persistent infection of certain high risk types of the Human Papillomavirus (HPV).

What is the point of screening?
Screening refers to testing a targeted population of healthy people, at designated intervals, for early forms of a disease. Most people associate going to the doctor with treatment of disease symptoms when they are already sick but screening is a proactive approach to public health that allows for early detection of abnormalities before any symptoms occur. Earlier detection means earlier treatment and therefore reduced mortality from the disease.

What is cervical screening?
Cervical screening involves a simple test known as a Pap or a smear to detect changes to the cells of the cervix which could develop into cancer. A qualified doctor or nurse will take a sample of cells from the cervix using a small brush. The cells are then sent to a lab to be examined for any abnormalities. If the lab results show no abnormalities, the doctor will inform the client return for another smear in 3-5 years (depending upon her age). If the lab results show abnormalities, the doctor will advise the client to either return for another smear in six to twelve months or will make a referral to a specialist clinic for further investigation. It is important to note that the test performed during screening is not a diagnostic test. This means that the Pap smear test can only detect abnormalities and cannot diagnose the particular reason for the abnormality.

Why should women be screened for cervical cancer?
Cervical cancer takes a long time to develop and often has no signs or symptoms. Regular screening is the only way to ensure that any abnormal cells in the cervix are detected early and treated early thereby preventing the development of cervical cancer.

Who should attend for cervical screening?
Every woman, whether lesbian, bisexual, heterosexual, immigrant, native Irish, single, married or have a long term partner, disabled, and/or Traveller between the ages of 25 and 60 should attend regular cervical screens.

Should disabled women attend for cervical screening?
Yes. Physically and/or intellectually disabled women share the same risk factors for developing cervical cancer as non disabled women and should therefore be invited to attend regular cervical screens in the same frequency and manner as non disabled women. It is important to note that many disabled women face multiple barriers in accessing cervical screening because of discrimination, societal reluctance to engage in dialogue relating to sexuality and disability and a lack of disability mainstreaming into programme design and delivery. Health care providers and carers should also be aware of the fact that disabled women are much more likely to experience sexual violence in their lifetime.

How often should a woman attend for screening?
CervicalCheck, in accordance with World Health Organisation guidelines, recommends that all women aged 25-44 should attend for screening every three years and women aged 45-64 every five years.

Should women engaged in sex work be screened more often?
Women engaged in sex work are at a higher risk of contracting HPV because of their higher number of sexual partners. However, the research is inconclusive as to the benefit of attending for screening more often than stipulated intervals. The Netherlands, for example, do not invite women registered as sex workers to attend more often for screening.

Should women under 25 be screened?
The recommended age for onset of screening varies across countries from age 20 in New Zealand to 30 in Finland. Other countries such as Canada recommend screening as soon as a woman becomes sexually active. The WHO, the IARC and European Guidelines recommend screening women starting from age 25. The WHO supports this position based on evidence that HPV infection is very common in young women but most infections are transient and that cervical cancer is rare before the age of 30. The WHO states that screening younger women will detect many lesions that will never develop into cancer, will lead to considerable over treatment and is not cost effective.

What is the cervical cancer incidence rate for women under 25 in Ireland?
According the National Cancer Registry the incidence rate for women under 25 was 1.3 per 100 000 women. This figure is compared to the peak incidence rate of 23.64 per 100 000 women aged 40-44

What is the HPV Vaccine?
There are currently two HPV vaccines licensed in Ireland, Gardasil and Cervarix. Both vaccines prevent infection from two high risk strains of HPV (16 & 18) that cause 73% of all cervical cancer. One of the vaccines (Gardasil) also protects against low risk HPV types 6 & 11 that cause 90% of all genital warts.

What is the recommended age for vaccination?
Given that HPV is sexually transmitted and is usually acquired within the first few years following sexual debut, the vaccine will have the most impact on the incidence of cervical cancer if routinely administered to pre adolescent girls before they become sexually active. The WHO recommends routine vaccination of girls between the ages of 9 and 13 as the primary target group for the vaccine..

What is a “catch up vaccination” programme?
A catch up vaccine is targeted at girls slightly older than the primary target age group in order to accelerate the impact of the vaccination programme and increase vaccination benefits in the short term. The age range of catch up programmes can include girls and women up to the age of 26 and usually only run in the first few years of a national vaccination programme.

Should girls who are already sexually active receive the vaccine?
Girls and women who are already sexually active could benefit from the vaccine because it is unlikely that they have been infected with every type of HPV included in the vaccine.

Why are boys not vaccinated?
Most HPV vaccine studies have focussed on women and clinical trials testing the vaccines in males is ongoing. EU licensing of Gardasil did not exclude males but did note that its efficacy in males was unknown. Even if the vaccine proves effective in males, routine vaccination is unlikely to be cost effective because the burden of disease associated with HPV types 16 & 18 in males is low.

How long does the vaccine protect against HPV infection?
Because the HPV vaccine is a new vaccine, only five year follow up data is available. Clinical trials report high levels of immunity after five years but longer term protection is unknown.

Is a booster necessary?
The long term protection of the vaccine is unknown and therefore there are no recommendations as of yet for a booster.

Does the vaccine protect against all cervical cancer?
No. The vaccine protects against two high risk types of HPV (16 & 18) that cause 73% of all cervical cancers. Vaccinated women and girls will still be at risk from other high risk types of HPV that can cause cervical and will therefore need to continue to have regular smear tests.

Are there any side effects of the vaccine?
The most common side effect is pain and swelling in the area where the vaccine is injected. Other less common side effects include fever, nausea, dizziness and diarrhoea.

Is the HPV vaccine available in Ireland?
Both vaccines, Cervarix and Gardasil, are available from family planning clinics and GPs in Ireland. Gardasil has been available since 2006 and Cervarix has been available since 2007. A free vaccination programme for 12 year old girls has been announced for 2010 but the implementation details have not yet been finalised.

How is the vaccine administered?
The vaccine is given in three separate doses at 0, 2 and 6 months for Gardasil and 0, 1 and 6 months for Cervarix. The vaccine is injected into the muscle of the upper arm or the thigh.

How much does the vaccine cost in Ireland
Three doses of the vaccine cost approximately €600 in Ireland. Some health insurance companies are offering coverage of the vaccine in their plans which will reduce the cost to €360. A free vaccination programme for 12 year old girls has been announced for 2010 but the implementation details have not yet been finalised.

What is the difference between the two licensed vaccines?
Gardasil was licensed for use in the EU in September 2006 and is produced by the pharmaceutical company Sanofi Pasteur (joint company of Merck and Sanofi-Aventis). Gardasil prevents infection from two high risk types of HPV (16 & 18) that are known to cause 73% of all cervical cancers. Gardasil also prevents infection from two low risk types of HPV (6 & 11) that cause 90% of all genital warts. Gardasil is licensed for use in girls from age 9.

Cervarix was licensed for use in the EU in September 2007 and is produced by the pharmaceutical company GlaxoSmithKline. Cervarix also prevents infection from the two high risk types of HPV (16 & 18) but does not protect against genital warts. Cervarix is licensed for use in girls from age 10.

Will girls who have been vaccinated need to attend for screening?
The HPV vaccine will protect against two types of HPV that cause 73% of all cervical cancers. Women are still at risk from the high risk types of HPV that cause 27% of cervical cancer and will therefore need to attend regular screening.

Is the vaccine safe?
The vaccine is made out of virus like particles and do not contain any live DNA particles. This means that you cannot become infected with HPV from the vaccine. The vaccines are considered very safe and well tolerated by recipients. There have been no serious adverse reactions to date but will be monitored closely as the vaccine is introduced to large populations.

Is it safe to administer the vaccine at the same time as other vaccines?
The HPV vaccine can be used together with other vaccines including those for the prevention of measles, mumps and rubella and also at the same time as the Hepatitis B vaccine.

What are the arguments against introducing the vaccine?
The most common arguments against the vaccine include:

• The long term effects of the vaccine are unknown as of yet
• The vaccine is expensive
• Routine vaccination may dilute the importance of continuing to attend for regular smears