What does early cancer screening involve? (4/6)
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A check-up with your gynaecologist does not take long and can protect you from cervical cancer. Since 1 January 2020, an organised screening programme has been available to women in Germany aged 20 and over.
The central component of early cancer screening is the PAP test, also known as the cervical or portio smear. The goal of this examination is to identify and treat pathological cells in the cervix. This ensures that the cancer is unable to spread.
Cervical examination
Your gynaecologist will start by asking you about your symptoms and possible risk factors. In general, the examination involves the following steps:
- a cell smear (PAP test)
- a manual examination
Your gynaecologist will use her finger to palpate the cervix via the vagina for possible changes. At the same time, she will palpate the abdominal wall from the outside using her other hand. Cells are taken from the mouth of the uterus and cervical canal for the PAP test with a speculum or brush. This cell smear is then examined under a microscope for pathological cell changes and assigned to one of the PAP groups. Alternatively, the thin-layer procedure may be performed. Here the smear is rinsed with a special liquid to allow the cervical cells to be assessed more reliably.
If cervical cancer is suspected, your gynaecologist can carry out further examinations:
- HPV test to detect human papillomaviruses
- Colposcopy
- Targeted removal of tissue from the mouth of the uterus and cervix (biopsy)
- Removal of a cone-shaped piece of tissue from the cervix (conisation)
If your gynaecologist suspects cervical cancer, a cervical endoscopy will be performed in order to take tissue from the cervix. During a colposcopy, your gynaecologist expands the vaginal walls with a metal spatula, known as a speculum. She then positions a special magnifying instrument, a colposcope, in front of your vagina. This enables the vagina and mouth of the uterus to be illuminated and enlarged. Tissue defects, growths and bleeding then become visible. Your gynaecologist will also dab a special liquid onto the mucous membranes of the cervix in order to identify pathological cells more effectively.
HPV test: part of your statutory early cancer screening from age 35 upwards
You gynaecologist can perform an HPV test if the results of the PAP test are either unclear or abnormal. The cell smear is examined in a laboratory for human papillomaviruses. If you are 35 or older, the test can be performed together with a screening smear test. This examination is carried out every 3 years. If you are younger, you can be infected with HP viruses more frequently, however these infections generally heal themselves more quickly in younger years.
Abnormal PAP findings: not necessarily a cause for concern!
Abnormal PAP findings are not a cancer diagnosis. This merely means that you have a higher risk of getting cervical cancer since cancer precursors may be present. Gynaecologists differentiate between five types of findings:
- Pap I: the cells are normal and healthy.
- Pap II: slight cellular changes are evident but neither cancer nor cancer precursors are suspected.
- Pap III: the findings are not clear and further testing is necessary.
- Pap IV: cancer precursors or cancer are possible. Further testing is required to confirm the diagnosis.
- Pap V: malignant tumour cells have been found and a cancer diagnosis is highly likely.
If the cellular changes are not very pronounced, the tissue can restore itself on its own. Treatment is not necessary at this stage. Nevertheless, it is important that you have regular check-ups and that your gynaecologist performs further testing if necessary.
Tip:
It is harder to examine the cells whilst you are on your period. We therefore recommend that you schedule your appointment one or two weeks after your period if possible.