El cervical cancer has become a clear example of how the combination of vaccination against the human papillomavirus (HPV) and organized screening can completely change the prognosis of cancer, a message that is reiterated in the world cancer dayEven so, there are still too many women who do not have access to these tests in time.
In recent years there have appeared new early detection strategies designed to overcome barriers such as modesty, fear of pain, or difficulties accessing the healthcare system. From the vaginal self-sampling or home testing until HPV detection in menstrual bloodThe research opens the door to more flexible screening adapted to women's real lives.
A highly preventable but still underdiagnosed tumor
The cervix is especially vulnerable to infection by high-risk HPVespecially the types 16 and 18responsible for the majority of cervical cancer cases. In Spain, this tumor accounts for around 3% of female cancers and it is the third most common gynecological cancer, although its incidence has been reduced thanks to the vaccination campaigns screening programs already.
Data from the Ministry of Health and the Carlos III Health Institute show a widespread increase in sexually transmitted infectionsespecially among 15- to 24-year-olds, a group in which the prevalence of HPV can reach 29%. Nonetheless, Most infections resolve on their own. And only a fraction, when it is persistent and not detected in time, ends up generating precancerous lesions that can evolve into cancer.
Specialists like Dr. Gema Garcia, from the Quirónsalud Infanta Luisa Hospital in Seville, remind us that it is about “one of the most preventable cancers” thanks to three pillars: knowledge of its HPV-related cause, availability of effective prophylactic vaccine and existence of population screeningHowever, they persist inequalities of access and shortcomings in health education that lead to the continued diagnosis of potentially preventable cases.
In our environment, the five-year survival It's around 60-65%, but the results improve significantly when the tumor is detected in early stages or even in the form of a precancerous lesion, something that is only possible if women regularly participate in screening programs.
HPV: common infection, preventable cancer
El human papilloma virus It is the most common sexually transmitted infection. It is estimated that over 80% of the sexually active population She will become infected at some point in her life. In Spain, the average prevalence in women is around 14,3%, with higher figures among younger people.
HPV infects mucous membranes and skinIt can cause warts and, in some cases, cancerous tumors. In the cervix, persistent infection with certain high-risk genotypes, especially those... 16 and 18Is a necessary condition for the development of cancer. Even so, having HPV does not automatically mean that a tumor will develop.
In women between 21 and 29 yearsHPV infection is very common, usually lasts a short time, and it is common for the body itself to clear up. immune system eliminates the virus without leaving any lasting effects. For this reason, in this age group, the following is usually recommended as the primary test: cytology every three yearsto avoid excessive testing and unnecessary follow-up resulting from the mere presence of the virus.
Scientists are more concerned about other age groups and by those who live in rural areas or vulnerable contexts, where it is easier for them to accumulate persistent infections undiagnosed due to lack of access to checkups and controls.
In addition to its impact on cancer, HPV can have repercussions on... emotional, sexual and reproductive life of the patients, especially when the diagnosis comes at ages when the project of motherhood is very present, which requires broader and more personalized approaches to care.
Cervical cancer screening: available tests and recommendations
The screening tests for the early detection of HPV and cellular changes in the cervix can prevent up to 90% of cases of cervical cancer by identifying and treating lesions before they become malignant. Despite this, in countries like United States only around one 75% of women They perform the tests at the recommended intervals.
Currently, two major screening strategies are combined: the HPV molecular test and cytologyThe first is the most direct and sensitive method, because search for the virus's genetic material in a sample of cells from the cervix. Cytology, on the other hand, does not detect the virus, but rather the cellular changes that this can produce.
Organizations such as the OMS And European scientific societies recommend, in women over 30, prioritizing the HPV test as the main test, with the possibility of spacing out the screening until every five years When the result is negative, cytology remains valid at these ages, but with shorter intervals. every three years.
Many programs use a mixed approach: cytology in the youngestwhich have very high rates of transient infection, and HPV test from age 30-35taking advantage of its greater sensitivity to detect relevant lesions. Some strategies combine both tests (co-test) at five-year intervals.
One key point that experts emphasize is that the precancerous lesions of the cervix are usually asymptomaticThey do not give clear signs in the form of pain or bleeding until more advanced stages, so waiting for symptoms means giving up the main advantage of screening: detecting the problem when it can still be treated with simple, conservative techniques and with a high probability of cure.
New screening methods: from home tests to menstrual blood
To increase participation, various research teams and healthcare systems are investing in more comfortable and less invasive testsOne of the lines of work focuses on the self-samplewhich allows the woman to collect the sample without the need for an in-person gynecological examination.
An example of this is the HPV tests that are sent to the customer's home, such as the device known as Teal WandThe procedure usually includes a preliminary questionnaire and, in some cases, a virtual consultation to confirm that the woman is a candidate. Afterward, the kit is sent by mail. detailed instructions on how to take the sample and return it to the laboratory. The results are shared with the patient and integrated into her medical record, coordinating appointments with specialists if it is deemed necessary.
Women can choose to have the results sent directly to their gynecologistAnd when no abnormalities are detected, the next test is scheduled for the three to five yearsAccording to the healthcare system's screening strategy, this type of approach has proven especially useful for those who, due to shame, fear, or lack of time, floor overlooked gynecological check-ups in the office.
Another emerging line, with great international impact, is the HPV detection in menstrual bloodA large community study, conducted in the Chinese province of Hubei and published in the magazine BMJ, has compared this method to the cervical spine measurement performed by professionals.
This research included 3.068 women between 20 and 54 years oldall with regular menstrual cycles. Each participant provided three samplesA menstrual blood sample collected using a mini-shopping kit (a sterile cotton strip attached to the standard compress), a cervical sample collected by a healthcare professional for comparison, and a second cervical sample for laboratory processing.
The test based on the menstrual blood reached a sensitivity of 94,7% to detect CIN2+ (grade 2 or higher cervical intraepithelial neoplasia), versus 92,1% of conventional cervical samples. specificity was very similar (89,1% versus 90%), and the negative predictive valueIn other words, the probability that a negative result actually means the absence of disease was identical in both methods: 99,9%.
The authors emphasize that this is a method “comfortable and non-invasive”which allows sample collection at home and could expand access to screening, especially for women who miss appointments due to fear of pain, concern about privacy, stigma or lack of information. The study even included a aplicación móvil so that participants could consult results and receive health advice.
What do experts think about menstrual blood as evidence?
Despite the good results, experts are calling for prudence. The doctor Marta del Pino, from the Gynecological Oncology Unit of the Hospital Clínic of Barcelona, considers it to be a “interesting work” because HPV detection in menstrual samples shows a comparable sensitivity to conventional cervical sampling to identify CIN2+ lesions and a very high negative predictive value, which can provide considerable reassurance when the result is negative.
However, he insists that it cannot be interpreted as a immediate replacement of the current screening. The study only includes women who They menstruate and have regular cycles, used a prototype device that still It is not commercially availableand biopsies were not performed on all participants with negative results, which may introduce verification bias and overestimate the actual effectiveness of the test.
Furthermore, when collecting material from the entire genital tractThe menstrual sample could detect HPV infections that are not located in the cervixincreasing the number of false positivesAs with any strategy based on virus detection, the positive predictive value It remains limited in the general population; that is, a significant portion of the positive results will not correspond to injuries that require treatment.
Before incorporating this type of test into routine practice, it would be necessary implementation studies in different environments, comparisons with other self-sampling methods already available and detailed analyses of cost-effectiveness and care pathways. Its real usefulness will depend on how it is integrated into healthcare systems and its ability to reach groups that are currently excluded from screening.
In parallel, it is worth remembering that there already exist established non-invasive alternatives, such as the vaginal self-sampling for HPV with PCR analysis, which has demonstrated a performance very similar to that of a sample taken by a professional and is included in various international recommendations. urine collected in a standardized manner It is also studied as a possible option, although with more variable results and, often, lower specificity.
Experiences in Spain and Europe: from the Girona program to the WHO objective
In Europe, many countries are adapting their programs to align with the strategy of the World Health Organization, which has set itself the goal of reducing the incidence of cervical cancer to below 4 cases per 100.000 womenTo achieve this, a high vaccination coverage, effective population screening and adequate follow-up of precursor lesions.
In Spain, in addition to the traditional regional programs based on cytologyStrategies focused on the HPV test as the primary testOne example is the new early detection program of the Girona health region, launched in 2025.
This program has replaced conventional cytology with a HPV detection test aimed at women and people with cervixes between 30 and 65 yearsIn its first year, the following have been carried out 26.488 testsa 13,9% positive results and 85,2% negative. The presence of the virus does not imply a cancer diagnosis, but it does allow select those who need a more in-depth study.
Of the 3.691 women with HPV-positive cases detected in Girona, 895 carried types considered more aggressiveTherefore, they have been instructed to undergo closer monitoring and, where appropriate, testing such as Via/ VilliThis involves observing the cervix using a magnifying device and applying special liquids, performing biopsies of suspicious areas to arrive at an accurate diagnosis.
According to data from the Girona cancer registry, the incidence rate The incidence of cervical cancer in the area is around 7,5 cases per 100.000 inhabitants per year, with about thirty annual diagnoses and a five-year survival rate of 62%A significant proportion of cases are concentrated in women who do not participate or do so insufficiently in screening programs, which supports the need to better reach this group.
The Girona plan also includes a second population phase based on self-sampling in pharmaciesWomen will receive a notification to pick up a sample collection device at participating offices, which they will then need to return for analysis. At the same time, the option to continue getting tested at sexual and reproductive health centers will remain available for those who feel more comfortable with the traditional method.
HPV vaccine, screening and inequalities in access
La vaccination against HPV It has demonstrated great effectiveness in reducing infections, precancerous lesions, and cervical cancer. In Spain, the vaccine is included in the children's calendar and it is recommended for both girls and boys, since the virus is also linked to tumors such as the cancer of the anus, penis, vulva, vagina or oropharynx.
Gynecologists like Dr. Manuel Izquierdo and the doctor Gema Garcia They insist that vaccination is already a central tool for prevention, and its impact will become increasingly noticeable in the coming decades, provided that broad coverage is achieved and accompanied by well-organized screening programs.
Even so, not all women have the same opportunities to access these measures. The inequalities are concentrated in older women, with a lower socioeconomic level or residents in areas with worse access to healthcare servicesIn practice, this translates into less participation in prevention strategies and a higher number of diagnoses in advanced stages, which require more complex and aggressive treatments.
The context of social media And the massive consumption of online health content doesn't always help either. The spread of confusing or scientifically unfounded messages contributes to perpetuating [the problem]. myths and stigmas regarding HPV, sexuality, and cervical cancer. Therefore, professionals recommend guiding the population towards reliable sources and to offer clear messages about the importance of safe sex, vaccination, and regular check-ups, and the importance of go to the gynecologist.
Another key issue is that screening should be directed at all people with a cervixRegardless of sex assigned at birth, gender identity, or sexual orientation. This includes trans men and non-binary people who have retained their cervix and have not undergone a total hysterectomy, a group often overlooked in mainstream campaigns.
Impact of treatments and fertility preservation
When cervical cancer is detected in initial phasesThe treatment may be limited to a conservative surgery that preserves the uterus, such as conization or localized interventions. In more advanced situations, although fortunately less frequent, surgery may be necessary. removal of the uterus, which eliminates the possibility of pregnancy using one's own uterus.
In some cases, it is also required radiation therapy and chemotherapyThese therapies are very effective against the tumor but can damage ovarian function, reduce the follicle reserve, and cause a ovarian failureThis has led to fertility preservation gaining importance in the approach to cervical cancer, especially in young women.
Assisted reproduction specialists remind us that, before starting cancer treatment, it is important to consider the option of freeze eggs through ovarian stimulation and vitrification, to attempt a pregnancy with own oocytes once the illness has been overcome. For those who were unable to preserve their fertility or whose ovaries have been damaged, the Egg donation It is presented as an alternative.
In any case, not all patients who receive cancer treatment lose their reproductive capacity. That is why the need for a individualized study For each situation, taking into account the type of tumor, the stage, the age, the desire for motherhood and the available technical options, always within teams multidisciplinary that integrate oncology, gynecology, assisted reproduction and psychological support.
The diagnosis of cervical cancer in young women also has a strong emotional impactProfessional support, clear information, and planning for a possible future reproductive project are important parts of the overall treatment, as important as the medical interventions themselves.
Looking to the future: artificial intelligence and new technologies
As the range of screening tests expands and vaccination becomes more widespread, technology is beginning to play an interesting role in the prevention of cervical cancer; among the Latest advances in the fight against cancer highlights the application of the Artificial Intelligence to the analysis of cytology and cervical samples.
According to Dr. Gema García, image analysis algorithms could improve diagnostic reproducibilityto reduce inter-observer variability and facilitate early detection of Cervical injuriesThese tools, when properly integrated into pathology laboratories, could optimize the work of human teams without replacing their clinical judgment.
In parallel, the combination of mobile appsMessaging platforms and electronic health record systems facilitate the sending of reminders, results and personalized advice, something that has already been successfully tested in some screening studies with self-samples or menstrual blood, such as those carried out in China.
The key will be that these technological innovations are used to reduce access gaps and not to expand them, ensuring that they also reach those with fewer digital resources or who live in contexts with limited health infrastructure.
Overall, the combination of HPV vaccine, age-appropriate screening, new less invasive tests and technological tools It paints a picture in which cervical cancer could go from being a significant public health problem to becoming a rare tumor, provided that a high participation in preventive programs and to decisively address the social, geographical and information inequalities that still leave many women out of the system today.
