39. Cervical Screening and Prevention

First principle: a preventable cancer — two intervention points

Vaccination — prevents, does not treat

• Routine at ~11–12 years (from 9; catch‑up into the twenties).
• 🚩 The vaccine prevents new HPV infection but does not treat existing infection or established CIN/cancer.
• Vaccinated people still require screening (not all oncogenic types are covered).

Screening — the modern shift

From abnormal screen to diagnosis

Pitfalls

• Believing vaccination removes the need to screen.
• Expecting the vaccine to clear an existing infection.
• Memorising one country's Pap schedule as universal.

Pearls

• 🎯 Vaccinate (prevents) + screen (HPV‑based); abnormal screen → colposcopy → biopsy.
• 🩺 Offer the vaccine even to the already‑sexually‑active within the eligible age — it still protects against not‑yet‑acquired types.

Next → The quietest cancer begins with a lump (Concept 40).