January is traditionally dedicated to cervical cancer prevention. During this month, we mark the European Cervical Cancer Prevention Week, and Croatia joins the awareness campaign through Daffodil Day (Dan mimoza) – the National Day in the Fight Against Cervical Cancer.
The aim is to raise awareness of the importance of preserving reproductive health and to educate about prevention methods, risk factors, and the value of regular gynecological check-ups. Cervical cancer is specific in that it can affect younger women; however, when detected early, it is almost completely curable.
We have selected five key questions about this malignancy, answered by gynecologist Dr. Dimitrije Milojković, a subspecialist in gynecologic oncology and Head of the Gynecology Department at IMC Priora.
Why does cervical cancer still affect around 300 women per year in Croatia, despite available prevention?
Data on the incidence of invasive cervical cancer in Croatia indicate that awareness of the risk of this disease is still insufficient, which results in a low response rate to preventive examinations. We know that in the world’s most developed countries, invasive cervical cancer has been almost eradicated thanks to preventive screening, HPV vaccination, and treatment of preinvasive lesions. In contrast, in developing countries, it remains among the most common malignancies overall. All of this shows that the prevalence of this disease is a measure not only of the quality of healthcare but also of a society’s overall level of development.
Why is cervical cancer increasingly occurring in younger women?
According to the Croatian Institute of Public Health, the average age of first sexual intercourse in Croatia is 16 to 17. If we know that it typically takes about 15 to 20 years from HPV infection, one of the main risk factors, to the development of cervical cancer, we arrive at the answer to this question. Around the same age, many young people also start smoking, which is another risk factor for the development of this disease.
Can cervical cancer be prevented?
One of the leading causes of cervical cancer is the previously mentioned HPV, i.e., a persistent infection with this virus, given that the body’s immune system clears 90% of infections within two years. The HPV vaccine has been available for two decades, and for the past ten years, it has also been part of Croatia’s National Immunization Program for all children in grades 5 to 8 of primary school. In addition, all citizens aged 9 to 25 are eligible to be vaccinated. This is a nine-valent vaccine that covers seven high-risk types and two low-risk types of HPV. After vaccination, neutralizing antibodies develop at titers 10 to 100 times higher than after natural infection.
Vaccination at an earlier age provides stronger protection—up to 90% prevention of certain types of cervical cancer. Although vaccination prevents more than 80% of long-term HPV infections, it does not eliminate the risk of infection and cancer development, which is why regular gynecological examinations are still necessary. These include a cervical swab (i.e., the Pap test) and HPV testing.
When should preventive check-ups begin?
Regular gynecological check-ups and counseling should begin before, or immediately after, the onset of sexual activity. According to the still-valid 2012 guidelines of professional societies in the Republic of Croatia for the diagnosis and treatment of premalignant cervical changes, and the launched (currently temporarily in reorganization) 3rd National Program for Early Detection of Cervical Cancer, the method of choice for diagnostics remains cytological testing, the Pap test.
More recently, the test has been improved with liquid-based cytology. It is performed from the age of 20, at three-year intervals if previous results have been expected. According to European Commission recommendations, for organized cervical cancer screening from the age of 30, the first-line method is HPV testing, and from the age of 25, HPV testing + Pap. If the HPV test is negative, repeat testing can be done at intervals of up to five years.
How successful is cervical cancer treatment?
In Croatia, over the past decade, around 300 women per year have been diagnosed with cervical cancer, and about 120 women per year have died from it. Although there has been an apparent decline in incidence, it is still not satisfactory, and it is particularly concerning that mortality is not decreasing. Results of the international CONCORD-3 study show that five-year survival for cervical cancer among women diagnosed in the period 2010 to 2014 is 63%, placing Croatia in the lower third of European Union countries included in the study. On the other hand, cervical cancer is almost completely curable if diagnosed in time, bringing us back again to the importance of regular preventive examinations.
