What are the key components of a Pap test. How does a colposcopy differ from a Pap smear. What types of cervical biopsies are used to diagnose pre-cancers and cancers. When is a cone biopsy recommended for cervical abnormalities.

Understanding the Pap Test: A Crucial Screening Tool for Cervical Health

The Pap test, also known as a Pap smear, is a fundamental screening tool used to detect potential cervical abnormalities. This test is primarily designed to identify precancerous changes in cervical cells, which could potentially develop into cervical cancer if left untreated. During a Pap test, a healthcare provider collects cells from the cervix and examines them under a microscope for any signs of abnormality.

Is a Pap test the same as an HPV test. While both are crucial for cervical cancer screening, they serve different purposes. A Pap test looks for cell changes in the cervix, while an HPV test specifically checks for the presence of high-risk human papillomavirus strains that can cause cervical cancer. Often, these tests are performed together, providing a more comprehensive assessment of cervical health.

What Does a Pap Test Reveal?

• Precancerous cell changes
• Abnormal cell growth
• Signs of inflammation or infection
• Presence of atypical squamous cells

It’s important to note that an abnormal Pap test result doesn’t necessarily indicate cancer. Many factors can contribute to abnormal results, including minor infections or hormonal changes. Further testing is often required to determine the cause of any abnormalities detected.

The Role of HPV Testing in Cervical Cancer Screening

Human Papillomavirus (HPV) is a key factor in the development of cervical cancer. HPV testing has become an integral part of cervical cancer screening protocols in many healthcare systems. This test specifically looks for the presence of high-risk HPV types that are most commonly associated with cervical cancer.

How does HPV testing complement Pap smears. HPV testing can be performed alongside or instead of a Pap test, depending on the patient’s age and risk factors. The combination of HPV and Pap testing, known as co-testing, provides a more comprehensive assessment of cervical cancer risk.

Benefits of HPV Testing

1. Identifies high-risk HPV infections before cell changes occur
2. Allows for earlier intervention and prevention
3. Helps determine the frequency of future screenings
4. May reduce the need for frequent Pap tests in some cases

Colposcopy: A Closer Look at Cervical Abnormalities

When Pap or HPV tests reveal abnormalities, a colposcopy is often the next step in the diagnostic process. This procedure allows healthcare providers to examine the cervix, vagina, and vulva in detail using a specialized microscope called a colposcope.

During a colposcopy, the cervix is coated with a solution of acetic acid, which helps highlight any abnormal areas. The doctor then uses the colposcope to magnify and illuminate these areas, allowing for a thorough visual examination.

What to Expect During a Colposcopy

• The procedure is typically performed in a doctor’s office
• It usually takes 10-20 minutes
• Mild discomfort similar to a Pap test may be experienced
• Biopsies may be taken if abnormal areas are identified

Are colposcopies painful. Most women report minimal discomfort during a colposcopy, similar to the sensation of a Pap test. If biopsies are taken, you may experience brief, sharp pain or cramping. Your healthcare provider can discuss pain management options if needed.

Cervical Biopsies: Diagnosing Precancerous and Cancerous Lesions

Cervical biopsies are essential diagnostic tools used when abnormalities are detected during screening tests or colposcopies. These procedures involve removing small samples of cervical tissue for microscopic examination, allowing for a definitive diagnosis of precancerous or cancerous changes.

Types of Cervical Biopsies

1. Colposcopic biopsy: Removal of a small piece of tissue from the cervix’s surface
2. Endocervical curettage: Scraping of tissue from the endocervical canal
3. Cone biopsy (conization): Removal of a cone-shaped piece of cervical tissue

How is a cervical biopsy performed. The method depends on the type of biopsy needed. Colposcopic biopsies are typically done during a colposcopy using small forceps. Endocervical curettage uses a narrow instrument to scrape tissue from inside the cervical canal. Cone biopsies are more extensive and may require local anesthesia or sedation.

Cone Biopsy: When and Why It’s Recommended

A cone biopsy, also known as conization, is a more extensive diagnostic and potentially therapeutic procedure. It involves removing a cone-shaped piece of tissue from the cervix, including the transformation zone where most cervical abnormalities develop.

Reasons for Recommending a Cone Biopsy

• To diagnose and potentially treat high-grade precancerous lesions
• To evaluate the extent of abnormal cells when less invasive biopsies are inconclusive
• To remove small, early-stage cervical cancers in some cases
• To further investigate abnormal Pap or HPV test results

Can a cone biopsy be therapeutic as well as diagnostic. Yes, in many cases, a cone biopsy can serve both purposes. By removing the abnormal tissue, it can effectively treat precancerous lesions while also providing a comprehensive sample for pathological examination.

Interpreting Cervical Cancer Screening Results

Understanding the results of cervical cancer screening tests is crucial for appropriate follow-up and treatment. Results can range from normal to various degrees of abnormality, each requiring different management approaches.

Common Pap Test Results

1. Normal: No abnormal cells detected
2. ASCUS: Atypical squamous cells of undetermined significance
3. LSIL: Low-grade squamous intraepithelial lesion
4. HSIL: High-grade squamous intraepithelial lesion
5. ASC-H: Atypical squamous cells, cannot exclude HSIL
6. AGC: Atypical glandular cells

What do these results mean for patient care. The interpretation of results guides the next steps in patient management. For example, ASCUS results might lead to HPV testing or repeat Pap tests, while HSIL results typically require further evaluation with colposcopy and possible biopsy.

Follow-up and Treatment Options for Abnormal Results

The management of abnormal cervical screening results depends on several factors, including the severity of the abnormality, the patient’s age, and their medical history. Follow-up options can range from increased surveillance to more invasive treatments.

Possible Follow-up Procedures

• Repeat Pap test or HPV test after a specified interval
• Colposcopy with or without biopsy
• Endocervical curettage
• Loop electrosurgical excision procedure (LEEP)
• Cryotherapy
• Laser therapy

How is the appropriate follow-up determined. Healthcare providers consider multiple factors when deciding on the best course of action. These include the specific test results, the patient’s risk factors, and their overall health status. The goal is to balance the need for thorough evaluation and treatment with the desire to avoid unnecessary procedures.

The Importance of Regular Cervical Cancer Screening

Regular cervical cancer screening is a cornerstone of women’s health care. These screenings can detect precancerous changes early when they are most treatable, significantly reducing the risk of developing invasive cervical cancer.

Recommended Screening Guidelines

1. Ages 21-29: Pap test every 3 years
2. Ages 30-65: Pap test and HPV test (co-testing) every 5 years, or Pap test alone every 3 years
3. Over 65: Screening may be discontinued if previous results have been consistently normal

Why are these screening intervals recommended. These guidelines are based on extensive research and aim to balance the benefits of early detection with the potential harms of overscreening, such as unnecessary procedures and anxiety. However, individual recommendations may vary based on personal risk factors and medical history.

Regular cervical cancer screening is a powerful tool in the fight against cervical cancer. By detecting and treating precancerous changes early, we can prevent many cases of invasive cervical cancer from developing. It’s essential for women to discuss their screening options with their healthcare providers and adhere to recommended screening schedules.

As our understanding of cervical cancer and its precursors continues to evolve, so too do our screening and diagnostic methods. The integration of HPV testing with traditional Pap smears has improved our ability to identify women at higher risk of developing cervical cancer. This allows for more targeted follow-up and intervention when needed.

It’s important to remember that while these screening tests are highly effective, they are not perfect. False positives and false negatives can occur, which is why regular screening and follow-up are crucial. Any unusual symptoms, such as abnormal bleeding or pain, should be reported to a healthcare provider promptly, even if recent screening tests were normal.

Advancements in cervical cancer prevention also include the development of HPV vaccines, which can protect against the most common high-risk HPV types responsible for cervical cancer. Vaccination, combined with regular screening, offers the best protection against cervical cancer.

As we continue to refine our approach to cervical cancer screening and prevention, the ultimate goal remains the same: to reduce the incidence and mortality of cervical cancer worldwide. Through education, regular screening, and appropriate follow-up care, we can make significant strides in achieving this goal.

In conclusion, understanding the various components of cervical cancer screening – from Pap tests and HPV testing to colposcopies and biopsies – empowers women to take an active role in their cervical health. By staying informed and adhering to recommended screening guidelines, women can significantly reduce their risk of developing cervical cancer and ensure that any potential issues are caught and addressed early.

Cervical Cancer Tests | How to Test For Cervical Cancer

Finding cervical cancer often starts with an abnormal HPV (human papillomavirus) or Pap test result. This will lead to further tests which can diagnose cervical cancer or pre-cancer. The Pap test and HPV test are screening tests, not diagnostic tests. They cannot tell for certain if you have cervical cancer. An abnormal Pap test or HPV test result may mean more testing is needed to see if a cancer or a pre-cancer is present.

Cervical cancer may also be suspected if you have symptoms like abnormal vaginal bleeding or pain during sex. Your primary doctor or gynecologist often can do the tests needed to diagnose pre-cancers and cancers and may also be able to treat a pre-cancer.

If there is a diagnosis of invasive cancer, your doctor should refer you to a gynecologic oncologist, a doctor who specializes in cancers of women’s reproductive systems.

Understanding abnormal cervical screening test results

Your current screening test results along with your past test results, determine your risk of developing cervical cancer. Your doctor will use them to figure out your next test or treatment. It could be a follow-up screening test in a year, a colposcopy, or one of the other procedures discussed below to treat any pre-cancers that might be found.  

Because there are many different follow-up or treatment options depending on your specific risk of developing cervical cancer, it is best to talk to your healthcare provider about your screening results in more detail, to fully understand your risk of cervical cancer and what follow-up plan is best for you.

Tests for people with symptoms of cervical cancer or abnormal cervical screening test results

Medical history and physical exam

First, the doctor will ask you about your personal and family medical history. This includes information related to risk factors and symptoms of cervical cancer. A complete physical exam will help evaluate your general state of health. You will have a pelvic exam and maybe a Pap test if one has not already been done. In addition, your lymph nodes will be felt to see if the cancer has spread (metastasis). 

Colposcopy

If you have certain symptoms that could mean cancer, if your Pap test result shows abnormal cells, or if your HPV test is positive, you will most likely need to have a procedure called a colposcopy. You will lie on the exam table as you do with a pelvic exam. The doctor will put a speculum in the vagina to help keep it open while examining the cervix with a colposcope. The colposcope is an instrument that stays outside the body and has magnifying lenses. It lets the doctor clearly see the surface of the cervix up close. Colposcopy itself is usually no more uncomfortable than any other speculum exam. It can be done safely even if you are pregnant. Like the Pap test, it is better not to do it during your menstrual period.

The doctor will put a weak solution of acetic acid (similar to vinegar) on your cervix to make any abnormal areas easier to see. If an abnormal area is seen, a small piece of tissue will be removed (biopsy) and sent to a lab to be looked at carefully. A biopsy is the best way to tell for certain if an abnormal area is a pre-cancer, a true cancer, or neither.

Types of cervical biopsies

Several types of biopsies can be used to diagnose cervical pre-cancers and cancers. If the biopsy can completely remove all of the abnormal tissue, it might be the only treatment needed.

Colposcopic biopsy

For this type of biopsy, first the cervix is examined with a colposcope to find the abnormal areas. Using a biopsy forceps, a small (about 1/8-inch) section of the abnormal area on the surface of the cervix is removed. The biopsy procedure may cause mild cramping, brief pain, and some slight bleeding afterward.

Endocervical curettage (endocervical scraping)

If colposcopy does not show any abnormal areas or if the transformation zone (the area at risk for HPV infection and pre-cancer) cannot be seen with the colposcope, another method must be used to check that area for cancer.

A narrow instrument (either a curette or a brush) is inserted into the endocervical canal (the part of the cervix closest to the uterus). The curette or brush is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the lab to be checked. After this procedure, patients may feel a cramping pain, and they may also have some light bleeding.

Cone biopsy

In this procedure, also known as conization, the doctor removes a cone-shaped piece of tissue from the cervix. The base of the cone is formed by the exocervix (outer part of the cervix), and the point or apex of the cone is from the endocervical canal. The tissue removed in the cone includes the transformation zone (the border between the exocervix and endocervix, where cervical pre-cancers and cancers are most likely to start). A cone biopsy can also be used as a treatment to completely remove many pre-cancers and some very early cancers.

The methods commonly used for cone biopsies are the loop electrosurgical excision procedure (LEEP), also called the large loop excision of the transformation zone (LLETZ), and the cold knife cone biopsy.

• Loop electrosurgical procedure (LEEP, LLETZ): In this method, the tissue is removed with a thin wire loop that is heated by electricity and acts as a small knife. For this procedure, a local anesthetic is used, and it can be done in your doctor’s office.
• Cold knife cone biopsy: This method is done in a hospital. A surgical scalpel or a laser is used to remove the tissue instead of a heated wire. You will receive anesthesia during the operation (either a general anesthesia, where you are asleep, or a spinal or epidural anesthesia, where an injection into the area around the spinal cord makes you numb below the waist).

Possible complications of cone biopsies include bleeding, infection and narrowing of the cervix. 

Having had any type of cone biopsy will not prevent most women from getting pregnant, but if a large amount of tissue has been removed, women may have a higher risk of giving birth prematurely.

For people with cervical cancer

If a biopsy shows that cancer is present, your doctor may order certain tests to see if and how far the cancer has spread. Many of the tests described below are not necessary for every patient. Decisions about using these tests are based on the results of the physical exam and biopsy.

Cystoscopy, proctoscopy, and examination under anesthesia

These are most often done in women who have large tumors. They are not necessary if the cancer is caught early.

In a cystoscopy, a slender tube with a lens and a light is placed into the bladder through the urethra. This lets the doctor check your bladder and urethra to see if cancer is growing into these areas. Biopsy samples can be removed during cystoscopy for testing in the lab. Cystoscopy can be done under a local anesthetic, but some patients may need general anesthesia. Your doctor will let you know what to expect before and after the procedure.

Proctoscopy is a visual inspection of the rectum through a lighted tube to look for spread of cervical cancer into your rectum.

Your doctor may also do a pelvic exam while you are under anesthesia to find out if the cancer has spread beyond the cervix.

Imaging studies

If your doctor finds that you have cervical cancer, certain imaging studies may be done to look inside the body. These tests can show if and where the cancer has spread, which will help you and your doctor decide on a treatment plan.

Chest x-ray

Your chest may be x-rayed to see if cancer has spread to your lungs.

Computed tomography (CT)

CT scans are usually done if the tumor is larger or if there is concern about cancer spread. For more information, see CT Scan for Cancer.

Magnetic resonance imaging (MRI)

MRI scans look at the soft tissue parts of the body sometimes better than other imaging tests, like a CT scan. Your doctor will decide which imaging test is best to use in your situation.

For more information, see MRI for Cancer. 

Positron emission tomography

(PET scan)

For a PET scan, a slightly radioactive form of sugar (known as FDG) is injected into the blood and collects mainly in cancer cells.

PET/CT scan: Often a PET scan is combined with a CT scan using a special machine that can do both at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with a more detailed picture on the CT scan. This is the type of PET scan most often used in patients with cervical cancer.

This test can help see if the cancer has spread to lymph nodes. PET scans can also be useful if your doctor thinks the cancer has spread but doesn’t know where.

Intravenous urography

Intravenous urography (also known as intravenous pyelogram, or IVP) is an x-ray of the urinary system taken after a special dye is injected into a vein. This test can find abnormal areas in the urinary tract, caused by the spread of cervical cancer. The most common finding is that the cancer has blocked the ureters (tubes that connect the kidneys to the bladder). IVP is rarely used for patients with cervical cancer because CT and MRI are also good at finding abnormal areas in the urinary tract, as well as others not seen with an IVP.

Abnormal Pap Tests Are Common, So What Do They Mean?

No one looks forward to a Pap test, but it’s one of the most important screenings that happen during visits to the gynecologist.

“Most cancers of the cervix can be identified early if you have regular pelvic exams and Pap smears,” says Reyna Payero, MD, an obstetrician-gynecologist (OBGYN) who focuses on health care across the continuum of a woman’s  lifespan. “Pap screening has been one of the most successful preventive care measures undertaken in medical history.”

Regular Pap testing reduces cancer rates by 80%, according to the National Cancer Institute. Because cervical cancer usually takes many years to develop, screening identifies abnormal cells before they become cancer. Regular screening allows earlier detection and treatment of precancerous lesions.

Payero recommends patients age 21 to 65 have a Pap test every three to five years if the tests are normal and every 12 months if not. 

In countries where Pap screening has not been implemented due to lack of resources, cervical cancer is the second most common cancer in women and third most common cause of cancer-related mortality. Payero says education about screening methods is the best prevention in decreasing cervical cancer.

Here’s what she told us about abnormal Pap results.

What is a Pap smear?

A Pap smear (also called a Pap test) is a screening test performed by a gynecologist during a regular exam. It’s the best way to check for abnormal cells in the cervix (the neck or opening of the uterus) and can be further utilized to identify the risks for cervical cancer.

This is not the test for HPV (human papilloma virus, the virus that causes cervical cancer), though the two tests may be performed at the same time during a pelvic exam.   

What does it mean when a Pap test is abnormal?  

An abnormal Pap test result rarely means cancer is present, especially in someone who has regular, annual Pap tests. An abnormal result means there are cells in the cervix that look unusual, which can be caused by yeast or bacterial infection, irritation, benign growths, hormonal changes, or pre-cancer.

It is also possible to have a false abnormal if vaginal medicine, cream, gels, or douches have been used within 48 hours of a screening test, or if you had sex, or are menstruating. Talk to your doctor about these possible interferences.  

How common is an abnormal Pap smear result?  

Abnormal Pap smear results are common. According to the National Institutes of Health, 3.8% of Pap tests come back abnormal.

Most of the abnormal cells found during a Pap test are the result of a cervical or vaginal infection and are not cancerous.

What should you do if you have an abnormal Pap?

If your Pap test is abnormal, follow up with your gynecologist immediately to discuss next steps.

If the second, follow-up Pap test result is also abnormal, you might have a cervical biopsy, also known as a colposcopy. A biopsy removes cells or tissue so they can be checked under a microscope for further examination and/or as a treatment to remove abnormal cells, lesions, or tissue.

If high grade cells are noted on the biopsy, procedures such as LEEP or cone biopsy are considered.

Cells from a Pap test. Photo from Getty Images.

Is there a relationship between an abnormal Pap today and something more serious in five or 10 years? 

An abnormal Pap test today may reveal pre-cancerous cells that could develop into cervical cancer later in life unless treated.

Development of cancer is a random process, requiring enough of the “right” mutations to cause a cell to replicate uncontrollably. A cell might look like it is in the beginning stages of that process, but might not fully progress to cancer. 

If a Pap test indicates pre-cancer, there will be regular and close follow-up to combat further development into cervical cancer.

If you have an abnormal Pap, should you get a vaccine to prevent cervical cancer?

According to the CDC, up to 93% of cervical cancers can be prevented by screening and with HPV vaccination. All patients should receive the vaccine. It is protective against nine strains of HPV.

Even if your Pap smear is abnormal, it may be due to only one strain, so you benefit from receiving the vaccine while undergoing treatment for the abnormal Pap.

Vaccination is definitely an important tool in our armament in preventing cervical cancer; however, the importance of routine screening is also vital in prevention.

What do all patients ask about Pap tests, and what do you tell them?  

Will the Pap smear be painful? No, it is not a painful procedure. However, it can be uncomfortable for some women. Fortunately, it’s quick.

Some patients might experience some light bleeding after the Pap smear, which should go away in a day or so.

Fomin Clinic — a network of multidisciplinary clinics

In 2018, VTsIOM found that less than half of Russians had heard about the human papillomavirus — only 44%. Even fewer people know that HPV infection can lead to cancer, only 39%. In this article, we talk about what the human papillomavirus is, what infection can lead to, how to avoid meeting the virus, and what to do if you suspect an infection in yourself or a loved one.

Human papillomavirus (HPV) is the collective name for more than 200 types of viruses that sometimes cause warts on the skin and genitals. However, most people do not even suspect that they may have HPV. And this is very bad – it has been proven that infection with certain types of HPV increases the likelihood of developing cancer.

Human papillomaviruses prefer to live and multiply in squamous epithelial cells. Most people become infected when the virus enters the skin through cracks and microtraumas in the mucosa or skin. Therefore, the easiest way to get the virus is from a sexual partner – during vaginal, anal and even oral sex.

All HPVs are divided into two large groups:

Low-risk HPV – this group includes ten types of the virus, but types 6 and 11 are most often mentioned. They rarely cause serious illness. Most often, viruses from this group lead to warts in the mouth, neck, genitals and around the anus.

True, these warts cannot be called completely harmless either. If warts appear on the mucous membranes of the throat, recurrent respiratory papillomatosis may develop, a condition that can lead to benign tumors of the respiratory tract and require repeated operations.

High-risk HPV – this group includes about 14 types of viruses, but most cases of cancer cause only 2 types: 16 and 18. In women, these viruses most often cause cancer of the cervix, vulva and vagina, and in men – cancer of the penis . In both sexes, these viruses can cause oropharyngeal cancer (cancer of the larynx).

According to some sources, the virus can be found in 11.7% of people worldwide, according to others – that at some point in life, 80% of people become infected with the virus. And since the peak incidence occurs at a young age, when people most often have sex, there is a good chance that a person over 25 years of age already has or once had the HPV virus.

Anyone who has a sexual partner who is already infected with the virus can “catch” HPV. Unfortunately, a condom cannot be considered 100% protection. The virus can enter the human body from any infected area of ​​the skin, including from an uncovered condom. However, when used correctly, male condoms reduce the chance of infection.

However, the most reliable way to avoid a viral infection is to get vaccinated against HPV in time. For this purpose, vaccination programs are operating abroad. Unfortunately, HPV vaccination is not included in the National Immunization Schedule in Russia. In our country, you can get vaccinated in a private clinic for money, or as part of free vaccination programs that take place in some cities.

Two HPV vaccines are registered in our country: Gardasil protects against both cancer-causing viruses types 16 and 18 and wart-causing viruses 6 and 11, while Cervarix only protects against types 16 and 18.

HPV vaccine recommendations vary worldwide. According to American practice, the optimal time for vaccination is 11-12 years, that is, before the onset of sexual activity. Moreover, it is recommended to vaccinate both boys and girls.

Vaccination will protect girls from contracting a dangerous type of HPV. Vaccinated boys, firstly, will receive protection against certain types of cancer, and, secondly, they will not be able to become carriers of the virus and infect their partners. This will help contribute to herd immunity.

The World Health Organization (WHO) recommends that only girls aged 9-14 be vaccinated. However, this recommendation is most likely due to economic rather than epidemiological reasons.

It has long been thought that HPV vaccination is justified before the age of 27 years. However, there has since been evidence that HPV vaccination is effective and safe for women aged 25-45.

Even if a woman already has the HPV virus, it still makes sense to get vaccinated. The vaccine will protect against other types of HPV, but it will not speed up or complicate the disease that you already have.

The bad news is that there is no cure for HPV. All we can do is to detect diseases that the virus can provoke in time and start treatment for them.

Important! HPV does not cause inflammation of the cervix and vaginal discharge. However, with such symptoms, you should contact your gynecologist as soon as possible.

The good news is that the human papillomavirus usually clears up within two years of being infected, so most people recover on their own by the age of 30. True, after that a person can become infected again – having had HPV, we do not acquire immunity to it.

HPV is the main risk factor for developing cervical cancer, because the virus provokes up to 99% of all cases of the disease. The most vulnerable group for this cancer is women aged 25-35 years. However, not everyone needs to be tested for the HPV virus, because most people cope with the virus on their own before the age of 30.

According to international recommendations, to avoid cervical cancer, you need to be examined:

from 21 to 30 years old – every 3-5 years to take a PAP test (PAP test, or Pap smear). If possible, it is preferable that the test be done by liquid cytology. This analysis is easier to standardize, so it gives a more reliable result than the “classic” smear, which is examined under a microscope.

from 30 to 65 years old – every 3-5 years you need to do a Pap test and take an analysis for HPV. This should be a vaginal smear, which will be examined by PCR for HPV types 16 and 18.

What happens if a dangerous type of HPV is found

It depends on how much the virus has managed to damage the cells. Three outcomes are possible:

HPV is present, but there are no changes in the cells. The woman will be assigned to the risk group. You do not need to do anything – you only need to regularly take tests, undergo examinations and observe.

HPV is present, and there are early cell changes in LSILs (or CIN-1). The woman will be assigned to the risk group. As a rule, nothing needs to be done in this situation either – in most cases, such changes go away by themselves. Most likely, the doctor will recommend a re-examination in 1 year, or suggest undergoing a colposcopy – an examination of the cervix, entrance and vaginal walls using an instrument similar to a microscope.

HPV is present, and there are noticeable changes in HSILs (or CIN-2 – CIN-3) cells. In this situation, most likely, colposcopy alone will not work. You will need a biopsy, a procedure in which the doctor takes suspicious cells for analysis and sends them to the laboratory.

Further actions depend on the results of the analysis. If malignant cells are found, they will need to be removed. A specific method for removing dangerous cells should be suggested by the attending oncologist.

It is believed that before the age of 21 it makes no sense to take Pap tests and HPV tests. After the age of 65, if previous tests were negative, it is no longer necessary to be screened for cervical cancer. Men do not need to be tested for HPV.

1. Human papillomavirus infection increases the risk of developing cancer. Women are especially at risk – it has been proven that 99% of cervical cancer cases are associated with HPV infection.

2. The best way to prevent HPV infection is to get vaccinated at 11-12 years of age. It makes sense for women to get vaccinated before the age of 45, even if they already have the human papillomavirus.

3. There is no cure for HPV. However, if women with HPV aged 21-65 are regularly examined, cervical cancer can be detected and treated in time.

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how much it costs, what to take with you

Tatyana Khvatinina

sent a child to Artek

In 2021, my son won a ticket to Artek.

The company where I work, together with a partner, annually holds such a competition for the children of employees. Children of employees from all regions participated, 15 winners received free trips to Artek.

In 2023, a commercial ticket to the camp costs 105,000 or 115,000 R depending on the shift, but you can’t just buy it like that: the child must have a portfolio. It is written on the Artek website that copies of diplomas or certificates of awarding the title of winner, prize-winning places at municipal, regional, all-Russian or international competitions and olympiads are accepted as a portfolio. All of them must be within the last 3 years. If a child participates in a partner competition and wins it, the winner’s diploma replaces the portfolio.

Before that, I had never sent a child to the camp, so I had to deal not only with personal things that I need to give my son with me, but also with travel tickets, documents, medical certificates and pocket money. In total, I spent on fees 27,476 R.

In 2021, we spent on fees for the camp 27,476 R

Air tickets

12,600 R

Clothes and shoes

5563 R

Money with you

4500 R

9 0076 PCR test for COVID-19

1700 R

Hygiene accessories

915 R

Aeroexpress

800 R

Things for swimming

599 R

Mobile communication

500 R

Aerosol against insects

9 0076 299 R

My son’s certificate that he was awarded a ticket to Artek

What money is needed for

I had no idea where to start fundraising. There were many questions: “What personal items should I take with me? What documents will be needed? What expenses to plan? To figure it out, I asked the parents of the children who had already been to Artek, studied the forums and read everything on the camp website that related to the child’s training camp.

Here’s what I needed to pay, buy and organize:

1. Travel.
2. Medical examinations.
3. Some clothes and shoes.
4. Personal hygiene items.
5. Money with you.

/guide/lagerya/

What to do with the child during the summer holidays

We had three weeks to prepare – it was just this time before the arrival that the results of the competition were announced. I’ll tell you more about each category.

Travel

Travel is not included in the price of a ticket that a child can win, it is always paid extra. We were offered to choose between an independent and group transfer.

Self transfer. If we chose this option, I would have to either bring my son to Simferopol myself, or send him alone. The distance from Moscow to Simferopol is about 1750 km, I would spend 5880 R on gasoline one way. At the same time, you would have to go with at least one additional overnight stay, which would also require money.

A ticket in a compartment for the Moscow-Simferopol train cost 8,000-12,000 R per person one way. At the same time, it goes for more than a day – it is hard to spend so much time on the road.

/family-rzdbonus/

How to get a free train ticket for a family

Of course, you could send your child by plane. The journey would take only 2.5 hours. A ticket without luggage for one person cost from 8,000 RUR, with luggage – about 15,000 RUR. Even if an adult flies to see off and meet a child without luggage, tickets for them will cost about 30,000 RUR.

It was also not clear to me what parents should do in the case of an independent transfer: either to transfer the child and go back to return for him in three weeks, or to stay in Crimea for this period.

I didn’t want to send my son on the road alone.

Group transfer was much more convenient in terms of organization: it was only necessary to bring the children to the airport. There they were met by an employee of the partner company that held the contest. He accompanied them to the camp. Parents did not have to make any powers of attorney: they are not needed to travel across the territory of Russia.

What to do? 08.08.19

Do I need a power of attorney for a child for a grandmother when traveling in Russia?

When choosing group transport, tickets for children were bought by the organizing company. An air ticket with luggage to Simferopol and back cost 12,600 R in 2021.

We live in Moscow, so we just boarded the Aeroexpress and paid 800 R for two tickets — in 2023, tickets already cost 1,000 R. But residents of other cities had to get to the capital first.

Collection of children at the airport. There were 10-12 people in the group

Documents

In order for the child to go to the camp, the parent must fill out a bunch of paperwork, get a mountain of certificates and take the child for a small medical examination. There is a list of documents on the Artek website, and forms are also printed from there. There are really a lot of documents. I’ll tell you more about them.

Tour. It is enough to enter the data of the child and parents there, everything else is filled in on the spot. On the reverse side there are rules and conditions for staying in the camp – the parent must confirm with a signature that he has read everything, discussed with the child and agrees.

Application for admission to study. There is a school near the camp – children who came to Artek not during the holidays go to it. Interestingly, the application contains clauses about the transfer of all rights to any works created in the camp to the Artek ICC.

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What certificates do you need to travel to a children’s camp

Application for participation in active activities. In it, the parent notes which activities the child can take part in during the shift. There are a variety of options – from swimming, horseback riding and hiking to sleeping on the second bunk of the bed.

Medical documents are a PCR test, a certificate of a sanitary and epidemiological conclusion and a notification that the child did not travel abroad within 14 days before arrival.

Consent to or refusal of seasonal vaccinations. Seasonal include vaccination against influenza in winter and against tick-borne encephalitis in summer. I signed a waiver: we are in the summer season, but the development of immunity from tick-borne encephalitis takes at least 6 weeks, and the shift lasts only 3 weeks. Although this is a necessary vaccination: Crimea is considered an endemic zone. You can get vaccinated in advance at the clinic – it’s free.

Consent for medical intervention and hospitalization. Sick children do not stay in the camp, they are sent to the hospital. Therefore, parental consent is required.

A child cannot be in the camp, even if he just has a sore throat. A colleague said that in 2020 his son caught a cold a couple of days before the end of his shift and he had to spend the rest of the time in the hospital. If the parents do not agree to the hospitalization of the child, they will have to come and take him home.

/prava/prava-deti/

Rights of children under 18

This is how all our completed documents for the camp looked like: it turned out to be a whole pack

Questionnaire in the form No. 5 for the Main Department of Internal Affairs of the Ministry of Internal Affairs of the Russian Federation. It is needed for registration at the place of stay. The child’s data is entered here: full name, place and date of birth, address of registration. The data card is handed over to the local passport and visa service.

Parental consent to follow camp rules. It is forbidden to bring alcohol, drugs, conventional and electronic cigarettes, weapons into the camp. In consent, parents must confirm that they are aware of the rules and have warned the child about them. If something from the list is found on him, he will be immediately excluded. Therefore, I did not allow my son to take a folding knife – even though, according to the documents, this is not a cold weapon.

Voluntary parental consent to inspect the student’s belongings. Children’s belongings may be searched if it is suspected that they have taken any of the above with them.

Original birth certificate or passport, if the child is over 14 years old. He is needed for the flight. Birth certificates and passports are taken for safekeeping during the shift and returned to the children before the return flight.

Other documents. These include a copy of the medical policy, the parent’s consent to the processing of the child’s personal data, a certificate from the school stating that he is studying there. Children under 14 years of age must make two copies of their birth certificate, over 14 years of age – two copies of their passport.

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How to send a child to Artek free of charge

Questionnaire No. 5 had to be completed in duplicate

Medical examinations

To go to the camp, the child must have three mandatory certificates:

90 195 Standard medical certificate for the camp in the form 079 / y.
1. Certificate of sanitary and epidemiological environment.
2. Fresh PCR test for COVID-19.

We issued all certificates for free, except for the PCR test, but we had to be nervous. According to the rules of Artek, a medical certificate must be issued no earlier than 14 days before arrival, but due to the situation with the coronavirus, we simply could not have time to do this. Or you would have to pay more.

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We also had questions about the 079/y certificate. It contains data on the child’s health status, health group, diagnoses, and medications taken. The dates of laboratory tests of a general blood and urine test, an analysis for enterobiasis and helminth eggs are also indicated here.

My son’s flight to the camp was planned for May 15 – accordingly, we could issue certificates only from the beginning of May. But in 2021, the period from May 1 to May 10 was declared non-working days, and the clinic was closed at that time. I was already prepared to take everything for a fee, but the clinic met me halfway – they allowed me to take tests before the May holidays, and enter the date of receipt on the card, which will be after them. Formally, we fulfilled the requirement of the camp.

Another surprise was waiting for me when I came for help. It turns out that in polyclinics at the place of residence it is done within three days. Only tests are not enough, you still need to come to an appointment with a pediatrician. The doctor will examine the throat, lymph nodes, skin and head, make sure that the child is healthy and does not have lice or suspicious rashes. I asked the doctor to prepare a certificate earlier, otherwise we would not be in time before departure.

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If we had done this certificate in a private center, it would have been faster. In Moscow clinics, it costs 2000-3000 R, if you already have test results on hand, and the turnkey design is more than 4500 R.

The certificate form lists diseases and contraindications with which a child will not be allowed into the camp: for example, diabetes mellitus, active tuberculosis, lack of preventive vaccinations in case of a threat of epidemics clinic

A certificate of the sanitary and epidemiological environment and a PCR test for coronavirus must be made no earlier than 3 days before arrival. In this case, the day of receipt of the result is taken into account, and not taken.

PCR test was done for a fee, for 1700 R. I received a certificate of the sanitary and epidemiological environment free of charge from the same district doctor who issued the certificate in form 079 / y. But the doctor explained that this certificate is only about contacts at the place of residence, and a certificate of contacts at the place of study must be taken from the school nurse. This is inconvenient: the nurse does not work every day, there is a high risk of not finding her, especially if the deadlines are running out.

Later, I thought that we should also get a certificate of the sanitary and epidemiological environment for a fee. Private clinics issue a single certificate – you just need to bring the child for examination and bring a fresh PCR test. I specified the price in one of the clinics: such a certificate costs 400 R if you do a PCR test from them, and 1000 R if you bring the result from other laboratories. The test itself is paid separately.

I spent about 2000 RUR on medical documents. I paid 1700 RUR for the PCR test, the rest of the money was spent on chocolates – this is gratitude to the doctors of the polyclinic for meeting me halfway and helping me complete all the paperwork on time.

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Despite all the medical documents, upon arrival at the camp, the children are re-examined by a doctor. For example, if a doctor finds that a child has lice, they will not be allowed into the camp that day. He will go for processing at the SES together with an escort, and after that he will go to the camp. It just happens a couple of days later.

It will be worse if they have symptoms of a cold. The sick child will be taken to the hospital to be isolated from other children. The minimum period of such isolation is a week, even if he recovers the very next day. At best, the child will miss part of the shift – it will be a shame.

It is in the interests of parents to ensure that the child feels well on the day of arrival. Therefore, try not to stress his immunity for a week before leaving for the camp: do not go to visit, do not visit shopping centers. The child should dress according to the weather so that he is neither hot nor cold. Watch his rest: immunity suffers from lack of sleep, therefore, in order to reduce the risk of illness, the child needs to sleep at least 8-9hours.

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Clothes and shoes

The Artek website lists what the child needs to bring from clothes. I tried to stick to this list, it largely coincides with the recommendations of Rospotrebnadzor.

On the camp site, the list of clothes was divided into two seasons. Source: Artek

I was guided by the summer season, but still I put one warm jacket on my son in case of a cold snap. I also put an additional white shirt on: a representative of the company that held the competition recommended taking clothes for performances. I decided that a white shirt and any dark trousers are quite versatile clothes for this occasion.

Girls should also bring casual and party dresses or a pair of skirts and smart blouses.

Later I found out that it was possible to put less clothes: the children were given camp uniforms and caps. Own things were needed only for sports activities and trips on excursions. The rest of the time the kids wore camp polo shirts or shirts and windbreakers. If I knew about it, I would not put many things. By the way, you can’t take the uniform from the camp, only caps are allowed to be taken away.

My son outgrew some of last year’s clothes, so I had to buy some more. Here is what we bought and how much it cost:

• summer boots — 1820 R;
• T-shirts – 1000 R;
• sandals – 999 R;
• baseball cap that we forgot at home – 599 R;
• pajamas – 645 R; We spent 599 R. Unfortunately, things for swimming were not useful: in May the sea was still cold, and the pool, which children usually go to before the start of the swimming season, was closed for reconstruction.

  We already had the rest of the items on the list. I ordered T-shirts and pajamas at Ozone, I bought everything else at Sportmaster with a fitting. In total, I spent 6162 rubles on clothes.

  Things that we prepared for packing in a suitcase

  We also had a suitcase. It turned out to be not particularly heavy – about 10 kg, which is quite lifting for a 13-year-old boy – but quite voluminous. On the way back, my son even had to transfer some of the things to his backpack, because they did not fit in the suitcase.

  To make things take up less space, we used several life hacks:

  1. We put small things into large ones — for example, put socks in shoes.
  2. They folded the shoes not together, but separately, wherever they fit.
  3. Rolled clothes into rolls.
  4. The heaviest and most voluminous shoes and the thickest long-sleeved sweater were put on the child on the road.

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  I did not put extra things like shoe polish and brushes for clothes. I thought that if I needed to put on a particularly solemn look, I could ask the counselors for an iron and a brush.

  Personal hygiene items

  The Artek website has a list of personal hygiene items that you need to take to the camp. Everything is standard: a brush with paste, laundry and toilet soap, washcloth, shampoo, towel, comb, nail scissors.

  Girls are advised to take the products they use in everyday life: washing gel, deodorant and cream. Decorative cosmetics can be used, but in reasonable quantities. If necessary, buy feminine hygiene items.

  At home, my son uses common shampoo and shower gel, so he had to buy everything he needed for the camp. In total, I spent 915 rubles on personal hygiene items.

  If a child goes to the same camp with a friend with whom he is going to live in a room, you can agree to share the necessary items: for example, one will take soap and toothpaste, the other shower gel and shampoo .

  From my own childhood, I remember that the big problem of any camp is insects, especially during trips to nature. That’s why I bought a spray against mosquitoes and ticks.

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  Other things

  There are also things that I did not give my son with me, but which may come in handy in other camps. I will give a few examples.

  Sunscreen. Pediatricians recommend using sunscreen with an SPF of at least 30 in all weathers to protect children’s skin. But I just forgot to buy it. It’s good that the sun was not aggressive in May.

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  First aid kit. In Artek, only those medicines that the child needs are allowed: they are indicated by the pediatrician in certificate 0/79u. The rest are issued by camp doctors. But if you are allowed to take your own medicines, you can give the child antiseptic agents for treating abrasions, sterile gauze bandages or napkins, headache pills and ointment for mosquito bites.

  Mug. Some camps advise you to bring your own mug. I didn’t give it to my son: in the dining room, drinks were poured into glasses, and you could take bottled water with you into the room.

  Slippers. You can take rubber slippers to walk around the room and take a shower. But this is not necessary: ​​the floors in the rooms are washed daily, you can walk in socks.

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  Beach shoes. When my child and I went on vacation, we always went to the beach in ordinary shoes, such as sandals. Therefore, I did not put slates for the beach – I thought that they would take up extra space. I also know that there are special shoes for swimming, but I have never used one myself.

  Towel. Many lists of must-haves include two towels – one for the body and one for the face. In fact, most often they are issued in camps. If in doubt, you can ask the administration before the trip.

  Food. When I was a kid, my parents gave me chips, cookies, candy, and soda to camp. Now in many camps it is forbidden to bring your own food. For example, in Artek they are asked to give food only on the road – on its territory, the remaining food is confiscated for security purposes.

  In Artek, children go on excursions, including in the mountains, so they will definitely need closed shoes that fix their ankles. This photo was taken by my son during a trip to the Ayu-Dag mountain

  Cash

  If necessary, you can do without cash. But I thought that the child would be uncomfortable: souvenirs are sold on excursions, and there is a vending machine with sweets in the camp. There is also a shop with Artek branded items: clothes, bags and caps with the camp logo. Parents were warned that there could be a problem with ATMs, so if we want to give the child money with us, let it be cash.

  I asked other parents, whose children had already been to Artek, how much money to give with them. Most agreed that 3,000-5,000 R is enough. I gave my son 4,500 R. And he also took his own Tinkoff Junior card, which had about 5,000 R. I warned him about ATMs, but received an answer: “But suddenly all the same can you take it off?” By the way, there was no way to withdraw money.

  9500 R

  son took with him on a trip

  Money must be handed over to the treasurer before the start of the shift: children are allowed to keep literally 500 R for current expenses. You can take more if needed. I think this is right: after all, children are different, and sometimes it is not safe to keep a large amount of money. If there was no treasurer in the camp, I would suggest that my son divide the money and keep a small amount with him, and hide the rest.

  The son and his roommates initially decided not to hand over their wallets, but to hide them in the air conditioner: it closes when it is turned off. Who knew that the cleaner who comes every day washes the air conditioners too! The children were called to the senior counselors, wagged a finger and asked not to carry money with them, but to leave it to the treasurer.

  By the way, it is also not recommended to take expensive smartphones to the camp. My son doesn’t have a fancy phone, there was no point in changing it. Before the trip, I put extra money into my account and, just in case, I activated the roaming service for 10 R per day. It turned out that in Crimea MegaFon did not catch well and he actually did not have the Internet there, so the son turned off roaming and used Wi-Fi in the camp.

  At Artek, my son spent about 1,500 R. He decided to save money so that he could later replenish his own piggy bank with the given amount, so he refused to buy camp merchandise. And the guys who were with him brought different things with them: a backpack, a longsleeve, a notebook.

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  How we gave money to teenagers

  The son said that such merch is made for the Morskoy camp, where he was. Source: “Artek Souvenirs of Crimea”

  Tips for parents on fees

  1. Study the website and social networks of the camp where you are going to send your child.