Experience reports from women who are in family planning, but for whom a conspicuous finding was made during cancer screening, are often characterised by uncertainty and frustration. After a joint appeal with anti-cancer activist Myriam von M., many women told us their stories. Some of them experienced high-risk pregnancies or even miscarriages after a conisation. They felt guilty and were afraid of a new pregnancy, despite their desire to have children.

Conspicuous finding: Effects on family planning

If there are abnormalities in cervical cancer screening, such as a conspicuous Pap finding or a positive HPV test, this can lead to psychological stress. This is shown by a new study for which 3,753 German women were surveyed.

• According to this study, almost every second woman is psychologically stressed by the risks of conisation.
• For almost a third of the respondents, the consideration of having a conisation has a strong influence on having a child.

These women’s insecurity is partly the result of the so-called “watchful waiting”. Any abnormalities found in the tissue often heal on their own. Therefore, they are often observed with repeated tests over a long period of time. Women who have not yet completed family planning might have the feeling as if they are losing valuable time. The knowledge that cervical cancer will develop over many years can also put women who wish to have children under time pressure. These women might want to become pregnant as quickly as possible before the supposedly bad results of the cervical smear worsen.

Is there a connection between conisation and preterm birth?

If the results of the examination remain conspicuous or if the findings deteriorate, the probability of cancer increases. In this case, the doctor is allowed to recommend and perform a conisation. The cervix is cut out in the shape of a cone [1].

It is controversial whether there is a direct connection between such an intervention and a premature birth. However, various scientific studies suggest that the risk of preterm birth increases after a conisation has been performed.

Study results from 2010 [2] showed:

• Every third woman who underwent two conisations had a preterm birth before the 37th week of pregnancy. Among the women with one conisation, this happened to eleven percent, without a conisation four percent were concerned.
• Extreme premature births before the 28th week of pregnancy occurred for three percent of women who had two conisations. It was one percent among the women with one conisation and 0.3 percent among those without surgery.

It becomes understandable that women who are affected are worried about planning a first or further pregnancy.

Signs of cervical cancer: Pregnancy is not impossible

Important Note: Abnormalities in cervical cancer screening are not an obstacle to the family planning for women. It is necessary to interpret the signs precisely. The human papillomavirus (HPV) infection can cause cancer, but it does not have to. The majority of women have had an HPV infection in their lives that usually heals on its own completely unnoticed. Conspicuous Pap finding might worsen, but it can also improve. Rarely does cancer actually develop out of it.

Cervical cancer develops through various preliminary stages. It can be diagnosed at an early stage. In this case, the cancer is almost always curable. The uterus itself is preserved and is not damaged.

It becomes clear that regular preventive examinations at the gynecologist are an important part of family planning even before the actual pregnancy. In case of abnormal Pap smear results or HPV infections, molecular biological methods can help to find out whether these abnormalities are actually a sign of a pre-cancerous stage or an already existing cancer. The time of the close examinations at the gynecologist can thus be significantly shortened and decisions to preserve the women’s healthcare can be made very soon. Therefore, surgical interventions such as a conisation can also be avoided.

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[1] https://www.krebsgesellschaft.de/onko-internetportal/basis-informationen-krebs/leben-mit-krebs/kinderwunsch-und-krebs/erhalt-der-fruchtbarkeit.html

[2] Ørtoft et al. (2010): After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy, in: BJOG 117:258–267.

 

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