The knowledge of our bodies that we gain via keeping the laws of niddah can be harnessed to guard our health. For many, niddah creates an enhanced awareness of our cycles and what is our “normal” regarding the length of our cycles, flow of blood, pain, discharge, etc. For example, changes in menstrual bleeding and bleeding after intercourse that lead us to ask halachic questions can also instruct us to contact our health care providers. One of the worries in such a case is that abnormal bleeding may be a sign of cervical cancer, and hence it is important to have knowledge about this area that affects women.

Cervical cancer is the only type of cancer that is totally preventable. There are two important interventions every woman should know about for cervical cancer. The first is the HPV vaccine. 99% of cervical cancer has been linked to the HPV virus. The HPV vaccine, which was introduced in 2006, is a safe and effective way to reduce the risk of cervical cancer (to learn more about the vaccine, you can read The Eden Center’s blogs on whether or not to vaccinate, and the benefits of giving the vaccine to children). The second intervention is screening, which is accomplished either by a Pap smear or an HPV test. These procedures aim to catch irregular cells in the cervix before they develop into cancer.

In 2019, there were 261 cases of invasive cervical cancer diagnosed in Israel, where it’s the 14th most common cancer for women.  It’s interesting to note that cervical cancer incidence in Israel is low relative to other countries in the world. But, screening also checks for cervical intraepithelial neoplasia (CIN), which are abnormal cells in the cervix that are not cancer but may develop into cancer, if untreated. CIN is more common, with about 4500 cases a year in Israel. 

The aim of screening is to catch CIN or early stage cervical cancer, because when caught early, they are easier to treat. There are two ways to screen: the first popular technique is the Pap smear, named after the scientist George Nicholas Papanicolaou. In this test a small sample of cells is taken from the cervix and examined under a microscope. If something looks irregular, there are further tests in order to decide if treatment is needed or if monitoring is enough. More recently, the HPV test was developed that, instead of looking at the cells, checks the DNA of the cells to see if they have been infected with certain strains of the HPV virus. This test is more accurate and reliable than the Pap and in Israel has replaced it in the kuppot cholim.

The current guidelines for the National Cancer Institute in the United States state that from the age of 25-65, a woman should be screened every 5 years with the HPV test. If one was consistent with screening and only had normal results, there is no need to screen after the age of 65. The experience of the woman is identical for both the Pap and the HPV test, the only question is what is measured.Screening and vaccination for cervical cancer certainly fall under the directive “Vnishmartem meod l’nafshotechem” which has been interpreted by many poskim to be a broad directive to care for our health.  

If you choose to get HPV testing, what can you expect? In order to allow the doctor to reach the cervix, a woman is asked to lie on her back with her feet in supports and knees bent. A speculum is inserted in order to allow for access to the cervix, and a brush or spatula is used to collect some cells. It is sent to the lab to check if there are abnormal cells (Pap) or presence of certain strains of HPV.  If there is an abnormal result, you may be sent for a colposcopy, which allows the doctor to closely examine the cervix and see how to proceed. There are options now for women to self-swab, which allows women to perform the check at her convenience, without being subject to a speculum examination which can cause pain or embarrassment.

If cervical cancer or CIN is diagnosed, depending on the stage, there are different types of treatment. This treatment is important but can have an impact on the quality of life of the woman. The medical community has begun to pay more attention to the impact on quality of life but there is more that needs to be explored. Taking proactive steps to safeguard our health, such as regular screening, is a critical way to get ahead of this preventable disease.

Yael Maizels is a scientist studying women’s health at Ariel University in the Institute for Personalized and Translational Medicine.

Together with colleagues, I am performing a study on the quality of life of women who have been diagnosed with cervical cancer or CIN. This study will help us understand your quality of life and how to improve it. If you have been diagnosed with cervical cancer or CIN at any point in your life and want to help us perform this study to improve the quality of life of women going through this, please help us and answer this survey.

LINK: Survey for women who have been diagnosed with CIN (at any stage)

LINK: Survey for women who have been diagnosed with cervical cancer (at any stage)

LINK: Data on cervical cancer and CIN was taken from research done by the non-profit Habayit Shel Bar