Cancer of the cervix (Carcinoma colli uteri) is a socially significant disease, the growth of morbidity and mortality in Bulgaria in recent years is not decreasing, but growing. The main reason for this is considered to be the lack of a National Screening Program, which would ensure early diagnosis of pre-cancerous conditions and early cancerous changes, allowing their complete cure. According to data from the National Patient Organization, about 1,300 cases of cervical cancer are diagnosed annually in our country, mainly among women between the ages of 30 and 44. Worldwide, according to data from the World Health Organization (WHO), cervical cancer is the fourth most common cancer among women. In 2018, about 570,000 women were diagnosed with cervical carcinoma, and about 311,000 of the patients had a fatal outcome. What are the causes and initial symptoms of cervical cancer? Infection with the human papilloma virus (HPV) is indicated as the main cause of the development of cervical carcinoma. There are more than 100 types of HPV, and it has been found that about 12 of them can lead to the development of cervical cancer, the so-called. high-risk types – 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59. A large percentage of people have encountered the virus at some point in their lives, and infection occurs through contact and sexual route – oral, anal and vaginal sex. Cervical cancer occurs with long-term persistence of infection with high-risk types of human papillomavirus. In the stages of precancer and early stages of cervical carcinoma, symptoms are absent. The appearance of symptoms is characteristic of the advanced stages of the disease, with more typical symptoms being: abnormal vaginal bleeding after intercourse or in the period between two periods (intermittent), pain during intercourse (dyspareunia), the appearance of an atypical vaginal discharge with an unpleasant odor . When the disease metastasizes and progresses, general ailments such as weakness, consumption syndrome, lack of appetite, bone pain, nausea, vomiting, etc. appear. In order not to reach advanced stages of cervical cancer, the most important thing is to know the risk factors and methods of primary and secondary prevention. Among the risk factors for cervical cancer disease are: 1. Starting sexual life at an early age – numerous studies prove that the early age of first sexual contact is associated with an increased risk of HPV infection and the subsequent development of cervical cancer; 2. Frequent change of sexual partners and a large number of sexual partners – increase the risk of developing a sexually transmitted infection; 3. Unprotected sexual contact – the use of barrier methods of contraception (condoms) significantly reduces the risk of HPV infection; 4. Multiple births – patients with three or more births have a higher risk of cervical cancer; 5.Long-term use of oral contraceptives and smoking; 6. Presence of a sexually transmitted disease – e.g. chlamydial infection, herpes simplex virus infection or HIV. What is cervical cancer prevention? For the prevention of cervical cancer, the so-called are extremely important. primary and secondary prevention. Primary prevention consists of timely vaccination, and secondary prevention consists of regular visits to your obstetrician-gynecologist and performing the necessary tests. Screening for cervical cancer consists of taking vaginal and cervical secretions for cytological examination (Pap-test) and testing for HPV during a certain period of time. It is recommended that the first screening test be carried out in women at the age of 21, and in the case of an earlier initiation of sexual life – up to three years after the first sexual act. For women aged 21-29 years, screening is recommended to consist of an independent cytological examination (smear) every 3 years. According to the latest 2020 American Cancer Society (ACS) recommendations, cervical cancer screening should begin in women at age 25. Recommendations for women between the ages of 30 and 65 consist of a stand-alone cytology every 3 years or a combined cytology and HPV test every 5 years. In the case of combined research, the so-called liquid-based cytology (Liquid-based cytology) over conventional cytology, as the method is much more specific and enables HPV genotyping from the same material. In patients over 65 years of age, it is recommended to stop screening for cervical carcinoma if the following criteria are met: presence of 2 consecutive negative HPV tests, two consecutive combined examinations (cytological and HPV) or three consecutive cytological examinations in the last 10 years. Cervical screening is not recommended for women who have undergone total hysterectomy and who do not have a history of high-grade precancerous lesions (CIN 2 or 3).For women aged 21-29 years, screening is recommended to consist of an independent cytological examination (smear) every 3 years. According to the latest 2020 American Cancer Society (ACS) recommendations, cervical cancer screening should begin in women at age 25. Recommendations for women between the ages of 30 and 65 consist of a stand-alone cytology every 3 years or a combined cytology and HPV test every 5 years. In the case of combined research, the so-called liquid-based cytology (Liquid-based cytology) over conventional cytology, as the method is much more specific and enables HPV genotyping from the same material. In patients over 65 years of age, it is recommended to stop screening for cervical carcinoma if the following criteria are met: presence of 2 consecutive negative HPV tests, two consecutive combined examinations (cytological and HPV) or three consecutive cytological examinations in the last 10 years. Cervical screening is not recommended for women who have undergone total hysterectomy and who do not have a history of high-grade precancerous lesions (CIN 2 or 3).For women aged 21-29 years, screening is recommended to consist of an independent cytological examination (smear) every 3 years. According to the latest 2020 American Cancer Society (ACS) recommendations, cervical cancer screening should begin in women at age 25. Recommendations for women between the ages of 30 and 65 consist of a stand-alone cytology every 3 years or a combined cytology and HPV test every 5 years. In the case of combined research, the so-called liquid-based cytology (Liquid-based cytology) over conventional cytology, as the method is much more specific and enables HPV genotyping from the same material. In patients over 65 years of age, it is recommended to suspend screening for cervical carcinoma if the following criteria are met: presence of 2 consecutive negative HPV tests, two consecutive combined examinations (cytological and HPV) or three consecutive cytological examinations in the last 10 years. Cervical screening is not recommended for women who have undergone total hysterectomy and who have no history of high-grade precancerous lesions (CIN 2 or 3).