By Cheryl Alexander
Over the past several months, cervical cancer and how to prevent the disease has
received renewed attention due to the introduction of the HPV (human
papillomavirus) vaccine, a vaccine designed to prevent cervical cancer and
other diseases. The vaccine was approved for use in the U.S. in June 2006, and
is the first vaccine to be developed against a known risk factor for the
development of a specific cancer. Though there are many strains of HPV, types
16 and 18 currently cause about 70 percent of cervical cancer cases.
The vaccine is targeted at girls and women ages 9 to 26 because the vaccine only
works if given before infection occurs; therefore, public health workers are
targeting girls before they begin having sex. The use of the vaccine in men to
prevent infection and interrupt transmission to women is initially considered
only a secondary market.
Because of the side effects of the HPV vaccine and the age group of the targeted
demographic, doctors are receiving many new inquiries from female patients
regarding cervical cancer and how it can be avoided, detected and successfully
treated.
What is cervical cancer?
The cervix is the lowest portion of a woman’s uterus, or womb, located in the vagina, and it connects the two. Cancer occurs
in the cervix just as in other body parts
—when the cells of the cervix change in a way that leads to abnormal growth and
invasion of other tissues or organs of the body. And, as in other cancers,
cervical cancer is much more likely to be cured if found and treated early.
A key difference between cervical cancer and other cancers is that typically its
progression from normal tissue, to precancerous (or dysplastic) changes in the
tissue, to invasive cancer is slow, which is important because the gradual
progression provides many opportunities for prevention and early detection and
treat- ment. Happily, these opportunities, along with advances in technology
and medicine, have caused the decline of cervical cancer over the past few
decades in the United States.
Risk factors and causes
of cervical cancer
Doctors cannot always explain why one woman develops cervical cancer and another
does not. However, we do know that a woman with certain risk factors may be
more likely than others to develop cervical cancer. Studies have found a number
of factors that may increase the risk of cervical cancer. These factors may act
together to increase the risk even more:
•Human papillomaviruses (HPVs): HPV (a group of viruses that can infect the cervix) infection is the
main risk factor for cervical cancer. HPV infections are very common (most
adults have been infected with HPV at some time in their lives), and can be
passed from person to person through sexual contact.
•Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests,
which help doctors find precancerous cells.
•Weakened immune system: Women infected with HIV (the virus that causes AIDS) or who take drugs that
suppress the immune system have a higher-than-average risk of developing
cervical cancer.
•Age: Cancer of the cervix occurs most often in women over the age of 40.
•Sexual history: Women who have had many sexual partners have a higher-than-average risk of
developing cervical cancer. Additionally, a woman who has had sexual
intercourse with a man who has had many sexual partners may be at higher risk
of developing cervical cancer. In both cases, the risk of developing cervical
cancer is higher because these women have a higher-than-average risk of HPV
infection.
•Smoking cigarettes: Women with a HPV infection who smoke have a higher risk of cervical cancer
than women with HPV infection who do not smoke.
•Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may increase the
risk of cervical cancer among women with HPV infection.
•Having many children: Studies suggest that giving birth to many children may increase the risk of
cervical cancer among women with HPV infection.
•Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer and certain other
cancers of the reproductive system in daughters exposed to this drug before
birth. DES was given to some pregnant women in the United States between 1940
and 1971, but it is no longer dispensed.
Symptoms
Early cervical cancers usually don’t cause symptoms. When the cancer grows larger, women may notice one or more of
these symptoms:
Abnormal vaginal bleeding
•Bleeding that occurs between regular menstrual periods
•Bleeding after sexual intercourse, douching or a pelvic exam
•Menstrual periods that last longer and are heavier than before
•Bleeding after menopause
Increased vaginal discharge
•Pelvic pain
•Pain during sex
Infections or other health problems may also cause these symptoms, so don’t panic. Just make an appointment as soon as possible with your ob/gyn, since
only a doctor can tell for sure.
Prevention
As with all cancers, early diagnosis is key to cure. Screening to check for
cervical changes before there are symptoms is very important because finding
and treating abnormal cells can prevent most cervical cancer. Also, screening
can help find cancer early, when treatment is more likely to be effective.
According to the doctors at MedicineNet, the success of screening is mainly
responsible for the decrease in the number of women diagnosed each year with
cervical cancer.
Regular pelvic examinations and Pap smears are the best ways to prevent cancer.
How often you should have a pelvic exam and Pap smear depends on your
individual situation. You should have your first Pap smear when you become
sexually active, no matter how old you are. If you are not sexually active, you
should have your first Pap smear at age 18 or earlier. In both cases, you
should have a Pap smear every year for at least 3 years.
If these Pap smears reveal no abnormal cells and you have few risk factors for
cervical cancer, the US Guide to Clinical Preventive Services recommends a
repeat Pap smear at least every 3 years. Because a woman
’s risk factors may change with her lifestyle, many medical professionals prefer
that you have a Pap smear yearly through age 65 years and older, regardless of
the number of negative tests you have had in the past. If you have had
precancerous changes or cancer of the cervix, your gynecologist will recommend
a schedule of follow-up examinations and tests.
Avoidance of HPV infection is becoming increasingly important in the prevention
of precancerous and cancerous changes of the cervix. Early age at first
intercourse is associated with increased risk. Abstinence is recommended as one
way to prevent the transmission of HPV.
Condoms may prevent HPV infection, although this has not yet been fully studied.
Cigarette smoking is another risk factor for cervical cancer that can be
prevented. Quitting smoking may de- crease your chances of developing cervical
cancer.
Prognosis
When precancerous or early cancerous changes are found and treated, the survival
rate is close to 100 percent. The prognosis for invasive cervical cancer
depends on the stage of the cancer when it is found.
The stage of a cancer is a measure of how far it has progressed, namely, what
other organs or tissues have been invaded. For the earliest stage of cervical
cancer, more than 90 percent of women survive at least 5 years after diagnosis.
Later stages of cervical cancer have a significantly worse outlook; 20 percent
or fewer of women with stage IV cervical cancer survive 5 years.
Though there were more than 11,000 new cases of cervical cancer in the United
States in 2008 and it is the second most common type of cancer in women world-
wide, consider this hopeful information:
Most women diagnosed with precancerous changes in the cervix are in their 20s
and 30s. The average age for true cervical cancer to be diagnosed is in a woman
’s mid-50s. This difference in the age at which precancerous changes are most
frequently diagnosed and the age at which cancer is diagnosed emphasizes the
slow progression of this disease and the reason why it can be prevented if
adequate steps are taken. Make sure you are being screened annually for risk
factors and dialogue with your doctor about what steps you can take to ensure
your continued good health.
