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Every two minutes somewhere in the world, a woman dies of cervical cancer. It is the second most common cancer in females worldwide. About 500,000 new cases are diagnosed every year. Most cases (80%) occur in countries that lack routine screening programs. The National Cancer Institute predicts that in the United States over 12,000 women will be told they have cervical cancer in 2012.

What Causes Cervical Cancer?

Almost all (over 98%) cervical cancers are linked to human papillomavirus (HPV) and most (about 75%) sexually active people will at some point be exposed. HPV is an extremely common sexually transmitted infection (STI). At any time, about one in five sexually active people are infected. Even people who are monogamous (only one sexual partner) are at risk if their current partner has had previous partners. The good news is that most healthy people recover from HPV infections without treatment.

There are many strains of HPV, but only a few cause cancer. Two strains (16 and 18) are responsible for about 70% of all cervical cancer. Once the virus enters the body (during sex) it causes changes in the cells of the cervix. This is sometimes referred to as dysplasia, cervical intraepithelial neoplasia (CIN), squamous intraepithelial neoplasia (SIL) or pre-cancer. If a woman's immune system does not reverse this process, cells become increasingly abnormal and can become cancerous. This process may take many years. Treating abnormalities while they are still mild is very important.

Detection of Cervical Cancers

Early detection through routine Pap smears has saved millions of lives. When a pap test is performed, a few cells are retrieved from the cervix and examined under a microscope. Recent Pap smear technology has increased testing accuracy. Not only can abnormalities be spotted early, some tests can detect the presence of HPV. In countries where regular screening is the norm, the number of new cervical cancer cases and cervical cancer deaths has been reduced by about 80%. Unfortunately, not all women take advantage of routine screening. Eleven percent of U. S. women report that they do not have Pap smears routinely.

Diagnosis and Treatment of Cervical Cancers and Pre-Cancers

There are many treatment options for abnormal cervical cells. Often, women are advised to simply have repeat testing in 3 – 6 months. Those with a healthy immune system may be able to clear the HPV infection and repair the tissue damage between screenings. If not, there are several other follow-up tests available.

When screening tests suggest that changes in cervical cells are getting worse, your healthcare provider may recommend a colposcopy. This can be done in a doctor's office. The provider will look at your cervix with a magnifying machine called a colposcope. He/she will be able to see abnormal looking groups of cells. Usually, a biopsy (small piece of tissue) is obtained. If the outside of your cervix looks normal, your provider may take a small scraping from just inside the opening of your cervix (cervical os). These procedures are slightly uncomfortable, but most trained practitioners can complete them in just a few minutes. Once the results of your biopsy are received you and your physician can make plans for treatment.

There are various treatment options for cervical cancers and pre-cancers. Some pre-cancers can be treated in your doctor's office. It is not uncommon, however, for treatment to be done in a hospital operating room, using an electrical cautery or laser. For advanced changes in cervical cells and early cancers, removal of the uterus (hysterectomy) may be warranted. When the cancer is severe and has invaded surrounding tissue, radiation therapy may be necessary and referral to a specialist is likely. Like other cancers, the outlook for full recovery is best when cervical cancer is found early.

Current Guidelines for the Screening for Cervical Cancer

The goal of cancer screening is to prevent cervical cancer. A discussion with your doctor will determine how frequently you should be screened. The American College of Obstetricians and Gynecologists has developed the following guidelines for cervical cancer screening:

• Cervical cancer screening should begin at 21 years of age
• Women ages 21 – 29 years should be screened every two years
• This interval may be extended to every three years for women aged at least 30 years who have had 3 consecutive negative screening tests and who have no other complicating factors

HPV Vaccine – The Newest Tool to Prevent Cervical Cancer

There are currently two FDA licensed HPV vaccines in use in the United States; Gardisil and Cervarix. Both vaccines prevent infection with the two most common cancer-causing strains of HPV. Gardasil also prevents 2 additional strains that cause genital warts in both men and women. They work best when they are given before young people start having sex (before they have a chance to get exposed). The Advisory Committee on Immunization Practices has recommended that one of these vaccines (each of which requires 3 doses) be given as part of the routine childhood vaccination schedule between 11 and 12 years. Adults up to the age of 26 years are also eligible for HPV vaccination.

If you have been putting off your pap smear due to lack of health insurance or high co-pays or deductibles, the Cancer Services Program of Ontario, Seneca and Yates Counties might be able to help. This program provides cervical cancer screening for women 40 years and older who are uninsured or underinsured. Call today for more information: 1- 866- 442-2262.

Printable Fact Sheet http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf

January, 2012