Cervical
Cancer: A Very Preventable Disease
Regular
screenings help keep women safe
Year
2002 estimates from the American Cancer Society included
approximately 13,000 new cases of invasive cervical cancer in the
United States, with nearly 4,100 women dying from this disease.
Worldwide, cervical
cancer is the second leading cancer killer of women.
Yet,
most of these cases are preventable and when found and treated early,
cervical cancer often can be cured.
"Cervical
cancer is preventable," says Dr. Steven R. Goldstein, a professor of
obstetrics and gynecology at New York University Medical Center.
The
Key Is Early Detection
Ninety-eight
to 99 percent of all cervical cancers are caused by the human papillomavirus,
or HPV. The virus, which is sexually transmitted and comes in several
dozen different varieties, currently infects some 20 percent of American
adults. While most cases of HPV resolve on their own, a small minority
progress to cervical cancer, making it the biggest health threat to
this part of the female anatomy.
Symptom-Free
HPV Puts Women At Risk
One
of the problems with genital HPV infections is that often they do not
come with visible signs and symptoms. A National Institute of
Allergy and Infectious Diseases study found that almost half
the women infected with HPV had no clear symptoms. Further, people infected
but who have no symptoms may not know they can transmit HPV to others.
Recently,
researchers reported in The New England Journal of Medicine
that they had developed a vaccine that had achieved a 100 percent success
rate against the version of the virus responsible for 50 percent of
all cases of cervical cancer. Despite these encouraging results, a workable
vaccine is still several years away.
Pap
Test: Best Weapon Against Cervical Cancer
For
now, the best weapon against cervical cancer is screening in the form
of a Pap test (also called Pap smear). And it is very effective.
"If
you look at mortality from cervical cancer from the 1940s before we
had the Pap smear until the 1990s, there's a dramatic decrease," says
Dr. Carolyn D. Runowicz, vice chairman of the department of obstetrics
and gynecology at St. Luke's Roosevelt Hospital in New York City.
"The
line is just a sharp drop, so the Pap smear is absolutely, unequivocally
a good example of screening if done correctly," adds Runowicz, who is
also one of the authors of the American Cancer Society's
cervical cancer guidelines.
A Pap
test is a way to examine cells collected from the cervix, or the "mouth"
of the womb (located at the top of the vagina), for the presence of
infection, inflammation, abnormal cells, and/or cancer. A Pap test,
along with a pelvic examination, is an important part of a woman's
routine healthcare because it may detect abnormalities that can lead
to invasive cancer.
The
problem is that not enough women are being screened, and most cases
of cervical cancers occur in unscreened women, Runowicz says.
"If
we could get every woman screened, we could eliminate this disease like
polio," she says. "Women sometimes think after their last baby, they
don't need to go to the gynecologist anymore. And they really couldn't
be more wrong—and cervical cancer screening is one reason among
many."
Runowicz
advises women to start having regular Pap tests within three years of
becoming sexually active or at age 21, whichever comes first.
"Invasive
cervical cancer in this country is virtually unheard of before the age
of 20, but the individual woman needs to speak with her healthcare provider
to determine what is an appropriate screening interval for her," she
says.
Always
consult your physician for more information.
Risk
Factors For Cervical Cancer
The
following have been suggested as risk factors for cervical cancer:
-
infection
with the human papillomavirus (HPV), most often as the result of
unprotected sex
-
infection
with the human immunodeficiency virus (HIV) - the precursor to AIDS,
or other conditions that weaken the immune system
-
age
- after age 25, the risk for invasive cervical cancer increases
-
smoking
-
low
socioeconomic level
-
poor
diet - lacking in fruits and vegetables
-
having
sexual intercourse before the age of 18
-
having
many sexual partners, and having partners who have had sexual intercourse
at a young age and/or those who have had many partners themselves
Online
Resources
American
Cancer Society
American
College of Obstetricians and Gynecologists
National
Cancer Institute (NCI)
National
Institute of Allergy and Infectious Diseases (NIAID), part of the National
Institutes of Health (NIH)
National
Institutes of Health
The
New England Journal of Medicine
US
Preventive Services Task Force
|
February
2003
Cervical
Cancer: A Very Preventable Disease
The
Key Is Early Detection
Symptom-Free
HPV Puts Women At Risk
Pap
Test: Best Weapon Against Cervical Cancer
Risk
Factors For Cervical Cancer
New
Guidelines for Cervical Cancer Screening
Abnormal
Pap Test Results
Online
Resources
In
Other Women's Health News:
New
Guidelines for Cervical Cancer Screening
Task
force recommendations are updated
While
regular screening for cervical cancer is strongly recommended for
women between the ages of 21 and 65, some women can safely discontinue
regular screening or be screened less often, says the US Preventive
Services Task Force.
The
task force says the harm of continued routine screening, such as false
positive tests and invasive procedures, outweighs the benefits of
regular screening for women aged 65 and over who have had regular,
normal Pap tests, and who are not otherwise at high risk for cervical
cancer.
Pap
testing followed by appropriate treatment can often effectively prevent
invasive cervical cancer by detecting pre-cancerous lesions before
they grow and spread, the task force says.
The
following are some recommendations from the task force, the nation's
leading independent panel of private-sector experts in prevention
and primary care:
-
Cervical
cancer screening is strongly recommended for women who have been
sexually active and have a cervix.
-
Screening
is not recommended for women who have had a total hysterectomy
for a benign (non-cancerous) condition.
-
There
is insufficient evidence to recommend for or against new technologies
such as liquid-based cytology instead of conventional Pap tests
to screen for cervical cancer.
-
There
also is insufficient evidence to recommend for or against the
use of human papillomavirus (HPV) testing as a primary screening
tool for cervical cancer.
Always
consult your physician for more information.
Abnormal
Pap Test Results
According
to the National Cancer Institute (NCI), when the
Pap test shows an ambiguous or minor abnormality, the test is usually
repeated to ensure accuracy.
If
the test shows a significant abnormality, a colposcopy may be performed
(using an instrument called a colposcope) to examine the vagina and
the cervix.
A
Schiller test may also be performed, in which the cervix is coated
with an iodine solution.
A
biopsy may be performed in which the physician removes a small amount
of cervical tissue for examination by a pathologist. This is the only
sure way to determine whether the abnormal cells indicate cancer.
Always
consult your physician for more information.
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