Cervical Cancer … Lower Your Risks through Preventative Measures
By LESLIE FELDMAN
When Cindy experienced spotting in between her menstrual cycles, her gynecologist found what looked like a polyp on
her cervix. Following a biopsy, she got the phone call that her tests came back positive for the disease.
Nothing will ever shock her more than hearing the words cervical cancer.
Cervical cancer is a disease in which cancer cells form in the cervix. The cervix is located in the lower portion of the uterus. It connects the uterus (where a baby grows when a woman is pregnant) to the vagina (birth canal).
Typically, cervical cancer develops slowly. The cancerous cells begin to grow in the tissues of the cervix and gradually spread throughout the cervix and surrounding areas. The average age of women diagnosed with cervical cancer is 48.
Cindy is one of about 11,000 women in the United States diagnosed with cervical cancer each year. Cervical cancer used to be the leading cause of cancer death for women in the United States.
However, in the past 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly. The Center for Disease Control (CDC) states that it is now 14th in the list of cancer deaths in women in the United States.
According to the National Cancer Institute, more than 30,000 women died of cervical cancer in the 1940s. With Pap smear screening starting in the 1950s, and now being available to essentially everyone in the United States, the death rate is about 4,000. Most of the women that die of cervical cancer haven’t had a pap smear in more than five years. 
“I believe that we could eradicate this disease by encouraging women between the ages of 20 and 70 to have a conversation with their healthcare provider as to the benefits of cervical cancer screening for them,” said William Bradford, DO, FACOOG, OB-GYN at May•Grant Associates in Lancaster (left).
“There are also ways to reduce the risk of cervical cancer without seeing a healthcare provider. Smoking has been linked to increased risk of cervical cancer; so has [having] more than one sex partner during their lifetime.”
Cervical cancer in its early stages is without signs or symptoms. Early, stage-1 cervical cancer is usually diagnosed by a physician, and the patient will then be offered radiation or a hysterectomy as a treatment option. Symptoms of later-stage cervical cancer may be a persistent odor and bloody drainage.
“The goal for screening tests is to be able to diagnose abnormalities in the pre-cancer time so that much less radical treatments may be offered and no change or decrease in lifespan may be expected,” said Bradford.
The most accurate test for cervical cancer is the pap smear screen. Consistently, the annual exam and Pap smear screening has been the “gold standard” for helping providers find and treat those with pre-cancer and those at risk for developing cancer.
HPV (human papillomavirus) screening may be helpful when deciding treatment options in certain patients. HPV is the most common sexually transmitted virus in the United States, and persistent HPV infections are now recognized as the cause of essentially all cervical cancers.
At least 50 percent of sexually active people will have genital HPV at some time in their lives. Those with multiple partners (more than five) or those with persistently slightly abnormal Pap tests may benefit from HPV testing.
“The goal here is to prevent unnecessary procedures or worrying over an abnormal pap,” added Bradford. “Many healthcare providers have also been offering HPV screening to those with slightly abnormal pap smears or those who have increased risk for cervical cancer.”
Many women are at a higher risk because of lifestyle and sex partner choices.
In addition, the National Cancer Institute’s SEER (Surveillance, Epidemiologym and End Results) data, a source of information on cancer incidence and survival in the United States, shows that the incidence of cervical cancer among American white women is about eight per 100,000.
American black women have a rate of 10 per 100,000, and Hispanic women, 12 per 100,000. Death rates from their cancer are 50 percent higher among the Hispanic population than the white population and twice as high among blacks compared to whites.
The most accurate data support that the best prevention against cervical cancer is being in a monogamous relationship and getting a yearly screening between the ages of 21 and 70.
To date, there are two vaccines available to women in this country to help prevent cervical cancer: Gardasil and Cervarix. Both may be offered to women from age 9 to 26. Up to a 75 percent reduction in cervical-cancer death rates can be achieved if patients are vaccinated before they are exposed to HPV and an appropriate immune response is attained.
“These vaccines, both FDA approved, come with risks and side effects, as all vaccines do,” Bradford explained. “It is always a good idea to be informed of the risk versus the benefit of any treatment plan or preventative medication.”
The CDC and the FDA (Food and Drug Administration) have recommended and approved the HPV vaccine for young male patients, beginning at age 11. The vaccine would protect them from HPV, the cause of most cervical and anal cancers, as well as most mouth and throat cancers.
For those diagnosed with the disease, there are a number of options depending on the stage of the cancer. Some treatments are standard and some are being tested in clinical trials.
Surgery is an option to remove the cancer. Total hysterectomy is a common procedure that removes the uterus, including the cervix. This can be performed one of three ways: vaginally, abdominally, or laparoscopically.
A radical hysterectomy removes the vagina and a wide variety of tissues and ligaments around these organs. Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue, and laser surgery uses a laser beam to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
In addition, radiation and chemotherapy can be used alone or in conjunction with each other and surgery.
Bradford believes that cervical cancer is best treated by being prevented.
“We should work very diligently to drive the cervical cancer-related deaths in this country to near zero. Screening is available to detect pre-cancer in women, when it is very treatable. With vaccines, Pap smears, and HPV testing, there is really no reason women in America can’t be assured of the eradication of this disease.”
