Cervical Cancer, Causes, Prevention and Screening

Last year, 11,270 new cases of cervical cancer were diagnosed and another 1.2 million women will develop dysplasia, a condition which left untreated will turn into cervical cancer. Cervical cancer is a malignancy that develops in tissues of the cervix: the organ which connects the uterus to the vagina. It is preventable, slow-growing (so that it can be detected and cured early in its course), and is nearly always caused by infection from the human papilloma virus (HPV).

Cause: Most cases of cervical cancer are caused by HPV – a highly contagious virus which can be transmitted easily by skin to skin and sexual contact.
• At least half of all sexually active Americans contract HPV during their lifetimes
• About 20 million Americans between the ages of 15 and 50 carry the virus.
• There are more than 100 types of HPV – of which more than a dozen (termed “high risk types”) can cause cervical cancer.
• Most often, a person’s immune system kills off the virus without intervention
• Exposure to high risk types of HPV is more likely to lead to cancerous changes of the cervix in women who smoke or whose immune system is impaired.
Prevention: Cervical cancer can be prevented by
• Having no intimate contact with either men or other women
• Obtaining the HPV vaccine – which can immunize against two high risk types of HPV (types 16 and 18), which cause about 70% of cervical cancers. It is given as a series of three injections over a period of six months. The vaccine is now FDA-approved for females and males between the ages of 9 and 26, although many physicians recommend the vaccine up to age 50 for sexually active women and men who have sex with men.
• Screening and treatment for early evidence of pre-malignant changes to the cervix

Screening: The “pap smear” (Papanicolaou test) is used to screen for cervical cancer as part of the gynecological examination. It can reveal early, pre-malignant changes to the cervix. It is done by gently scraping the cervix with a wooden or plastic spatula and then by inserting a very small brush into the opening of the cervix. The cells thus obtained are then evaluated by a commercial laboratory. For maximum accuracy, your provider should be submitting a liquid-based preparation (not the old-fashioned smear submitted on glass slides). The same cells can be evaluated for the presence of HPV.

Lately, when and how often to screen has become controversial. Consensus among the various guideline commissions is still pending, but it is likely that recommendations will be as follows:
• The first Pap test should be done at Age 21, then repeated every two years.
• At Age 30, the Pap test and HPV screen (done using the same cells collected for the Pap) should be done; if both are negative and you’ve had at least three consecutive normal Pap smears, screening can be reduced to every three years.
If the Pap is normal but high risk HPV is present, Paps should be repeated at least yearly.
If the Pap is abnormal, further testing is necessary – starting with ‘colposcopy’. This procedure starts like a regular gynecologic examination, with the speculum inserted into the vagina. The doctor then brushes a material on the cervix to highlight any abnormal areas. The ‘colposcope’ – a large microscope positioned about a foot away – shines light into the vagina so the abnormal areas can be seen through the microscope. These areas are then biopsied and evaluated by a special laboratory.
Note: You should continue to see your doctor at least yearly for general gynecologic check-ups, even though the Pap test might be done less frequently.
Of all cancers, cervical cancer is almost unique in that it is preventable. Ask your healthcare provider whether you should consider the HPV vaccine. Cervical cancer can be detected early, treated, and cured. Ask your provider how frequently you should be screened.

By Margaret Lewin, MD, FACP is the Medical Director of Cinergy Health (www.cinergyhealth.com)

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