It's been nearly 40 years since President Nixon declared the "War on Cancer." And while we've made great strides in screening, diagnosis and treatment, it is a rare cancer against which we've actually "won" the battle. More and more, however, it's looking like cervical cancer may be that cancer.
In 2008, there were an estimated 11,070 new cases of cervical cancer and 3,870 deaths, about 1 percent of all cancer deaths in women. This represents a 50 percent drop in cervical cancer incidence and deaths in the past 30 years, thanks to improved screening and early treatment. While such a drop is an amazing improvement, we are not yet where we need to be, particularly when it comes to minority women.
African-American women are 30 percent more likely to develop cervical cancer and twice as likely to die from it as Caucasian women. In addition, Hispanic women are twice as likely to develop cervical cancer, with 3 percent of all cancer deaths in Hispanics due to cervical cancer.
The numbers are even bleaker when you leave the United States. Although the global incidence and death rates of cervical cancer have plummeted 75 percent in the past 50 years in developed countries, cervical cancer remains the second most common cause of cancer and cancer deaths among women in developing countries, with a 55 percent mortality rate (compared to rates below 5 percent for most women in the United States). In fact, the World Health Organization reports that 83 percent of all cases of cervical cancer worldwide occur in developing countries.
This shows the importance of screening and prevention, which often isn't available in developing countries. In the United States, however, low-income, uninsured and medically underserved women have access to the state and federally funded National Breast and Cervical Cancer Early Detection Program, which covers cervical and breast cancer screenings. For information on a participating clinic in your area, go to http://www.cdc.gov/cancer/nbccedp.
HPV Testing: Is it for You?
Although most women know how often they should have a Pap smear (hint: typically once a year), when was the last time you were tested for the human papillomavirus (HPV)? Should you even be tested for the virus?
The answer is … it depends.
While the Pap test evaluates cells from your cervix for any abnormalities, including precancerous and cancerous changes, the HPV test identifies genetic material from the 13 most common types of HPV that cause those changes. A sample for both tests can be collected at the same time, and the same sample can even be used for both tests.
However, the test is only recommended for women 30 and older. Younger women shouldn't be screened because the virus is so common and widespread and cervical cancer so rare in women under 30 that identifying the virus wouldn't mean anything. And while the test itself is painless with no risks, it does carry a financial cost. Most insurance companies cover the HPV test, as long as it is provided within recommended guidelines. Some states require that insurers cover the cost.
Whether you should get tested is between you and your health care professional, so be sure to discuss the test. The American Society for Colposcopy and Cervical Pathology and the American Cancer Society currently recommend routine HPV screening for women 30 and older.
You should consider screening even if you received the HPV vaccine when you were younger. The vaccine does not protect against all forms of cancer-causing HPV. We also don't know how long its protection will last.
If you are 30 or older and your HPV test is negative, breathe a sigh of relief and move on. A negative test means you do not have the virus; if you were infected at some point, your body got rid of it. The negative test also means you don't need another Pap or HPV screening for three years because without any evidence of long-term infection with the HPV, it's highly unlikely you'll develop cervical cancer.
If your test was positive, however, don't panic! It does not mean you have cancer. Remember: HPV is a very common virus. In fact, most women will have HPV at some point in their lives, if they are sexually active, but very few will develop cervical cancer. Most of the time, your immune system gets rid of HPV. If your Pap was normal, you don't need to do anything except have another HPV test in 12 months to see if your body has shed the virus. There is no treatment for HPV.
At follow-up testing, if you still have the virus or if your Pap test results are inconclusive or abnormal, your health care professional may want to examine your cervix more closely to be sure there are no cellular changes.
If your HPV test was positive and the Pap smear was inconclusive or abnormal, your health care provider will likely conduct additional tests to confirm the findings. You may need a colposcopy, in which the cervix is examined under a bright light, and/or a biopsy.
Once you pass age 70 or have had a total hysterectomy (in which the cervix was removed) for reasons other than cancer, you may no longer need a Pap or HPV test. Discuss with your health care provider how long you should continue to get screened.
Be sure to ask your health care professional questions if you have worries or concerns about your HPV test results and so you understand his or her recommendations for next steps. An HPV infection isn't anything to be ashamed of and it doesn't mean your partner has been unfaithful. The virus can persist in your body for quite a while: years, in fact; that's why screening is so important.
HPV is spread by direct genital contact during vaginal or anal intercourse, so if you have HPV, it's possible to infect your partner. Using condoms correctly and every time you have sex may reduce your risk of being exposed to or transmitting HPV, but the virus can live on areas the condom can't cover. So, the only way to make sure you don't infect a partner is to not have any type of sexual contact, including oral and anal sex, until your body sheds the virus on its own.
According to the American Society for Colposcopy and Cervical Pathology, most sexually active couples will share the HPV infection until your immune system gets rid of it. Partners who are sexually intimate only with each other do not pass the same virus back and forth. When the infection goes away, your immune system remembers it and will prevent a new infection with the same HPV type from recurring. However, because there are many different types of HPV, becoming immune to one HPV type may not protect you from getting HPV again if you are exposed to another HPV type.
Three Shots Is All It Takes
There's been a lot of publicity lately about the vaccine designed to protect adolescents and young women against the human papillomavirus (HPV). Is it safe? Is it cost effective? Is it effective? The answer to all those questions is yes. But here's the thing that seems to get lost in many discussions about the vaccine—it is the first effective vaccine in the world that protects against cancer. Yet because the viruses that cause cervical cancer are mainly spread via sex or sexual acts, some think that vaccinating young girls is paramount to handing them a condom and telling to "go for it."
Nothing could be further from the truth. The reality is that the HPV vaccine, Gardasil, has been studied in more than 10,000 women, and there is no evidence that it spurs girls to become sexually active. In fact, research finds that girls who receive the vaccine are less likely to become sexually active.
Despite lingering questions about the vaccine, girls are getting their shots. The U.S. Centers for Disease Control and Prevention (CDC) reported in September 2008 that one in four teenaged girls had received the three-dose vaccine.
Other key facts about the vaccine:
• The CDC's Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists recommends the HPV vaccine for girls and women ages 9 to 26 years. It is specifically recommended for 11- and 12-year-old girls, who are most likely not infected with genital HPV viruses.
• You do not need to be pretested for HPV before being vaccinated, and you can be vaccinated even if you are currently infected with HPV (although the vaccine is less effective).
• The HPV vaccine is also approved for protection against vulva and vaginal cancers.
• You still need regular Pap tests and if you are 30 or older, HPV tests, even after you're vaccinated against HPV because there is a very tiny chance you could still develop cervical cancer (the vaccine protects against the viruses responsible for 70 percent of cervical cancers).
• Just one state (Virginia) currently mandates the vaccine for school admission, but at least a dozen others are considering it.
• Although the vaccine's protection lasts at least five years, women may eventually need a booster.
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