Cervical Cancer – Is It Preventable?

Cervical cancer is the second most common cancer in women worldwide. It is also the second most frequent cause of cancer-related death in women in developing countries. It is estimated that 530,000 new cases of this disease and 275,000 resultant deaths occur each year around the world. Is cervical cancer a preventable disease and if so, how can we prevent it?

How does cervical cancer develop?

The cervix is the lower part of the uterus (womb). Most cervical cancers begin in the cells lining the cervix. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix gradually develop pre-cancerous changes that turn into cancer. These changes usually take several years, but they can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment, only some women, usually those who skip a regular gynecologic check-up and don’t receive proper treatment, will develop cervical cancer.

Pre-cancerous changes are separated into different categories based on how the cells of the cervix look under a microscope. There are two main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. Most of the cervical cancers are squamous cell carcinomas.

What are the common signs and symptoms?

Women with early cervical cancers and pre-cancers usually have no symptoms, which is why it’s vital to get regular pelvic exam and Pap tests. Symptoms often begin when the cancer becomes invasive and grows into nearby tissue. When this happens, the most common symptoms are:

• Abnormal vaginal bleeding, such as bleeding after vaginal intercourse or douching, bleeding after menopause, bleeding and spotting between periods.
• An unusual discharge from the vagina − the discharge may contain some blood, with odor, and may occur between your periods or after menopause.
• Pain during intercourse.

What are the risk factors?

Here are the common risk factors that have been proven to be associated with cervical cancer:

• High-risk human papillomavirus (HPV)
• Smoking
• Sexual intercourse at an early age
• Multiple sexual partners
• Sexually transmitted diseases such as Chlamydia
• Immunosuppression
• Prolonged use of oral contraceptives (> 5 yrs)

What is the significance of human papillomavirus (HPV)?

There are more than 150 known human papilloma viruses. Of them, more than 40 types can be transmitted through sexual contact. Infection by high-risk human papillomavirus (HPV) is the most important risk factor for cervical cancer.

HPV is classified into two major groups – low-risk and high-risk. Low-risk HPV can cause type of growth on the skin called papilloma or more commonly known as warts. Warts can occur at or around genital organs. High-risk HPV is strongly linked to cancers of vulva, cervix, and vagina in women.

Infection with HPV is common and usually does not cause any symptoms. Often, the body can clear HPV infection on its own within two years or less, most women will never even know it. However, if the infection becomes persistent, it can cause cell changes that may progress into cancer. Currently there is no cure for HPV infection, but there are reliable tests to detect HPV infection as well as effective treatments for the warts and abnormal cells that HPV causes.

The major breakthrough in medicine – HPV vaccines offer significant protection against cervical cancer. Currently there are two safe and effective HPV vaccines available (Gardasil and Cervarix) that protect against the types of HPV infection that cause most cervical cancers (HPV types 16 and 18). Both vaccines should be given as a three-shot series. The vaccines are recommended to females as young as nine years old.

Finally, Is cervical cancer preventable?

The answer is YES!

With regular screening tests and follow-up, cervical cancer is the easiest gynecologic cancer to prevent. New technologies for cervical cancer screening continue to evolve as do recommendations for screening tests and managing the results. Here are the two screening tests mentioned earlier that can help prevent cervical cancer or diagnose it early:

• The Pap test (or Pap smear) looks for cell changes on the cervix that may develop into cervical cancer.
• The HPV test looks for the human papillomavirus infection.

An abnormal Pap test result or persistent HPV infection may require more testing including colposcopy (examining cervix under a microscope with biopsy) and endocervical scraping. Close follow-up and treating precancerous cells of the cervix are the ways to prevent progression to cervical cancer.

A pelvic exam at during an annual check-up is very important, but this does not mean a Pap test is done. Regular Pap tests are recommended for all women starting at age 21, and HPV testing can begin at age 30.
In addition, getting the HPV vaccine and living a healthy lifestyle including diet, nutrition, exercise, smoking cessation, delaying sexual debut, and limiting sexual partners all can significantly reduce cervical cancer risk.

References:

Centers for Disease Control and Prevention: www.cdc.gov

American Congress of Obstetrics and Gynecology (ACOG): www.acog.org

American Cancer Society: www.cancer.org