Conditions

9 Things Doctors Wish You Knew About Cervical Cancer

Cervical cancer can be deadly. But if you follow the recommendations for prevention and screening, and then cervical cancer becomes very treatable. Here are the latest developments you need to know.

By Tina Donvito

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The deadliness of cervical cancer is greater than we thoughtiStock/m-imagephotographyThe cervical cancer mortality rate has dropped drastically in the last 40 years—by over 50 percent, according to the American Cancer Society. This is largely due to screening with the Pap test, which any woman who sees a gynecologist knows well. That’s the good news. The bad news is that the rate of deaths from cervical cancer is actually higher than we thought. According to a new study from Johns Hopkins, the way the original rate was calculated was flawed. “Prior calculations did not account for hysterectomy,” says study author Anne F. Rositch, PhD, MSPH, an assistant professor of epidemiology at Johns Hopkins Bloomberg School of Public Health. Instead, “following the concept of using only those ‘at risk’ for a specific cancer, we limited our cervical cancer ‘at risk’ population to females with a cervix.” Although this doesn’t mean more women are actually dying than previously thought, it does mean that the chance of dying among the women at risk is greater. For white women in the United States, the new estimates are 4.7 women per 100,000, 47 percent higher than the previous estimate of 3.2; for black women, the rate is 10.1 per 100,000, 77 percent higher than the previous estimate of 5.7.

You’ve probably had the virus that causes cervical canceriStock/RapidEyeAlthough the new study is alarming, dying of cervical cancer is still rare, especially now that we know the cause. In the 1980s, researchers discovered that the human papillomavirus (HPV) is at the root of the cancer. “Virtually all cases of cervical cancer are caused by a persistent high-risk HPV infection,” says Mahboobeh Safaeian, MPH, Ph.D., director of Clinical Sciences for HPV at Roche Molecular Diagnostics. HPV is an extremely common virus spread through intimate contact, including but not limited to sex. According to the CDC, condoms can help prevent the spread of the infection but won’t protect against it completely because HPV can infect areas not covered by a condom. “While most women will acquire HPV infection via intercourse at some point if not vaccinated, in most women, HPV is cleared by the immune system and does not have adverse effects or cause cancer,” says Kimberly Levinson, MD, MPH, a a gynecologic oncologist with Johns Hopkins Medicine. “However, if HPV persists, it can cause changes to the cervical cells leading to dysplasia [abnormal cells] and ultimately cancer.” Read why you might be at risk for STDs that are at a record high.

If you’ve had HPV, you won’t necessarily get cervical canceriStock/PeopleimagesOK, so most people who aren’t vaccinated will get a virus that could cause cancer? Yikes! While that is a very scary thought, there are many strains of HPV, most of which are perfectly harmless. “There are over 150 different types of HPV,” Dr. Safaeian says. “Of these, 14 HPV types are considered high-risk because of their association with cancer, with HPV 16 and HPV 18 identified as the highest‐risk genotypes. HPV16 and 18 are responsible for approximately 70 percent of all cervical cancers.” The CDC’s statistics indicate that 79 million Americans are infected with HPV (men and women), and 11,000 women get cervical cancer each year—so the risk of actually getting cancer is still quite low. “Fortunately, cervical cancer is a preventable disease with adequate screening, treatment, and vaccination,” Dr. Safaeian says. Here are other cervical cancer risks you need to know.

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The HPV vaccine is safe and effective in preventing cervical canceriStock/fstop123The HPV vaccine has caused a lot of controversy since it came out 10 years ago, with some people worried about long-term side effects. However, many studies have shown the vaccine to be safe, and claims otherwise should be met with skepticism. “On a daily basis, I tell cancer patients that I long for the day when I can prescribe them a magic pill that could make their cancer go away,” Dr. Levinson says. “This vaccine is that pill—in the form of a shot! We can use the vaccine to prevent this horrible disease that continues to kill young women.” A recent statement by 69 National Cancer Institute-designated cancer centers strongly encourage people to follow the recommendations for HPV vaccination. New CDC guidelines say two doses should be given to all 11- to 12-year-olds and three doses should be given to 15- to 26-year-olds. This applies to both boys and girls because although men can’t get cervical cancer, they can pass HPV to women who can. The ultimate goal is to vaccinate children before they become sexually active to avoid the spread of the infection completely. “The newest HPV vaccine prevents against nine strains of HPV virus, which cause up to 90 percent of cervical cancers,” Dr. Rositch says. “For the generation of adult women who are beyond the age of vaccination, the data from this new study [showing an increased risk of dying] should help prompt them to vaccinate their daughters and sons.” These are other vaccine myths to ignore.

You don’t need a Pap every year to detect pre-canceriStock/fstop123Because the HPV vaccine is only approved for use in people under 26 years old, the second line of defense is still the good old Pap test. Everyone’s favorite part of their gynecological exam (not), the invasive test involves swabbing a sample from the cervix to detect pre-cancerous cells. Luckily, you probably don’t need the test annually anymore. “The guidelines for cervical cancer screening have changed significantly over the past several years,” Dr. Levinson says, noting that they now vary based on your age and the results of previous screenings. New recommendations from the American College of Obstetricians and Gynecologists (ACOG) advise no Pap tests for those under age 21; a Pap every three years for women age 21 to 29; and a Pap with the new HPV test (more on that later) every five years for women 30 to 65. The new recommendations stem partly from the fact that many abnormal cells clear on their own within a few years, and treating them right away can sometimes cause other problems later on, like miscarriage. “For women with abnormal screening tests, management with further testing and repeat screening is based specifically on the patient’s findings,” Dr. Levinson says, so talk to your gynecologist about the right course of action for you. Cervical cancer from HPV, thankfully, takes a long time to develop. Find out what you should and shouldn’t do before a Pap test.

New screening methods might even be better than PapsiStock/megafloppPaps detect abnormal cells, but a new test can actually detect HPV itself, making it an even better indicator of a woman’s risk for developing cervical cancer. The HPV test “simultaneously detects 12 high-risk HPV types and provides individual results for the highest risk types, HPV 16 and HPV 18,” Dr. Safaeian says. “It can provide clinicians with the support they need to more accurately identify women at highest risk for cervical cancer—women who test positive for HPV16 and/or HPV18— and distinguish those who need immediate management from those who can be watched over time or be returned to routine screening intervals.” Unfortunately, this test is also gathered the same way a Pap is, so there’s no getting out of putting your feet in the stirrups. The HPV test is also why frequent Paps are less necessary. “Screening can be extended to every five years [for women 30 to 65] because HPV testing is a sensitive test, meaning it is quite good at identifying women who have the HPV infection,” Dr. Levinson says. “These women can then be referred for further testing to identify whether pre-cancers or cancers are present. For women who do not have HPV infection, their risk of subsequent development of pre-cancer or cancer is very low.” Women under 30 don’t need the HPV test because the virus so often clears on its own, and only becomes of concern when it hangs around for a while.

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Older women can still get cervical canceriStock/Highwaystarz-PhotographyAnother finding from the Johns Hopkins study was that the death rate for older women was higher than previously thought, potentially because a greater number of older women have had hysterectomies and shouldn’t have been included in the “at risk” population. But older women can still get cervical cancer. “I think these data highlight that older women remain at risk of getting and dying from cervical cancer, so it’s important to screen according to the guidelines,” says Dr. Rositch. “Although screening is not recommended for the majority of women over age 65, it’s important to ensure that women have been adequately screened and with negative results before exiting screening.” Right now, the guidelines say you should have had three negative Paps or two negative HPV tests in a row within the last 10 years, with the most recent being in the last five years, before you can stop the screening. Even a hysterectomy might not be enough to get you out of the tests—ACOG says you might still need them if your cervix wasn’t totally removed or if you have a history of cervical cell changes. You might have these questions about menopause you were too embarrassed to ask.

African-American women are more at risk of dying from cervical canceriStock/monkeybusinessimagesAs seen from the Johns Hopkins study’s results, there is a larger racial disparity in the risk of dying from cervical cancer among white and black women than previously thought. The gap was underestimated by 44 percent, and socio-economic factors may play a part in the reason why, although more research is needed. “We already have national and state-level data to suggest that black women are less likely to receive adequate therapy at initial diagnosis [for cervical cancer], but we need to determine actionable reasons why care is differential to begin to address the mortality difference,” Dr. Rositch says. “There are likely social determinants of health contributing to these racial disparities.” Dr. Safaeian says other reasons could include “inadequate screening, differential immune response to the infection and cervical precancers, to name a few.” But if you are African-American, no need to panic—just make sure you get your regular screenings.

You might not have cervical cancer symptoms until it’s too lateiStock/iascicSo much of cervical cancer awareness efforts focuses on screening because the disease is so preventable—but once symptoms appear, it’s often very far along and hard to treat. “Cervical cancer symptoms such as bleeding often do not present until the disease is quite advanced,” Dr. Levinson says. “This is the reason why vaccination and cervical cancer screening are so critical.” The American Cancer Society says improvements in the treatment of cervical cancer are on the horizon, including immunotherapy, gene-targeted drug therapy, hyperthermia, and improved biopsy methods. But with cervical cancer, an ounce of prevention is still worth a pound of cure.

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