Cervical cancer is the third most common cancer and cause of death among gynecologic cancers in the United States. According to the American Cancer Society, 12,990 women in the U.S. will be diagnosed with cervical cancer and 4,120 will lose their lives to the disease this year. It’s important to talk about cervical cancer because it can be prevented with routine screening and vaccination protocols.
Dr. Jill Johnson, an Obstetrician/Gynecologist at Florida Hospital, shares some insight on cervical cancer risks, causes and prevention strategies.
The most important risk factor for cervical cancer is human papilloma virus (HPV) infection, which is very common among U.S. adults. In fact, the Centers for Disease Control and Prevention reports that 79 million Americans are currently infected with HPV and 14 million new cases are diagnosed per year.
Dr. Johnson explains, “The association between HPV and cervical cancer is so strong that other behavioral covariables are found to be dependent upon HPV infection, meaning that most risk factors for cervical cancer are associated with variables that increase the risk of acquiring HPV or the inability to clear HPV infection.”
“The human papilloma virus is central to the development of cervical cancer,” says Dr. Johnson. In fact, she states that the virus can be detected in over 99 percent of cervical cancer cases.
Dr. Johnson expresses the importance for women to know that while it is very common, not all women with HPV infection get cervical cancer. “Most healthy adults can clear the HPV infection, but for some (mostly people age 30 and older) the infection can become chronic and persistent, which is what can lead to abnormal pap tests and, if untreated, can lead to cervical cancer,” she adds.
These factors have guided physicians in developing the current recommendations for cervical cancer screening.
There are two central components to preventing cervical cancer: HPV vaccination and routine screenings with the Pap test.
The HPV vaccine has been approved by the FDA and shown to be effective at preventing HPV infection. Dr. Johnson says that in general, the HPV vaccine is recommended for girls and boys between age 11 and 12, but is appropriate for patients as young as age 9 and up to age 26.
“The recommendations are based on data showing that the vaccine is most effective if administered before a patient is exposed to HPV, and 50 percent of new HPV infections occur in 15-24 year olds,” she explains. Dr. Johnson also points out that being exposed to HPV infection is not a contraindication to get the vaccine; it is just most effective when given before HPV exposure.
If vaccination protocols are implemented appropriately, approximately 90 percent of invasive cervical cancer worldwide could be prevented, in addition to precancerous cervical lesions. Pediatricians, family physicians and gynecologists all play an important part in educating parents and patients about their roles in preventing cervical cancer in the future.
Routine Cervical Cancer Screening
Screening tests, like the Pap test, can detect most precancerous cells in the cervix. If precancerous cells are found and removed early, cancer can often be prevented.
Dr. Johnson explains, “Unfortunately, up to 50 percent of women diagnosed with cervical cancer have never had a Pap test, and 10 percent have not had a Pap test in five years.” If women had routine annual examinations and pap testing, the rate of cervical cancer would decline.
The recommendations for routine screening tests can differ for each woman. In general, guidelines recommend Pap testing begin at age 21. Screening with a pap is then performed every 3 years in women aged 21-29 and every 5 years for women aged 30-65. If the pap or HPV test is abnormal, these recommendations change according to set protocols and follow up algorithms. Therefore, it is important to schedule yearly gynecological exams, when cervical cancer screening is most often performed.
Dr. Johnson concludes, “Even if your routine Pap tests are not recommended each year, it is important to still have an annual well-woman exam.” This checkup includes additional exams critical to your health, such as a pelvic and breast exam, provides education regarding health maintenance, and the opportunity to talk with your doctor about any gynecological concerns you may have.”