Cervical cancer not an inherited disease

On Call

June 25, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

Since it seems that more and more types of cancer can be inherited, I would like to know if a recent diagnosis of cervical cancer in my mother increases my own risk for this form of cancer.

To date, there is no evidence that inherited genes play a significant role in the development of cancer of the cervix, the narrow lower portion of the uterus. Much evidence points to infection with certain human papilloma viruses as a cause, since they are detected in more than 90 percent of cervical cancers.

This evidence undoubtedly explains why sexual activity at an early age, multiple sexual partners and a history of herpes, genital warts and other venereal infections are risk factors for this cancer, along with smoking and a mother's use of the drug diethylstilbestrol (DES) during her pregnancy with the cancer patient.

Over the past 40 years the incidence and death rate from cervical cancer have fallen greatly due to early detection and treatment. With regular pelvic exams and Pap smears (microscopic examinations of a small sample of cells scraped from the cervix and upper vagina) abnormal cells can be found and removed from the surface of the cervix before they progress to truly malignant cells that invade the deeper layers of tissue or spread to other sites. Cellular changes in cervical cancer progress from a condition known as dysplasia to carcinoma in-situ before invasion occurs. About a third to a half of cervical dysplasias progress to invasive cancer if not treated.

Annual Pap smears after age 18 or after the onset of sexual activity can detect cervical dysplasia or carcinoma in-situ. After three or more annual Pap smears are normal, a doctor will usually reduce their frequency. Young women exposed to DES during their mother's pregnancy need to have Pap smears starting at age 14 or when menstruation begins, whichever comes first. A woman also should obtain a gynecological examination and Pap smear whenever unexplained vaginal leeching occurs, especially after menopause. Many women stop getting Pap smears after the menopause despite the fact that the relative incidence of cervical cancer increases in older women.

Abnormal cancer cells can be destroyed by cauterization (use of heat to burn them away), cryosurgery (use of liquid nitrogen to freeze the cells), or laser surgery. Larger abnormalities may be treated by conization, removal of a cone-shaped section of the cervix.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 6/25/96

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