Thousands of women were diagnosed with cervical cancer this year, despite advances in testing and prevention. If left undiscovered and untreated, the cancer can be deadly, said gynecological oncologist Dr. Dwight D. Im, director for the Gynecologic Oncology Center at Mercy Medical Center. He answers questions ahead of National Cervical Cancer Screening Month and national Cervical Health Awareness Month in January.
Cervical cancer cases are dropping, thanks to Pap tests
Dwight D. Im, director for The Gynecologic Oncology Center… (Amy Davis, Baltimore Sun )
Question: Who gets cervical cancer, and how common is it?
Answer: In the United States, cancer of the cervix (the lowest portion of a woman's uterus or womb) accounts for about 6 percent of all cancers in women, typically those ages 50-55. About 12,200 women in this country were diagnosed with cervical cancer in 2010. It is much more common in developing nations and worldwide, where cervical cancer is the second most common cancer among women. Though cervical cancer is more common in postmenopausal women, it is biomodal, meaning it is also fairly common in younger women as well, and women in their 30s and even their 20s have developed this disease.
Thanks to the introduction of the Pap test about 50 years ago, the number of deaths due to cervical cancer has dropped 75 percent. Over 90 percent of women who develop cervical cancer are found to have the human papilloma virus or HPV.
Q: What is HPV and how is it related?
A: HPV refers to a group of more than 100 viruses that are known to cause warts, or papillomas, which are benign (not cancerous). Certain strains of HPV can cause warts on hands and feet, while other strains can lead to growths on the genitals and even the throat. Some types of HPV are associated with cancer, like cervical cancer; about 70 percent of cervical cancer cases are due to high-risk HPV types 16 and 18. HPV of this sort is typically passed from one person to another during unprotected sex. Cancer develops when abnormal cells in the lining of the cervix multiply following HPV infection, becoming a lesion or tumor. Malignant tumors can grow and spread, becoming life-threatening.
Q: Can cervical cancer be prevented or the risks lessened?
A: The most common form of cervical cancer typically begins with pre-cancerous changes which means one way to prevent cervical cancer is to locate and treat these pre-cancers before they become malignant and to prevent the pre-cancers from appearing in the first place. Your doctor does this by performing a Pap test (or Pap smear, where a sample of cells is taken from the surface of the cervix during a routine gynecological exam). Doctors received a new weapon in the fight against HPV and cervical cancer in 2006 when the Food and Drug Administration approved the first preventive HPV vaccine, Gardasil, which protects against four types of HPV, including types 16 and 18.
Q: How important is early detection of cervical cancer for treatment?
A: One important characteristic about cervical cancer is how slowly it often progresses from normal cervical tissue, to precancerous, to invasive cancer. This slow progression provides opportunities for early detection and treatment, which is why it is so important that women receive a regular Pap smear. The American Cancer Society recommends that women have their first Pap smear about three years after they become sexually active or by age 21, whichever comes first. Subsequent Pap smears should follow every two years with a liquid-based Pap test or annually with a conventional Pap test.
Q: Is the number of people getting screened increasing?
A: In my practice, I do see more women coming in for their annual Pap test and gynecologic exam; it is the development of the Pap test, and the improvements in the test itself, that account for the drop in cervical cancer cases in the United States. Today, gynecologists are tailoring how frequently their patients receive their Pap, according to each patient's age, medical and sexual history, and other factors. Pap smears are not 100 percent accurate, which reinforces the importance of having Pap tests regularly so if an early abnormal change is missed, it's more likely to be picked up during the next Pap test.
Q: How is it treated?
A: How your doctor treats your cervical cancer is dependent on a number of factors: what stage is the cancer, how far has it progressed; your age and overall health, medical history, your tolerance to certain medications, procedures and therapies, etc. Following the cervical cancer diagnosis and staging, your doctor will work with you to develop the best treatment plan possible to address your specific cancer. This treatment may include surgery to remove as much of the cancer as possible (new advances include the use of a laser to vaporize abnormal cells, and cryosurgery, which kills abnormal cells by freezing them with a metal probe cooled with liquid nitrogen); radiation, to shrink tumors and kill cancer cells and chemotherapy.
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