Cervical Cancer: One of the Deadliest but Most Preventable Cancers

Sara Isani, MDBy Sara Isani, MD, as published in the December 2013 edition of the New Jersey Department of Health's 'New Jersey Health Matters'

According to the National Cancer Institute, cervical cancer is the third most common cancer in women worldwide.   Virtually 100 percent of cervical cancer cases are caused by infection by high-risk types of the human papillomavirus (HPV).  HPV infection of the genital tract is common— individuals are exposed to the virus during any kind of sexual contact (including oral or anal sex), but transmission is higher with sexual activity as a teenager and a greater number of lifetime sexual partners.   Once HPV infects cells, it can interfere with cell regulation and lead to abnormal growth.  While HPV can cause varying medical problems, like genital warts, the most serious health concern is the development of precancer (also known as dysplasia) or cancer of the cervix, which is caused by the high-risk HPV types.  Risk factors that further increase the chance of HPV causing cervical cancer include cigarette smoking and compromise of the immune system as in the case of co-infection with HIV or use of immunosuppressive medical treatments.

The importance of Pap smears 
Fortunately, in the U.S., the incidence of cervical cancer has decreased significantly over the last 50 years.  The first breakthrough in cervical cancer prevention was the adoption of the Pap smear for screening.  The Pap smear is a test conducted during a pelvic examination in which cells are gently brushed off the cervix and analyzed under a microscope to look for abnormal cells.  More recently, we can also check for the presence of the high-risk HPV types in these cells.  The results of these two screening tests allow clinicians to detect pre-cancer before it progresses to cancer or find cancer at an early, curable stage.  Widespread screening and subsequent diagnosis of pre-cancer/early cancer has led to a dramatic drop in cervical cancer rates and deaths in developed countries.  However, many women in the U.S. still do not get recommended screening and later develop advanced-stage cervical cancer.  All women should start getting pap smears and/or HPV testing at age 21.  A woman should consult with her doctor about the frequency of screening, as it depends on age and results from prior tests. 

The HPV vaccine
A recent important discovery in preventing cervical cancer is the HPV vaccine.  Normally the immune system helps guard against infections, but sometimes HPV can escape this kind of attack.  The current commercially-available vaccine helps the body mount a stronger immune response when first exposed to four of the most common HPV types to prevent infection of the cervical cells.  Vaccination is recommended for all females aged 9 to 26 and involves completing the full series of three injections over six months.  Vaccination does NOT mean that a woman can stop getting Pap smears since the vaccine does not 100 percent guarantee against cervical cancer.

Prevention is key
Remember, by quitting smoking, vaccinating against HPV when age appropriate, undergoing regular Pap smears and protecting yourself against sexually-transmitted diseases, you can help reduce your risk to developing cervical cancer.

Sara Isani, MD, is a gynecologic oncologist at Rutgers Cancer Institute of New Jersey and an assistant professor of obstetrics, gynecology and reproductive sciences at Rutgers Robert Wood Johnson Medical School.

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