Cervical Cancer: Preventative Measures Are the Key

Tara Berman, MD is a medical oncologist at Inova Schar Cancer Institute and she is part of the team at Inova Saville Cancer Screening and Prevention Center.

Approximately 0.7 percent of women will be diagnosed with cervical cancer at some point during their lifetime, based on 2017–2019 SEER data. Hispanic women have the highest rates of developing cervical cancer, and Black women have the highest mortality rates from cervical cancer. However, the number of Americans with cervical cancer, and the number of deaths from it, have been declining for decades.

The reasons for the decline — and the ways we will continue to reduce this cancer’s incidence — are testing and vaccination.

The American Cancer Society estimates that about 14,100 new cases of invasive cervical cancer will be diagnosed in 2022, and about 4,280 women will die from cervical cancer.

That’s still too many, although the numbers are slowly improving. According to the U.S. Preventive Services Task Force, the number of deaths from cervical cancer in the U.S. declined from 2.8 to 2.3 deaths per 100,000 women from 2000 to 2015.

All women are at risk for cervical cancer, although it occurs most often in women above age 30. Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer. HPV is a common, sexually transmitted virus that infects at least half of sexually active people in their lives. However, only a small portion of these women will develop cervical cancer. Other risk factors for cervical cancer include: having HIV (the virus causing AIDS) or another immune condition that makes it challenging for the body to fight off health problems; smoking; using birth control pills for a long time (five or more years); having given birth to three or more children; and having several sexual partners.

Cervical cancer is a preventable disease, with declining incidence rates in the United States thanks to testing and screening at gynecological visits and early vaccination.

Recommendations for Testing and Vaccination

The Task Force recommendations for testing women for cervical cancer is divided into three segments:

  • Women ages 21 to 29: Screen every three years with a Pap test.
  • Women ages 30 to 65: Screen every three years with a Pap test, every five years with an HPV test, or every five year with co-testing (the Pap test and HPV test administered at the same time).
  • Women younger than 21, women older than 65 with normal screening test results for several years and women who have had the cervix removed as part of a total hysterectomy for a non-cancerous condition, like fibroids: Do not screen.

What’s the difference between the tests? A Pap test, also known as a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. Both tests can be done in a doctor’s office or clinic, including the Inova Saville Cancer Screening and Prevention Center for high-risk patients.

The HPV vaccine is an important part of the fight against cervical cancer, as well. Virtually all cervical cancers are caused by HPV. Therefore, everyone — not just girls and women — should get the HPV vaccine when they’re eligible.

The CDC recommends that boys and girls who are 11 or 12 years old receive the vaccine, and those age 26 or younger who did not receive the vaccine at that age should get a catch-up vaccination.

The primary HPV vaccine administered in the U.S. is approved from age 9 to 45; patients ages 27 to 45 should consult with their primary care physician about the vaccine.

The research surrounding the HPV vaccine and cervical cancer is encouraging —we can, in fact, reduce the incidence of cervical cancer through this vaccination.

It’s important to note that vaccination is not a cure. It does not treat existing HPV, but it prevents it from occurring.

Stopping Cervical Cancer Before It Develops

As a medical gynecologic oncologist, I see patients after they have been diagnosed with cancer. Therefore, I feel strongly about the preventative power of vaccination and testing.

One reason, of course, is the severity of the disease and the available treatments. Once cancer develops, a patient faces organ removal through surgery, or   chemotherapy and radiation treatments. If the cancer has spread, treatments will be aggressive. These are difficult regimens for anyone to go through.

As a physician, I want to empower people to do everything they can before cancer reaches this stage.  

Another reason I strongly encourage prevention and screening — and am thrilled that the Inova Saville Cancer Screening and Prevention Center has opened this year — is the ability to detect pre-malignant changes in the cervix early enough to treat them so they never have the chance to develop into cancer.

A Pap smear can help us detect pre-malignant changes in the cervix, and we can intervene once they are spotted.

Cervical cancer develops in what is called a stepwise fashion, meaning tissue slowly progresses from non-cancerous to cancerous. When premalignant lesions are detected, physicians can act and take surgical measures to eradicate the metastatic tissue.

This is an important window, where doctors can intervene to prevent the development of cancer. That’s why screening is so important.

Reprinted from Berman TA, Schiller JT. Human papillomavirus in cervical cancer and oropharyngeal cancer: One cause, two diseases. Cancer. 2017 Jun 15;123(12):2219-2229.

Take Advantage of Preventative Measures

The primary message I want to send about cervical cancer is that it is preventable with early, proactive intervention. Young people should receive the HPV vaccination. Women should continue to see their gynecologists annually for Pap smears or at appropriate screening intervals based on HPV testing determined by their gynecologist.  Other steps women can take to reduce their risk of developing cervical cancer include not smoking, limiting number of sexual partners, and using condoms during sex. Regarding condoms, it is important to note that HPV infection can occur in both male and female genital areas that are not covered or protected by a latex condom, so this does not fully prevent transmission. However, condom use has been associated with a lower rate of cervical cancer. In addition, some studies suggest high concentrates of folate and vitamin B12 in the body may independently protect against the development of pre-malignant changes in the cervix. Potential benefits and risks of supplementation with folate and B12 should be discussed with your doctor.

Too often, my patients undergoing treatment for cervical cancer often say they wish they had taken advantage of the available preventative measures for their disease. They make sure their children receive HPV vaccinations and schedule regular Pap and HPV tests.

There are no easy treatments for cervical cancer after it has developed. Surgery, radiation and chemotherapy are physically demanding, intense regimens. 

With the tests and vaccines available today, we hope we can continue to observe a decline in rates of cervical cancer. Women should feel empowered to take advantage of these disease prevention methods and schedule screening as soon as possible.

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