According to the most recent statistics from the American Cancer Society regarding cervical cancer, there will be approximately over 12,000 new cases of invasive cervical cancer diagnosed and around 4,000 women will die of the disease annually. Some researchers predict that non-invasive cervical cancer (curable) will be diagnosed four times more often than invasive. However, the outlook has much improved over the years; between 1955 and 1992, the death rate from this disease decreased by approximately 70 percent due to the use of the Pap test to detect the cancer at its earliest, most curable stages
Recently, we talked with Dr. Sacha Wax, MD, OBGYN who also practices at Lakeside Women’s Specialty Center and who is also on staff at East Jerrferson General Hospital about the details of cervical cancer: causes, prevention, progression and treatment.
Is cervical cancer preventable? What are the precautions and the measures of detection? Cervical cancer is not 100% preventable. The goal with prevention and treatment is early detection with annual gynecologic exams and Pap smear collection. Precautions can also include reducing modifiable risk factors, specifically smoking which increases risk of developing [it] four-fold. Most women with cervical cancer have a visible lesion on the cervix and have early symptoms such as post-coital bleeding, abnormal bleeding, postmenopausal bleeding, and foul-smelling vaginal discharge or with later symptoms including pelvic pain, bladder or rectal symptoms. In general, treatment and prognosis depends upon the type and stage of cervical cancer.
If you have an abnormal pap smear, what does that mean at that time and moving forward? A pap smear is a swab that is used to collect an exfoliation of cells on the cervix and is best at detecting pre-cervical cancer lesions, also known as cervical dysplasia… . This is not always visible to the naked eye thus this why a pap smear is performed during a pelvic exam. The cells collected by the Pap smear are sent to a pathologist who then views the cells under a microscope to determine if they appear abnormal and assign a degree of abnormality in the form of a grade… . Since a pap smear is only an exfoliation of cells and does not give a true tissue diagnosis, we confirm the suspected grade abnormality with a biopsy of the cervix also known as colposcopy. This biopsy helps confirm the grade of dysplasia that determines treatment. Thus to further explain the continuum of cancer: normal cervix, cervical dysplasia grade 1 through 3, carcinoma in situ, then cervical cancer. On the other hand, when a physician calls a patient to inform them that they have an abnormal pap, it does not necessarily mean that they have cervical cancer; they most likely have cervical dysplasia. The patient needs a confirmatory biopsy to rule out a higher grade and treatment is based off of dysplasia severity.
How does age affect the possible onset of this disease? There is no average age for cervical cancer, but there are two age ranges during which it peaks… between ages 35-39 and 60-64. There are fertility preserving treatment options for younger women with early stage cervical cancer. Besides this, overall treatment is the same regardless of age; however, each case should be individualized.
Human papilloma virus (HPV) causes cervical cancer. How can we prevent it? There are over 100 types of HPV identified that are cervical cancer precursors; it is transmitted via sexual intercourse, but condoms do not always prevent transmission as HPV can be transmitted via skin-to-skin contact on exposed surfaces. There are high-risk types of HPV, but not all types cause cervical cancer. 80% of women will become infected by HPV in their lifetime and disease prevention includes both vaccination and screening. Gardasil is a vaccine against [two] HPV types that are responsible for 75% of cervical cancers. Ideally, young girls and boys should be vaccinated prior to sexual activity, starting as early as age nine up to age 26. Current recommendations advise against testing for HPV types in adolescents because it is so common and may cause unnecessary invasive treatments that could affect fertility. Most adolescents are young, healthy and readily able to clear the virus.
What is the progression of cervical cancer? Most cervical cancers are slow growing and spread by direct invasion to the surrounding organs. Invasive lesions spread first to the surrounding cervical supportive ligaments, vessels and lymphatics followed by the vagina, bladder and rectum, respectively. The progression of high-grade cervical dysplasia to cervical cancer often spans 8 to 12 years.
What are the best recommendations, other than regular check-ups and Pap tests, you can make in order to prevent cervical cancer? Vaccinate young people, live a healthy lifestyle, maintain good health, and avoid tobacco products.