Cervical cancer, in which cells of cervix grow out of control, is the third most common type of cancer amongst US women. In 2018, an estimated 158 000 new cases and 95 766 deaths were reported due to cervical cancer, which is the third most common type of cancer.
The World Health Organization urged countries in the South-East Asia Region to accelerate efforts to eliminate cervical cancer by 2030. Four countries in the region – Bhutan, Maldives, Sri Lanka, and Thailand – have introduced HPV vaccine nationally.
In the United States, its incidence and mortality are well below that of breast, lung, endometrial, colon, and ovarian cancer. The mortality and incidence of cervical cancer have significantly declined after the introduction of routine Papanicolaou (Pap) smear screening. Cervical cancers are most often squamous cell carcinomas that arise from infection with a high-risk human papillomavirus (HPV) serotype.
What Can I Do to Reduce my Risk?
The two most important things you can do to help prevent cervical cancer are to have regular screening tests starting at age 21 and getting the HPV vaccine if you are eligible, and to be tested regularly, according to American Cancer Society (ACS) guidelines.
The most common form of cervical cancer starts with precancerous changes and there are ways to stop this from developing. The first way is to find and treat precancerous lesions before they become invasive cancers, and the second is to prevent the emergence of precancerous lesions.
Finding cervical pre-cancers
A well-proven way to prevent cervical cancer is to have screening tests. Screening is having tests to find conditions that may lead to cancers and can find precancerous lesions before they can turn into invasive cancer. The Pap test (or Pap smear) and the human papillomavirus (HPV) test are specific tests used during screening for cervical cancer. These tests are done the same way. A health professional uses a special tool to gently scrape or brush the cervix to remove cells for testing. If a precancerous lesion is found, it can be treated, keeping it from turning into cervical cancer.
The HPV test looks for infection by high-risk types of HPV that are more likely to cause precancers and cancers of the cervix. There are certain HPV tests approved to be a primary HPV test and others approved as part of a co-test. The type you get most often depends on which test is available in your area.
- The HPV test is most often used in 2 situations: The ACS recommends the primary HPV test* as the preferred test for cervical cancer screening for people 25-65 years of age.
- Some HPV tests are approved only as part of a co-test, while the HPV test and the Pap test are done at the same time to screen for cervical cancer. Because a primary HPV test may not be an option everywhere, a co-test every 5 years or a Pap test every 3 years are still good options.
The Pap test or smear is a procedure used to collect cells from the cervix so that they can be looked at closely in the lab to find cancerous and precancerous lesion. It is important to know that most invasive cervical cancers are found in women who have not had regular Pap tests. A Pap test can be done during a pelvic exam, but not all pelvic exams include a Pap test.
The most widely used system for describing Pap test results is the Bethesda System (TBS). There are 3 main categories, some of which have sub-categories:
- Negative for intraepithelial lesion or malignancy
- Epithelial cell abnormalities
- Other malignant neoplasms.
Primary prevention
Preventing primary infection with HPV with HPV immunisation preferably before first sexual intercourse.
Indications:
Current guidelines:
- Administration of 2 doses of nine-valent HPV vaccine to all individuals between 11–12 years of age.
- The 2nd dose should be administered 6–12 months after the 1st dose.
- Immunisation can be started as early as 9 years of age.
- Administration of 3 doses of nine-valent HPV vaccine to all unvaccinated individuals between 15–26 years of age.
- The 2nd dose should be given 1–2 months after the 1st dose and the 3rd dose 6 months after the first dose.
FDA-approved vaccines
- Bivalent vaccine (Cervarix®): protection against high-risk HPV types (16 and 18).
- Tetravalent vaccine (Gardasil®): protection against high-risk HPV types (16 and 18), as well as against low-risk types (6 and 11, being the most common cause of genital warts).
- Nine-valent vaccine (Gardasil®9): protection against high-risk HPV types (16, 18, 31, 33, 45, 52, and 58), as well as against low-risk types (6 and 11).
Secondary prevention
Every woman aged 21–65 should undergo screening for cervical cancer.
The ACOG currently recommends the following screening for women with previously normal exams:
- < 21 years: no screening required.
- 21–29 years: Pap smear every 3 years.
- 30–65 years: Pap smear every 3 years OR co-testing (Pap smear with HPV test) every 5 years.
- > 65 years: no more testing required if the previous testing was negative.
Immunocompromised women (e.g. HIV) and women with DES exposure but average life-expectancy should continue screening.
Screening for women with HIV: Pap smear twice in the first year after HIV diagnosis and annually thereafter.
Things to do to prevent pre-cancers and cancers
Get an HPV vaccine.
- These vaccines only work to prevent HPV infection − they will not treat an infection that is already there.
Limit exposure to HPV.
- HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. Although HPV can be spread during skin-to-skin contact − including vaginal, anal, and oral sex − sex does not have to occur for the infection to spread. All that is needed is skin-to-skin contact with an area of the body infected with HPV. This means that the virus can be spread without sex. It is even possible for a genital infection to spread through hand-to-genital contact.
- Limiting the number of sex partners and avoiding sex with people who have had many other sex partners may lower your risk of exposure to HPV.
Use a condom.
- Condoms (rubbers) provide some protection against HPV, but they do not completely prevent infection. One reason that condoms cannot give complete protection is because they do not cover every possible HPV-infected area of the body, such as skin of the genital or anal area. Still, condoms provide some protection against HPV, and they also help protect against HIV and some other sexually transmitted infections.
Do not smoke.
- Not smoking is another important way to reduce the risk of cervical pre-cancer and cancer.
Reference :
- Johns Hopkins University. Statistics: Gynecological Health at a Glance. https://www.hopkinsmedicine.org/healthlibrary/conditions/gynecological_health/statistics_gynecological_health_at_a_glance_85,P00587. Updated January 1, 2012.
- National Cancer Institute. Cervical Cancer Prevention (PDQ®)–Health Professional Version. https://www.cancer.gov/types/cervical/hp/cervical-prevention-pdq#section/_AboutThis_1. Updated February 27, 2017. Accessed March 14, 2017.
National Center for Chronic Disease Prevention and Health Promotion (U.S.), Division of Cancer Prevention and Control. Cervical cancer screening with the HPV test and the Pap test in women ages 30 and older. url: https://www.cdc.gov/cancer/cervical/pdf/hpv_testing_2012_english.pdf - National Center for Chronic Disease Prevention and Health Promotion (U.S.), Division of Cancer Prevention and Control. Cervical cancer screening with the HPV test and the Pap test in women ages 30 and older. url: https://www.cdc.gov/cancer/cervical/pdf/hpv_testing_2012_english.pdf WebMD. Cancer-related anorexia/cachexia an ongoing challenge despite an increasing range of drug choices. Drug Ther Perspect. 2001; 17(22). url: http://www.medscape.com/viewarticle/414908_1.
- U.S. Food and Drug Administration. Human Papillomavirus Vaccine. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm172678.htm. Updated September 12, 2016.
- Editors of the American Society for colposcopy and Cervical Pathology. Updated Consensus Guidelines for Managing Abnormal Cervical Cancer — Screening Tests and Cancer Precursors. url: https://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf
- The American Cancer Society medical and editorial content team. Radiation Therapy for Cervical Cancer. https://www.cancer.org/cancer/cervical-cancer/treating/radiation.html. Updated December 5, 2016.