Cervical Cancer: Risks and Detection (or Prevention and Detection)

Cervical Cancer: Risks and Detection (or Prevention and Detection)

While cervical cancer is the third most common female cancer worldwide, it is also one of the most detectable. While some factors, such as family history, cannot be controlled, other risk factors can be minimized. Women can protect themselves by knowing the risk factors and by taking the necessary steps to be screened for the disease annually.

Risk Factors

Risk factors play a large role in the development of cervical cancer. Major risk factors include:

  • earlier onset of sexual activity
  • cigarette smoking
  • multiple sexual partners
  • immune-suppression
  • human papilloma virus (HPV)

Infection with specific high risk strains of HPV is central to the pathogenesis of cervical cancer. Eight high-risk types of HPV are responsible for 95% of cervical cancers. Two types of HPV, #16 and #18, are responsible for 70% of the cases. In the United States, up to 50% of sexually active young women will have a positive test within 36 months of first sexual activity. Most women will clear their HPV infection within eight to 24 months. Some infections, however, do not clear; and persistent infection for years is believed to be a factor in progression toward cervical cancer.

Recently, vaccination has become an option to help prevent HPV. Two vaccines have been approved for the prevention of two HPV high risk types. Gardasil and Cervarix are the brand names of these vaccines. Vaccination should be a topic for discussion with your gynecologist or primary care provider.

One preventable risk factor for cervical cancer is cigarette smoking. Cigarette smoking increases the risk of cervical cancer four fold. For those who smoke, it should serve as an important reason to stop.

Screenings/Detection

Cervical cancer screening has the potential to detect precancerous lesions and prevent cancer, as well as detect early stage disease and decrease cancer mortality. The Pap smear has become a model for cancer screening and is the primary screening test for cervical cancer. However, it is intended as a screening test rather than a diagnostic test. Approximately 50-60 million Pap tests are preformed in the United States each year, with annual spending on cervical cancer screening estimated to exceed 7.5 billion dollars.

In the United States, causes of invasive cervical cancer likely represent failure to have appropriate screening rather than inaccuracies of screening when performed. More than half of the women developing cervical cancer either have never had a cervical cytology screening or have not been screened within the previous five years.

Several new recommendations regarding cervical screening have been published over the last year. Most groups recommend initial Pap screening beginning at age 21. The frequency of Pap screening and possible HPV co-testing for women over the age of 30 has to be determined on an individual basis after reviewing prior history of cervical disease and discussion of risk factors. The Pap test could possibly be spread out over intervals longer than yearly depending on individual risk factors. Several agency guidelines suggest ending screening at age 65 when one has had recent adequate negative screening. Remember, these are only guidelines and each patient work with their personal provider to best establish an individualized screening protocol.

Some research trends are moving physician groups toward an annual wellness exam. This plan may not include an annual Pap test, but the wellness exam could include screenings such as mammograms, colon cancer screening recommendations, blood tests, sexual disease testing, obesity discussion, and lifestyle behaviors, just to name a few.

We have made strides in decreasing the number of cervical cancer diagnosis with newer technology and with the availability of vaccines. As a physician who has chosen to specialize in women’s health, my hope is that researchers continue to look for new ways to detect and treat this dreadful disease. If you have questions about cervical cancer or have not had your annual screening, please contact my office for an appointment.

Dr. Frank Pierce- The Jackson Clinic