Cervical cancer is the second most common type of cancer for women worldwide.
Because it develops over time, it is also one of the most preventable. To increase knowledge about this disease, Congress has designated January as Cervical Health Awareness Month.
What is the Cervix?
"The cervix is the narrow opening of the uterus," described Obstetrician/Gynecologist Patricia Vigder, D.O.. "It is a small structure about an inch long and an inch wide. It opens slightly to allow menstrual flow and opens widely to deliver a baby. The cervix is a dynamic structure that can change its opening depending on the phase of the menstrual cycle, or the progression of labor."
Cervical Cancer and HPV
HPV (human papillomavirus) is the major cause of cervical cancer in women. HPV has also been linked with other cancers, and with genital warts. There are about 100 types of HPV, which is spread by sexual contact.
"HPV is the most common sexually transmitted infection in the U.S.," Dr. Vigder added. "At least 50 percent of sexually active people will come in contact with HPV at some time in their lives. It is most common in young women and men, who are in their late teens and early 20s.
"The majority of women infected with HPV do not develop cervical cancer, since about 90% of HPV infections resolve on their own within 2 years. Some women, however, do not clear HPV on their own, and are considered to have persistent infection. They are at a greater risk of developing cervical cell abnormalities and cancer. HPV can also cause genital warts, which can be disfiguring and uncomfortable."
There is no medicine to treat or cure HPV infection. The best approach is prevention and early diagnosis.
"Cancer of the cervix tends to occur during midlife," explained Dr. Vigder. "Half of the women diagnosed with this disease are between 35 and 55 years of age, only 20 percent of the women are diagnosed when they are older than 65.
"The best way to detect pre-cancerous changes or early cancer is to have a test of the cells of the cervix," said Dr. Vigder. "This is called a PAP smear, developed by Dr. Georgios Papanikolaou, a Greek physician, in the early 1900s. It is a non-painful, noninvasive test that can diagnose pre-cancerous cell changes as well as cancer of the cervix. Since pre-cancerous changes and early cervical cancer do not cause symptoms, this easy test can be lifesaving."
You should contact an OB/GYN if you experience:
-Abnormal bleeding, such as between regular menstrual periods, after sexual intercourse, or after a pelvic exam
-Pelvic pain not related to your menstrual cycle
-Heavy or unusual discharge that may be watery, thick, or have a foul odor
-Increased urinary frequency or pain during urination
Although these can be signs of benign (non-cancerous) conditions, your doctor will check you for cervical cancer as part of the work up.
"Cervical cancer is one of the most preventable cancers today," said Dr. Vigder. "It is important to remember that cervical cancer takes many years to develop. If caught early, the five year survival rate is almost 100 percent. Regular Pap testing can help detect pre-cancerous or abnormal cells early enough so that cervical cancer can be prevented.
"In addition to a Pap test, your doctor may also recommend an HPV test. The HPV test does not indicate the presence of pre-cancerous or cancerous cells, but instead determines whether or not a woman has an HPV infection. The HPV test cannot tell you whether your infection is new or if it is persistent, but it will assist you and your doctor to determine appropriate follow-up and intervals for cervical cancer screening."
Two HPV vaccines are licensed by the Food and Drug Administration and recommended by the Centers for Disease Control and Prevention (CDC). These vaccines are Cervarix (made by GlaxoSmithKline) and Gardasil (made by Merck).
"The HPV vaccine is given in three doses," Dr. Vigder stated. "It works by targeting HPV types that cause up to 70 percent of all cervical cancers and about 90 percent of genital warts, but it will not treat existing HPV infections or their complications."
The Cervarix and Gardasil vaccines are licensed and effective for individuals ages 9 through 26 years. The CDC recommends vaccination for this age group. "People who have already had sexual contact before getting all three doses of an HPV vaccine may still benefit if they were not infected before their vaccination with HPV," said Dr. Vigder. "The best way to be sure that a person gets the most benefit from an HPV vaccination is to complete all three doses before sexual activity begins."
Cervarix protects against five types of cancer causing HPV. Gardasil protects against two types of cancer causing HPV, and also protects against two types of HPV that cause genital warts.
"Even if a woman has had the HPV vaccine, she should continue to have her regular Pap test and HPV test as recommended," Dr. Vigder concluded. "At this time, the vaccine only protects against 70-80 percent of the potential cervical cancer cases."
In addition to routine Pap testing, women may want to consider minimizing risk factors that could contribute to cervical cancer, such as: multiple sexual partners, sexual intercourse at an early age, Chlamydia infection, and, cigarette smoking.
Patricia Vigder, D.O., is a board certified obstetrician/gynecologist affiliated with Salem Community Hospital's medical staff. Appointments: 330-332-1939.