As 2022 begins, Cervical Cancer Awareness Month arrives to remind us that there is a cancer that scientists and physicians have really gotten a handle on — as long as anyone with a cervix follows the advice of those experts.
According to the American Cancer Society, in 2022 about 14,140 new cases of invasive cervical cancer will be diagnosed, and about 4,280 women will die from cervical cancer. This is a huge improvement over the days when cervical cancer was a leading cancer killer of women, however. The cervical cancer death rate dropped significantly in the U.S. after introduction of the Pap test in the 1950s.
Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44, with the average age at diagnosis being 50.
Ernest Han, M.D., Ph.D., chief of City of Hope’s Division of Gynecologic Oncology, Department of Surgery, stresses that there is a two-pronged attack that is key to avoiding cervical cancer altogether. Both help fight off HPV (human papillomavirus), which causes about 99% of cervical cancers, with the HPV vaccine being the first line of defense.
"It's such an important thing, the HPV vaccine. I mean, how many vaccines can we say actually prevent you from getting cancer? When we see patients — young people — who come in with advanced cancers that the HPV vaccine could have prevented, it is sad to see their lives completely altered, when all they needed was a shot."
Importance of the HPV Vaccine
The HPV vaccine not only helps protect against cervical cancer, but works to prevent vaginal, vulvar, anal, throat and back-of-mouth cancers, as well as genital warts, which is why Han strongly advocates to parents to have their children vaccinated.
"It's disappointing that here in America we're not 100% vaccinated for HPV. I know that our government has been trying to achieve that high a level of vaccination, but we still continue to struggle with this," he commented.
"The HPV vaccine really should be part of the general vaccines that every child gets. We really need to get that message out." The fully vaccinated rate in the U.S. as of 2020 is about 60%.
For those with or without an HPV vaccine, Han recommends getting regularly screened for HPV, which is the main cause of cervical cancer. Doctors test for the high-risk HPV types that are most likely to cause cervical cancer by looking for pieces of their DNA in cervical cells by performing a swab.
In line with the new guidelines established in 2020 by the American Cancer Society (ACS), screenings should begin at age 25 and continue to age 65, happening every five years. The preferable/primary test is an HPV test, with a cytology test (a Pap smear) only used if an HPV test is not available. "Some countries out there have already converted to using just HPV-based screenings, as opposed to using cytology at all. I think that shift is coming, so I wonder if it's just a matter of time for the United States to go down that path as well," Han pondered.
Looking to the Future
Han looks forward to a time when HPV testing becomes as common as an over-the-counter pregnancy test, something that he believes is coming to the United States sooner rather than later.
"There have been studies looking at self-administered HPV tests, for women to just do their own swab and collect a sample. That could, I think, help more patients get screened. It would be nice if you could just go find an HPV test on the shelf, like you buy a pregnancy test. Purchase it and do it yourself, send it into a lab and get a result. I think more people could be screened that way and, hopefully, it would be more of an impetus for women to get themselves checked," he said.
"Of course, we'd also need a mechanism in place for them to know the next steps they need to take if they get a positive test. We'd still need them to access the appropriate care for additional medical workup and potentially additional tests.”
Han pointed out that there are still health facilities around the United States that are unable to administer HPV testing, which is becoming the gold standard for cervical cancer screening. The key is finding cervical cancer early enough to eradicate it without too much effect on a person's body. That means that some people who lack access to routine preventive health care would really benefit from home tests. And, of course, such home tests would have been of huge benefit during the COVID-19 pandemic, when breast and cervical cancer screenings dropped by as much as 94%.
"It's really exciting that there are things that we can continuously improve on as our technology advances, things that can help us screen more people. Early detection will always be what gives patients the best chance for a cure, and a home-testing kit would potentially make a significant difference. That test coming onto the market in the coming years would be a big advance to stopping cervical cancer from happening," he said.