Cervical cancer: Much progress, still too many diagnoses

December 31, 2013 | by Denise Heady

Cervical cancer was once one of the most-common causes of cancer death for women in the United States. Now, with better screening techniques, targeted treatments and vaccinations, the death rate has declined dramatically.

HPV vaccine January has been deemed National Cervical Cancer Awareness Month. It's a time to reflect on how much progress has been made against the disease, and how much more needs to be done.

“The diagnosis and treatment of cervical cancers have changed markedly in the past 10 years,” said Robert J. Morgan, M.D., co-director of the gynecological cancers program at City of Hope. “The addition of chemotherapy to radiation in locally advanced cervical cancer in the early part of this century added significantly to the long-term, disease-free survivals in this illness.”

Discovering the connection between the human papillomavirus (HPV) and cervical cancer was also groundbreaking, allowing for vaccination to lower the risk of cancer. "This discovery has increased our understanding of the pathogenesis of this illness and has allowed the development of very effective vaccines that can prevent the illness from occurring,” Morgan said.

This milestone is especially notable during January, which Congress has deemed Cervical Cancer Awareness Month. Most people will acquire the HPV infection at some point in their lives, but their immune systems will usually eliminate the virus, Morgan said. The risk of developing cervical cancer, however, rises with exposure to the HPV strains that can cause the disease.

HPV types 16 and 18 are known as high-risk strains, causing about two-thirds of all cervical cancers. According to the National Cancer Institute, the HPV vaccination has been found to prevent nearly 100 percent of the precancerous cervical cell changes that are caused by these two strains.  (The virus has more than 150 strains; some are harmless, some cause warts and some can lead to a range of cancers.)

Experts point out that HPV vaccination isn’t just for females. “The virus can be transmitted through male sexual partners and there is a small risk of penile cancer in men infected with the HPV. So both men and women should be vaccinated,” Morgan said. “Unfortunately, these vaccines are not yet used by large enough percentages of the population.”

The Centers for Disease Control and Prevention (CDC) currently recommends the HPV vaccination for preteen girls and boys at age 11 or 12, before they become sexually active. It also recommends the vaccine for teenagers who didn't get the vaccine when they were younger, women through age 26, and men through age 21.

Even with the leaps in treating and preventing cervical cancer, much progress is needed in treating patients with advanced disease. Annually, almost 12,000 women in the U.S. are diagnosed with cervical cancer, and almost 4,000 die from it, according to the CDC.

However, Morgan noted that cervical cancer is one of the few cancers that can be diagnosed in the premalignant stage, allowing patients to avoid aggressive treatments with radiation and chemotherapy.

“If women have regular gynecologic care with pap smears as recommended, the illness is almost 100 percent preventable,” Morgan said.

It is also important for women to remember — even those who have received the vaccine — to continue to see their gynecologists for routine gynecological care.



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