Cervical cancer is a leading cause of female mortality worldwide. In areas without screening programs (pap smears and HPV testing), like Africa and Central America, it is the leading cause of cancer-related mortality amongst women. In developed countries like the United States, in 2012 cervical cancer was the eleventh most common type of cancer in women and the ninth most common cause of cancer deaths. In the US almost 13,000 new cases of invasive cervical cancer and about 4,100 cancer-related deaths occur each year. It is the third most common cancer diagnosis and cause of death amongst gynecologic cancers in the US.
All these statistics may seem grim, but the good news is that for the most part, with proper surveillance, the changes that lead to cervical cancer can be caught early enough to prevent it from progressing to advanced cancer. Cancer that starts in the cervix (the exit to the uterus (or womb) and top most part of the vagina) typically begins in the transformation zone, where the cells from outside the cervical canal meet the cells from the inside. The vast majority of cervical cancer is related to infection with the human papilloma virus (HPV). About 80% of women will become infected with the HPV virus during their lifetime, most in their late teens or early twenties when sexual activity starts. Most will have the virus killed by their immune system, and once out of the cervical cells, the changes caused to the cells revert to normal, healthy cervical cells. A small group will be unable to clear the HPV virus and those can progress to pre-cancerous cells that if left unchecked, progress to cervical cancer, usually over many years.
There is currently a vaccine available to help the immune system fight off HPV without ever having come in contact with it. Gardasil is currently available as a 9-valent vaccine. It covers against 9 types of HPV, including HPV 16 and 18 which together cause about 2/3 of all cervical cancers. It also protects against HPV strains that can cause genital warts. It is given as 3 doses between the ages of 9 and 26 and provides 97-100% immunity.
There have been changes in recent years to the recommendations by professional societies as to how often and how to screen for cervical cancer. Even if a yearly pap smear is not indicated, an annual pelvic examination should still be performed as part of a well woman visit with an obstetrician/gynecologist. After a discussion with your healthcare professional, you can make an informed decision as to when and if you need to have cervical cancer screening.
Cervical cancer is preventable and treatable, but only if it’s diagnosed early enough to intervene.