What is Cervical Cancer?
Worldwide,
cervical cancer occurs in approximately 500,000 new cases and results in
240,000 deaths annually. In the United States, cervical cancer accounts for
nearly 12,200 new cases and 4,210 deaths annually. It is unfortunate to report
this high statistic because deaths from cervical cancer can be prevented with
screening and early detection.
The
cervix is located at the base of the uterus, or womb. In cervical cancer, the
normal cells lining the cervix develop into pre-cancerous cells over time.
Pre-cancerous cells can turn into cancerous cells over several years, but this
process may be as rapid as less than one year in some cases. Not all women with
pre-cancerous cells will develop cervical cancer, but most cases of cervical
cancer can be prevented with early detection of these pre-cancerous cells. Screening
is especially important as it can detect abnormal changes in the cervix so that
pre-cancers can be successfully treated before they develop into cervical
cancers.
What Are Common Risk Factors
for Cervical Cancer?
Having
risk factors does not necessarily mean you will develop cervical cancer.
However, it’s important to know these because many can be avoided. The most
important risk factor for developing cervical cancer is human papilloma virus (HPV). It is believed that a woman has to be
infected with HPV to develop cervical cancer.
We
will take a closer look at HPV, but first here are some additional factors that
may put you at increased risk for developing cervical cancer:
·
Smoking
·
Family history of cervical cancer (first degree relative)
·
Chlamydia (a sexually transmitted infection)
·
A weakened immune system because of other diseases or medications
·
Diet low in fruits and vegetables
·
Being overweight
·
Long-term oral contraceptive use (birth control pills)
·
Multiple (3 or more) full-term pregnancies
·
Young age at first full-term pregnancy (younger than 17 years)
·
Low income – no access to health care services
·
Women who’s mothers were exposed to diethylstilbestrol (DES) – a
hormone given to women to prevent miscarriages in 1940 – 1971
What Are Signs and Symptoms
of Cervical Cancer?
·
Abnormal vaginal bleeding:
o
Bleeding after intercourse
o
Bleeding after menopause
o
Spotting between menstrual periods
o
Longer or heavier menstrual periods than usual
o
Bleeding after douching
o
Bleeding after a pelvic exam
·
Unusual vaginal discharge (including some blood between periods or
after menopause)
·
Pain during intercourse
These signs or symptoms may
not necessarily be due to cervical cancer, and may be caused by other
conditions such as infections. Women with early cervical cancers or pre-cancers
may have no symptoms at all.
What Is HPV?
HPV
infection is very common and can be transmitted through skin-to-skin contact
with an area of the body that is infected with HPV, which includes sexual
contact such as intercourse or oral sex.
HPV
is made up of a group of viruses that can cause papillomas, or warts, on the surface of the skin, genitals, anus,
mouth, and throat. There are certain strains of HPV that are considered high-risk
because they are highly linked with cancers, including cervical cancer. These
high-risk strains are HPV 16 and HPV 18, and they cause up to 70% of all
cervical cancers. Other low-risk types of HPV are rarely linked to cervical
cancer, such as HPV 6 and HPV 11, which commonly cause genital warts.
Can HPV Infection Be
Prevented?
Though
they can provide some type of protection against HPV, condoms don’t fully
protect against the infection because they do not cover enough of the body area
that may be infected with HPV. However, there are 2 types of vaccines that can
protect women and men from HPV infection. Gardasil protects against HPV types
6, 11, 16, and 18 (both high-risk and low-risk strains). Cervarix protects
against the high-risk strains, HPV types 16 and 18. These vaccines can only
prevent infection, but they cannot treat an already existing HPV infection.
Because of this, the Federal Advisory Committee on Immunization Practices
(ACIP) and the American Cancer Society (ACS) recommend that all girls ages 11
to 12 should be routinely vaccinated, and also girls as young as 9 years when
doctors recommend it. If girls have not been vaccinated by age 12, they are
recommended to get vaccinated between the ages of 13 and 26 years. The Gardasil
vaccine is also recommended for boys between the ages of 9 and 26 years.
How Do I Get Screened for
Cervical Cancer?
Early
detection is key to preventing cervical cancers and successfully treating early
stage cervical cancers. This can be done with a yearly Pap test (or Pap Smear).
Most late-stage cervical cancers are found in women who have not had Pap tests regularly.
Since the HPV vaccine doesn’t protect against all HPV strains that can cause
cervical cancer, it’s important to get yearly Pap tests and pelvic exams even
if you have been vaccinated. Your doctor may also recommend testing for HPV
when necessary.
Here
are the ACS recommendations for screening and early detection:
·
Women should start getting tested for cervical cancer about 3 years
after they first start having sex with a regular Pap test every year. There is
a liquid-based Pap test that may be done every 2 years instead.
·
After the age of 30, if women have had 3 consecutive normal Pap test
results, they can be tested every 2 to 3 years rather than yearly.
·
Women over 30 with normal immune systems and no abnormal test results
may get a Pap test plus an HPV DNA test every 3 years.
·
Women who have risk factors for cervical cancer should continue to get
Pap tests yearly.
Treatment for Cervical
Cancer
Staging
for cervical cancers depends on how far the cancer has spread, and treatment
can vary between stages. Stage I is when the cancer is limited to the cervix,
while Stage IV is the most advanced and the cancer may spread as far as the
bladder or rectum. Treatment options include surgery to cut out cancerous
tissue, radiation to shrink the tumor, and chemotherapy.
In Summary
The
best treatment for cervical cancer is prevention and early detection. Regular
Pap tests and pelvic exams can alert your doctor to abnormal changes in the
cells of the cervix so that precautions can be taken for pre-cancers or
treatment can be started for early stage cervical cancers. If you do not have
insurance or access to health care services, there are programs available to
help you get screened for free or at a low-cost. General information about cervical
cancer and about access programs can be found at:
Illinois
Breast and Cervical Cancer Program
(217)
785-1050
Contact
the Department of Health in your state for participating programs. You can also
contact the CDC for more information at 1-800-CDC-INFO (1-800-232-4626) or go
to www.cdc.gov/cancer/nbccedp.
For
more information about cervical cancer and health awareness, please visit the
American Cancer Society website at http://www.cancer.org.
You can also talk to your UIC Pharmacist at one of the UIC Pharmacy locations.
Prepared by:
Anita Lammers, UIC PharmD
Candidate, Class of 2012
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