Cervical Cancer: Do You Know Your Risk?

Reviewed By:
Joanne Poje Tomasulo, M.D., ACOG

Holding the number three spot on the list of common gynecological cancers, cervical cancer can be prevented and cured when detected early. On a yearly basis, about 11,000 women in the United States are diagnosed with cervical cancer, and more than 3,800 die from the disease, according to the American Cancer Society. Across the globe, close to 500,000 women are affected by this malignancy. In some parts of the world, cervical cancer is the most commonly found cancer in women, according to the National Cervical Cancer Public Education Campaign.

However, most cases of cervical cancer are preventable, either with a recently developed vaccine or with regular screenings for cervical cancer. Both the vaccine and the screening are related to the greatest risk factor for cervical cancer, the human papillomavirus (HPV).

Most cases of cervical cancer are caused by some strain of HPV. There are more than 100 types of HPV, some of them common viruses frequently found on the skin as warts. Others are transmitted through skin to skin and sexual contact, where they can contribute to HPV infection.

HPV exposure on the cervix may cause no problems or may cause an infection that clears on its own. In a few cases, HPV infection of the cervix can initiate changes that eventually develop into precancerous lesions, which may develop into cervical cancer if left untreated.

HPV infections generally do not produce symptoms, so people do not know they have the virus, and more importantly, do not realize they can pass it to other people through sexual contact. Your risk for contracting HPV increases with sexual activity. Although using condoms can reduce the risk of transmission, they cannot completely prevent HPV. Most risk factors for HPV are associated with sexual activity, including an early age for sexual activity, number of sexual partners and having unprotected sex. In addition, having another sexually transmitted infection such as chlamydia or HIV also increases the risk of contracting HPV.

Despite the fact that HPV is so common, it is one of the few carcinogens that can be stopped or managed before it becomes cancer. For years, doctors have been able to manage HPV and its potential damage through regular Pap smears. More recently, a vaccine introduced in 2006 can prevent infection from the strains of HPV that cause most cases of cervical cancer.

The Pap smear is an extremely simple test. During a pelvic examination, a doctor scrapes the cervix to gather cells, which are put on to a slide or are dipped in a fluid mixture especially for the test. A technologist or pathologist examines the cells under a microscope, where lesions or changed cells can be identified. Pap tests can detect precancerous lesions, also known as cervical intraepithelial neoplasia (CIN), which if untreated can lead to cancer.

After a problem is detected, the patient may be monitored with more frequent Pap smears or treatments may be planned to remove any lesions before the progress to cervical cancer.

Pap testing should begin at the onset of sexual activity or at age 21 and continue annually. After age 30, women who have had three years of normal Pap smears may get screened every two or three years if they have no other risk factors for cervical cancer, such as a weakened immune system or HIV infection.

In recent years, a new weapon was added in the war against cervical cancer: the HPV vaccine. First introduced in 2006, the vaccine can prevent the transmission of four major strains of HPV, including the two strains that cause 70 percent of cervical cancer. The vaccine is approved for use in girls and women ages 9 to 26. The vaccine is most effective when it is administered before any potential exposure to HPV, which means before any sexual activity. Although approved for girls as young as 9, the vaccine is recommended for girls ages 11 and 12. For now, the vaccine is not approved for older women or for boys or men, despite the fact that they can transmit HPV.

Knowing your risk for cervical cancer also gives you the tools to prevent it. The best ways to reduce your risk for cervical cancer include:

• Ask your doctor about the HPV vaccine and if you're eligible, get it. The vaccine is given in three doses over six months, so don't forget the last two doses.
  
• Get regular gynecological exams with Pap smears. Follow your doctor's recommendations for anything unusual, such as getting follow-up Pap smears more often or methods to treat any lesions.
  
• Reduce your risk in your sex life. Practice safe sex with fewer partners. Get tested for other sexually transmitted disease because they can increase the risk of contracting HPV in addition to other complications.

Cervical cancer is one of the bright spots in advances in cancer care and prevention. Since the advent of the regular use of the Pap smear in the 1950s, cervical cancer cases and death rates have dropped significantly in nations where Pap smears are readily available. In countries where women still struggle for regular preventive healthcare, cervical cancer is still a major killer. Knowing your own risk and how to reduce it can help keep cervical cancer out of your life.