Researchers at Moffitt Cancer Center and colleagues at the University of South Florida and The Ohio State University have published a paper in the September issue of Cancer Epidemiology, Biomarkers & Prevention that provides an overview on preventing invasive cervical cancer.
“The good news is that over the past several decades, the incidence of invasive cervical cancer has declined dramatically,” said senior author Anna R. Giuliano, Ph.D., director of Moffitt’s Center for Infection Research in Cancer and senior member of the Cancer Epidemiology Department. “The bad news is that 60 percent of invasive cervical cancers occur in women who are members of underserved racial or ethnic minorities, in women residing in rural areas or living in poverty.”
The incidence of invasive cervical cancer has declined 75 percent since the 1940s. According to the authors, rates have decreased from 14.8 per 100,000 women in 1975 to 6.6 per 100,000 in 2008. Credit for the decline is given to the more widespread use of the Pap smear.
The number of current cases of invasive cervical cancer varies by race and ethnicity, geography, and socioeconomic status. For Hispanics, the incidence of invasive cervical cancer is 10.4 per 100,000, higher than any other group. Among blacks 85 and older, the incidence is three times higher than white women in the same age group.
“In looking across the nation, there are geographic and socioeconomic disparities associated with invasive cervical cancer rates,” noted lead author Christine M. Pierce Campbell, Ph.D., a postdoctoral fellow within Moffitt’s Cancer Epidemiology Department. “Along the U.S.-Mexico border, in the deep South and in Appalachia, rates are higher than in other regions of the nation. Also, many studies have shown that socioeconomic status predicts who gets screened, diagnosed and treated for invasive cervical cancer, regardless of race and ethnicity.”
Giuliano, Pierce Campbell and their co-authors also note that federal and local funding of prevention programs, such as the National Breast and Cervical Cancer Early Detection Program, the only nationwide screening program, has helped reduce incidence. Although the National Breast and Cervical Cancer Early Detection Program was implemented to promote screening among high-risk and low-income women, the program has historically served few of the women eligible for the service. The numbers of those taking advantage of the service vary by state, but between 2004 and 2006, only 8.7 percent of women eligible for screening received it, the authors said.
Important Facts About Cervical Cancer
• Cervical cancer can usually be prevented if women are screened regularly with a test called the Pap test.
• It is estimated that during 2003, about 12,200 women in the U.S. will be diagnosed with cervical cancer, and 4,100 women will die of the disease.
• Any woman who has a cervix can get cervical cancer, especially if she or her sexual partner has had sex with several other partners.
• Most often, cervical cancer develops in women aged 40 or older.
• Abnormal cells in the cervix and cervical cancer don’t always cause symptoms, especially at first. That’s why getting tested for cervical cancer is important, even if there are no symptoms.
• When it is found early and treated, cervical cancer is highly curable.
• Most deaths from cervical cancer could be avoided if women had regular checkups with the Pap test.
Human papillomavirus (HPV) vaccination, now in two forms, could also reduce incidence, the authors said. GARDASIL, the first HPV vaccine targeting females ages 9 to 26 to prevent invasive cervical cancer, was released in 2006. It was followed by the CERVARIX vaccine, which is targeted to females 10 to 25.
However, HPV vaccine use lags behind other adolescent vaccines, Giuliano said.
“Barriers to HPV vaccination include costs, perceived safety issues, and the perception that vaccination is unnecessary if the woman or child is not sexually active,” Pierce Campbell said. “Parental knowledge, attitudes and beliefs influence utilization, as well. Physician recommendation of the HPV vaccine is a key factor to its use, yet many primary care physicians have not been proactive in promoting it, especially to young adolescents in the target age groups.”
The most important thing you can do to avoid getting cervical cancer is to have regular Pap tests.
What is the Pap Test?
The Pap test, also called the Pap smear, is a cervical cancer screening test. It is not used to detect other kinds of cancer. It is done in a doctor’s office or a clinic. This test can find abnormal cells in the cervix that may turn into cancer if they’re not treated.
During the test, the doctor or nurse uses a plastic or metal instrument, called a speculum, to widen the vagina. This helps the doctor or nurse examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. These cells are placed on a slide and sent to a laboratory to be checked for abnormal cells.
The doctor or nurse also performs a pelvic exam, checking the uterus, ovaries and other organs to make sure there are no problems. There are times when a doctor may perform a pelvic exam without giving you a Pap test. Ask your doctor or nurse which tests you’re having, if you’re unsure.
Who Does Not Need to be Tested?
The only women who do not need regular Pap tests are:
• Those over age 65 who have had regular Pap
tests with normal results and have been told
by their doctors that they don’t need to be
• Women who do not have a cervix. This
includes women whose cervix was removed as
part of an operation to remove the uterus.
(The surgery is called a hysterectomy.)
However, a small number of women who
have had this operation still have a cervix and
should continue having regular Pap tests. If
you’re not sure whether you have a cervix,
speak to your doctor about it.
Because HPV infection in men contributes to HPV infection in women and the subsequent development of invasive cervical cancer, an additional strategy to reduce incidence has been the HPV vaccination of males, the authors said.
“Gender-neutral HPV vaccination would result in maximal disease reduction,” they wrote. “Universal HPV vaccination has the potential to reduce the incidence of invasive cervical cancer and its precancerous lesions by 91 percent.”