Conquering Cervical Cancer

CDC recommends screenings and vaccination
Author: Sarah M. Aldridge, MS

Although cancer is a mighty foe, some types can be conquered. One of those types is cervical cancer. According to the US Centers for Disease Control and Prevention (CDC), 93% of new cervical cancers could be prevented by routine screening and vaccination. A CDC Vital Signs report in November 2014 stated that 8 million women ages 21-65 did not get screened in the five-year period ending in 2012. Of those, more than 70% had health insurance and a regular physician. With an estimated 10,000 new cases of cervical cancer diagnosed yearly in the US, it’s time to do something about it.

If you’re not sure what cervical cancer is or how it spreads, read on. If appropriate, make an appointment with your ob/gyn to get screened, tested and treated.

The virus-cancer connection

The cervix is the lower part of the uterus, connecting it and the vagina. Cervical cancer develops from an infection by the human papilloma virus (HPV). HPV belongs to a family of more than 100 viruses, a dozen of which cause papillomas, or warts, in genital areas. 

HPV spreads when a person has skin-to-skin sexual contact with an infected individual, typically during vaginal, oral or anal sex. The CDC estimates that ¾ of adults who have had sex will get an HPV infection in their lifetime. In most cases, the immune system destroys HPV and there are no lasting effects.

After infection, cervical cells do not suddenly become cancerous. Instead, changes occur slowly, often taking years to develop. Further, pre-cancerous cells can revert to normal cervical cells.

However, the American Cancer Society (ACS) says certain HPV strains, or genotypes, are high risk, causing chronic infections in about 10% of infected women. Nearly 70% of all cervical cancers are caused by two genotypes: HPV 16 and 18.

If you have a chronic infection, HPV penetrates deeper into cervical cells. Cells that break free can travel in your bloodstream or lymph to other sites, such as the lungs, liver or bones. At these distant locations, new cells and tissues can become infected, resulting in tumors. 

Who’s at risk

Risk factors that increase your chance of HPV infection becoming cancerous include: 

  • family history
  • cigarette smoking 
  • being overweight 
  • long-term use of oral contraceptives 
  • taking immunosuppressant drugs

Sexually active women younger than 30 who have had many partners are also at increased risk for cervical cancer.

The link between smoking and cervical cancer is found in the chemicals in tobacco, says the ACS. When you inhale a stream of smoke, your lungs absorb the chemicals, which are then carried in the blood to other body parts. The chemicals damage cells either directly or indirectly. It is thought that tobacco by-products, found in the cervical mucus of women smokers, damage the DNA of these cells. The other possibility is that smokers’ immune systems are less capable of fighting HPV infection.

Symptoms, if any

The problem with cervical cancer is that in the early stages there are no symptoms. After HPV spreads to other tissues, you might experience the following: 

  • abnormal vaginal bleeding or discharge after intercourse, between periods or during menopause
  • menorrhagia (longer, heavier periods)
  • pain during intercourse
  • pelvic pain

Testing

A Pap test can detect pre-cancerous changes in cervical cells and the presence of HPV. Your ob/gyn will use an instrument to scrape cells from the lining of your cervix. Viewing the cells under a microscope can help your doctor detect any changes. 

If you have a bleeding disorder, ask the nurse at your hemophilia treatment center (HTC) if you need a form of prophylaxis before your Pap test. (Read “An Ounce of Prevention,” HemAware Winter 2012)

Preventing, protecting

The goal of cervical cancer awareness is to prevent infections. The CDC now recommends that girls get vaccinated against HPV at age 11 or 12, before they’re likely to be exposed to the virus. Merck’s Gardasil® protects against HPV genotypes 6 and 11 (the most frequent causes of genital warts), and genotypes 16 and 18. It helps prevent cervical cancer; cancers of the anus, vagina and vulva; and genital warts. GlaxoSmithKline’s Cervarix®, for girls and young women ages 9-25, helps prevent cervical cancers caused by HPV genotypes 16 and 18. 

Both vaccines are given in a series of three injections over a 6-month period. The ACS warns that no HPV vaccine conveys complete protection against all genotypes that can cause cervical cancer. You will still need screening after you’ve been vaccinated.

In April 2014, the US Food and Drug Administration (FDA) approved the use of the cobas® HPV test to screen for primary cervical cancer in women 25 and older. It identifies 14 HPV genotypes, including 16 and 18. (Read “New Approval for HPV Test,” HemAware Summer 2014)

When you schedule your next ob/gyn appointment, make a note to yourself about being tested for HPV. If you catch cancer early, you can be the conqueror.