Overview
Cancer of the Cervix is the second most
common type of cancer in women worldwide, after breast cancer. In
the US each year there are about 15,000 new cases of cervical
cancer, resulting in nearly 5000 deaths. Although cervical cancer
remains a major public health problem in third world countries,
causing significant morbidity and mortality, in the US and
other developed countries, it is relatively uncommon.
Accounting for this difference in the incidence of cervical cancer
between the developed and developing nations is the
availability of intense screening programs in the former, while
such programs are virtually non-existent in third world
countries. Yet a preponderance of evidence exists to suggest that
cancer of the cervix
- has
a known cause
- is
preventable using established screening programs and follow-up
- is
almost always curable if detected early.
From the foregoing, it makes sense to argue
that any effort to reduce the incidence of cancer of the cervix
in any population group, particularly in blacks worldwide,
should be directed towards aggressive health education and
preventive strategies.
What is Cervical Cancer?
The cervix (neck) of the uterus is part of
the female reproductive system. It is the narrow, lower part of
the uterus (womb) that connects the vagina below to the uterus
above. Cancer of the cervix results when cells in the cervix
become abnormal and divide uncontrollably, creating a mass of
extra tissue called a tumor. The key thing to remember is that the
development of cancer of the cervix occurs in a stepwise fashion.
In other words, there are well known trigger factors called
carcinogens that are believed to induce the normal
cervical cells to become abnormal; subsequently these abnormal
cells begin to multiply without control or order, leading to the
mass of extra tissue called cancer of the cervix. Hence any
attempt at preventing cancer of the cervix should be channeled
towards identifying individuals with these trigger factors as
well as screening for these abnormal cells (pre-cancerous cells)
before they transform into cancerous cells.
Risk Factors for Cervical Cancer
- Pap
test history – It is now well established that women, who
have either never had Pap
tests or have not had them as frequently as recommended,
have a higher risk of developing cervical cancer. The Pap test
is a screening test in which cells in and around the cervix
are examined to detect any abnormalities. There are a range of abnormalities known to lead to cancer of the cervix. Thus, when detected
prior to cancer development, treatment can be offered to
prevent cancer of the cervix. In the US, inadequately screened
populations, such as African-American and Hispanic women,
appear more susceptible to cancer of the cervix. It
remains true however, that regardless of race, the women who
remain most susceptible to the development of cervical cancer
are those who do not receive screening at all. Therefore, to
reduce the rates of cervical cancer development as well as
deaths from it in African-American women, efforts should
be directed towards getting more of them to undergo Pap tests.
This is the challenge for these women and their health care
providers.
- Sexual
History – Women who were sexually active at a very early
age and/or have had many sexual partners are believed to have
a higher risk of developing cancer of the cervix.
- Human
Papillomavirus (HPV) infection – HPV is a sexually
transmitted virus that is now recognized as the major cause of
cancer of the cervix. It is now established that persistent
HPV infection increases by over 250 times the relative risk of
cervical cancer. It is believed that HPV can induce normal
cervical cells to become cancerous.
- Smoking
– Although the mechanism by which it contributes to the
development of cancer of cervix is not well known, smoking
remains a risk factor for cervical cancer. The suggested
theories include: (a) the chemicals associated with smoking
may induce normal cells of the cervix to become abnormal (i.e.
precancerous) and (b) by lowering a woman’s individual
immune surveillance, smoking increases her risk of developing
cancer of the cervix.
- HIV
infection – Women with HIV infection have a higher risk
of developing cancer of the cervix.
Symptoms of Cervical Cancer
Unfortunately, early cervical cancer is not associated with pain, and often
does not cause any symptoms that can lead a patient to seek a
physician. In fact, by the time symptoms attributable to cervical
cancer appear, it may be incurable. It thus follows that the best
protection against cancer of the cervix is not to wait for the
symptoms to appear, but to reduce your risk factors when
feasible, and get
regular Pap smears. However, a good rule of the thumb is that
anytime abnormal vaginal bleeding occurs in a woman, she should
see a doctor to be screened for cervical cancer and other
abnormalities.
Prevention
Since its introduction in the 1940s,
the Pap smear has proven to be one of the most cost-effective,
evidence-based preventive tests ever developed in the health care
arena. When current screening guidelines are followed, the rate of
cervical cancer invariably declines, as has been demonstrated in the developed
countries. It is disheartening therefore, to note that, despite the
availability of this simple life-saving test, many women,
particularly in third world countries and in the African-American
population, continue to be afflicted by this disease that is
potentially preventable and curable. Surely, the best, and perhaps
the only way we can favorably alter this dismal statistic is to
remain vigilant and screen all women at risk of developing
cervical cancer. The current consensus screening guidelines
recommend that all sexually active women, or all women over the age
of 18 (whichever comes first) should get a baseline Pap test. Once three
normal annual Pap smears are documented, the interval for
continued surveillance with screening Pap smears might be
lengthened at the discretion of the physician and the patient. The
goal of the Pap smear is to detect any precancerous conditions,
which if found and treated, could prevent cervical cancer from
developing.
Treatment Options
Once the diagnosis of cancer of the
cervix is established, there are basically three main types of
treatment; surgery, radiation therapy, and less frequently drug
treatment (chemotherapy). Your doctor will discuss which options
are best for your situation.
Resources
1. American Cancer Society
http://www.cancer.org
2. National Cancer Institute
http://www.cancernet.nci.nih.gov
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Cervical Cancer