January is a month designated to cervical health awareness, specifically focusing on HPV (human papillomavirus) and HPV vaccination awareness. More than 13,000 women in the United States will be diagnosed with cervical cancer each year, and more than 4,000 of women will die. Cervical cancer is the fourth most common type of cancer for women worldwide, but because it develops over time, it is also one of the most preventable types of cancer. Cervical cancer is a cancer that forms in the cervix, the narrow passageway between the uterus and the vagina. The most common are squamous cell cancers (80-90%), which are the type of thin endothelial cells that line the top layer of the cervix. The remaining 10-20% of cervical cancer cases are adenocarcinomas, which develops in the glands that produce mucus. Deaths from cervical cancers are on the decline because of the increase in use of the Pap test. If suspicious cells are detected using a Pap smear, then there is an almost 100% likelihood of beating the disease. Most women that fully progress to cervical cancer have never had a Pap test, or have not had one recently (within 5 years). Cervical cancer, like most cancers, tends to occur during midlife, between the ages of 35 to 44. It rarely affects women under 25 or over 65.
What causes cervical cancer?
The most common cause of all cervical cancers is HPV - a common sexually transmitted disease that usually has no other symptoms. HPV has been found to be the cause of 99% of cervical cancer. There are over 150 different types of the virus, most of them being relatively low risk. Most sexually active people will acquire at least some of the 150 different strains of the virus. Some have been linked to genital warts and a few of the strains have been directly related to cancer. HPV triggers abnormal cell growth that can lead to genital and anal warts, precancerous cell changes known as dysplasia or neoplasia and, if left undetected and untreated, invasive cancer of the cervix, anus, vulva, vagina, penis or mouth and throat.
More than 70% of the cervical cancer cases can be linked to just two of the strains - HPV-16 and HPV-18. HPV is actually the most common STD in the United States and 80% of women have been infected with at least one strain of HPV. 90% of HPV infections resolve on their own in less than 2 years and the majority of women will never develop cervical cancer from an HPV infection. Women who can’t clear an HPV infection are most likely to develop cancer, but only if not detected or treated for many years. Development of cancer from HPV happens gradually over many years through a number of pre-cancerous stages, called cervical intra-epithelial neoplasia (CIN). Large CIN changes have a 1 in 3 chance of developing into cancer, but most CIN lesions regress on their own.
How do you prevent cervical cancer?
The five year survival rate of cervical cancer is around 70%. If detected early, this number jumps up to 92%. This is a drastically large survival rate compared to other types of cancer. Cervical cancer is highly preventable in countries where testing, screening and HPV vaccines are readily available. In countries with limited access to these, the survival rate greatly decreases. In the United States the HPV vaccine has been available since 2006. The two surefire ways to prevent cervical cancer are to be vaccinated with the HPV vaccine at a young age and to also obtain regular screenings throughout adulthood - both Pap smears and HPV testing. Regular screenings can help catch precancerous cells early and prevent almost all cases from developing into cancer. The Pap smear is directly looking for precancerous cells, or any cells with abnormal features or warning signs. HPV tests are testing to see if you have any strains of HPV that might lead to cancer.
Cervical cancer is hard to detect if you are relying solely on exhibition of symptoms, as most symptoms don’t present themselves until late stages of the disease. Precancerous changes almost never cause pain or any other symptoms. The most common symptom is abnormal bleeding, usually between menstrual periods or during sexual intercourse. Bleeding after menopause may also be a sign of cervical cancer.
How can the HPV vaccine help?
The HPV vaccine protects against most strains of HPV that cause cervical cancer, as well as other types of cancers. Because it is given to children before they are sexually active, it will prevent them from contracting any of the strains of HPV from sexual contact. The vaccination is recommended for both boys and girls from the ages of 11-15, but can be started as early as the age of 9. It is strongly recommended for everyone through the age of 25, even if you haven’t been vaccinated as a child. The WHO recommends vaccinating with a two dose schedule, one vaccine followed 6 months after the first. A three dose schedule is recommended for people over the age of 15 or for people with weakened immune systems, like those with HIV. However, as of 2018, only about half of teens in the United States have had the HPV vaccine. “The HPV vaccine continues to be the best way to protect our young boys and girls from developing certain cancers, including cervical cancer,” CDC director Robert Redfield, MD, said in a press release. “The HPV vaccine is safe, and we encourage parents to get their pre-teens vaccinated and take the next step to prevent their children from developing HPV-related cancer later in life.”
The Guardasil vaccine protects against the two main cancer causing strains of HPV, HPV-16 and HPV-18, and also against five more high risk strains and two strains that cause genital and anal warts. Multiple studies have found that girls that received the HPV vaccine in grade 6 had a 57% reduction in the amount of cervical pre-cancer cells than unvaccinated women. “Every year in the United States, HPV causes cancer in men and women, but we have the power to change this,” said Lisa Richardson, MD, MPH, director of CDC’s Division of Cancer Prevention and Control. “Cervical cancer was once the leading cause of cancer deaths among women in the U.S. The HPV vaccine and cervical cancer screening have made it one of the most preventable cancers. HPV vaccination is cancer prevention.”
So what can you do to check your cervical health? The most foolproof way to make sure you don’t have cervical cancer is to maintain a regular testing schedule. You should be meeting with your OBGYN once a year for a normal visit and also getting a Pap smear at least every 3 years. If you follow this, then there is almost no chance that you will find precancerous cells that are too late to treat or have already progressed into full blown cancer. You can also help decrease the amount of the disease by spreading knowledge to others. Help educate others on their own cervical health and encourage them to get regular Pap smears and to also vaccinate their children or grandchildren with the HPV vaccine.
If you or someone you know is suffering from cervical cancer or other diseases, Advocate In-Home Care an American In-Home Care company can help. Visit our website to learn more about the in home health services we offer for you and your loved ones.