Gynecologic Cancer: What Every Woman Should Know
Cervical Cancer: Advances in Prevention Could Dramatically Reduce Deaths
Updated on: June 20, 2003
Carolyn D. Runowicz, M.D., Vice Chair, Department of Obstetrics and Gynecology, St. Luke’s-Roosevelt Hospital Center Professor of Clinical Obstetrics and Gynecology, Columbia College of Physicians and Surgeons, New York, New York
Recent advances in screening for cervical cancer and progress in the development of a vaccine offer hope that cervical cancer can be eradicated.
In the U.S., regular use of the Pap smear for cervical cancer screening has already produced a 70 percent decline in the annual death rate from this cancer. In the mid-1940's, prior to the introduction and widespread use of the Pap smear, cervical cancer caused the deaths of approximately 15,000 American women annually. The estimated number of deaths for the current calendar year is 4,100, according to American Cancer Society statistics.
In the U.S., approximately half of cervical cancers occur among women not participating in regular screening. The problem of unscreened women, combined with known difficulties detecting cancers that start in the hidden glandular region of the cervix, account for most new cases of cervical cancer. Worldwide, if all women were regularly screened for cervical cancer, the disease could be almost entirely eliminated.
New ACS Guidelines
In 2002, new guidelines for cervical cancer screening were published by the American Cancer Society (ACS). The new guidelines reflect the current understanding of the underlying cause of cervical cancer and precancers, and take into consideration new screening and diagnostic technologies. The new guidelines, endorsed by the Society of Gynecologic Oncologists (SGO) and the Gynecologic Cancer Foundation (GCF), among other leading medical groups, contain important information concerning the prevention and early detection of cervical cancer, including the following:
- Cervical cancer screening should begin approximately three years after a woman begins having vaginal intercourse, but no later than 21 years of age.
- Cervical screening should be done every year with regular Pap tests or every two years using liquid-based Pap tests.
- Starting at age 30, women who have had three consecutive normal Pap tests may continue screening every two to three years. However, it is recommended that women continue to see their health care providers on an annual basis for health check-ups and to learn good prevention practices.
- Women 70 years of age and older who have had three or more normal Pap test results and no abnormal results in the last 10 years may choose to stop cervical cancer screening.
Scientists are now certain that human papillomavirus (HPV), a sexually transmitted viral infection, is the cause of virtually all cervical cancer.
Recently, the FDA approved the HC2 High-Risk HPV DNA Test, manufactured by Digene Corp. for cervical cancer screening. The FDA report reads, "The new indication allows the test to be used for screening, in conjunction with the Pap test, for women over age 30…Knowing whether or not a woman is infected with high-risk HPV is added information that will help physicians detect and treat early cell changes that might eventually lead to cervical cancer."
More importantly, when the HPV test is negative, the physicians will have greater confidence that this woman has little or no risk of developing cervical cancer or pre-cancers.
In describing why this new approach is not recommended for women under the age of 30, Debbie Saslow, Ph.D., director of breast and gynecologic cancer programs for ACS said, "The risk of HPV progressing — causing changes that could lead to cancer — is greater in women over age 30 than younger women, which is why the new screening test isn’t recommended for younger women. HPV infections in younger women tend to go away by themselves."
It is also important to note that HPV is a very common acute infection in women under the age of 30. So, testing for HPV in this age group would not be effective, since it is so widespread.
In women over the age of 30, the HPV infection is more likely to be persistent, which may have a more serious consequence. However, even with restricting HPV testing to women 30 years of age and older, 5-15% of women will be "high-risk" HPV DNA positive.
"This is an exciting time for women and their physicians," said Joan Walker, M.D., professor and chief, Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Medicine, University of Oklahoma Health Sciences Center. "If we can convince women to be screened according to the new guidelines developed by the American Cancer Society, I am confident that we can come very close to eliminating cervical cancer as a cause of death among American women."
The Vaccine Front
There is also promising news from the vaccine front. Currently, clinical trials are underway to develop a vaccine to stop the spread of HPV. In a study published in the New England Journal of Medicine in November 2002, a vaccine was shown to prevent cervical cancer by making young women immune to the most common type of the high-risk HPV that causes cervical cancers and precancers.
Additional tests are underway on a new version of the vaccine against multiple types of HPV, which could prevent 70 percent of cervical cancer if successful. The study, led by Dr. Laura A. Koutsky, a researcher at the University of Washington, states that the vaccine will be most successful if it is given prior to the onset of sexual activity. However, more studies need to be done to confirm the results of this important study and to expand the vaccine to cover more than one type of "high-risk" HPV. A vaccine will not be available for several years.
In the meantime, public education efforts are underway to ensure that women know the importance of screening and early detection. As the lead partner in the National Cervical Cancer Public Education Campaign, the Gynecologic Cancer Foundation is working with leading women’s health and professional organizations to ensure that women know that with regular screening, cervical cancer is preventable.
"When it comes to cervical cancer, women hold their destinies in their own hands," said Dr. Walker. "With regular screening, this is one gynecologic cancer we can generally prevent or detect in its earliest stages."
This article by the Gynecologic Cancer Foundation originally appeared in an advertising supplement to the New York Times on Sunday, June 22, 2003.
GCF gratefully acknowledges Aventis Oncology for its generous support of this educational supplement. The content of this supplement is the work of many individuals and does not reflect commercial interests.
Aventis Pharmaceuticals
www.AventisOncology.com
