Ladies Pay Attention to Your Cervix: January is Cervical Health Awareness Month

Saturday, January 16, 2010

Written by Elizabeth Poynor, MD

The United States Congress has designated January as Cervical Health Awareness Month. Cervical cancer screening, especially the Pap smear, has been one of the great triumphs in cancer prevention. Worldwide, cervical cancer remains one of the leading causes of death in women because many areas of the world do not have well-executed screening programs.

In North America, where Pap smear screening is well established, cervical cancer is one of the more uncommon cancers. It is important, however, to continue to emphasize the importance of screening and cervical health so we don’t become complacent about this largely preventable disease.

The Pap smear was designed to pick up early pre-cancerous changes in the cervix. It is not designed to detect cancer cells, cells from the uterus or the ovaries. While Pap smear screening recommendations have recently been under debate in this country, it is generally recommended that women start Pap smear screening soon after becoming sexually active, and yearly thereafter.

Two protocols for women’s cancer screening — mammograms and Pap smears — have been credited as two of our greatest triumphs, leading to lower cancer death rates for both breast and cervical cancer. With cervical cancer, the story appeared pretty straightforward: In the United States, the cervical cancer death rate declined by 65 percent between 1955 and 1992, in large part due to the effectiveness of Pap smear screening. The death rate continues to decline each year.

We’re still absorbing last week’s news that new breast cancer screening recommendations had been issued by an obscure government-sponsored group, which was recommending fewer and less frequent mammograms for most women; we were comforted to know that, at least for now, major medical institutions have stated that their yearly mammogram recommendations will not change. Still, I have already been placed on a mailing list to sign a petition to contest the new mammogram recommendations, and we have a lot of work to do to prevent their enactment.

If abnormal cells are detected on the Pap smear, a colposcopy will be recommended. A colposcopy is a microscopic examination of the cervix, and biopsies will be taken of abnormal areas that are seen.

Treatment of the abnormal Pap smear will be dependent on the biopsy results; it may consist of observation, with more frequent visits to the medical office, or require larger biopsies. The latter could be a LEEP (loop electrosurgical excision procedure) or a conization of the cervix. These larger biopsies remove the abnormal cells and also gather more diagnostic data to assure that no invasive cancer is present. This type of management of women has throughout the years led to lower rates of cervical cancer.

One of the great newer advances in gynecologic oncology over the past 10 years, has been the realization that the human papilloma virus (HPV) causes nearly all cervical cancers. HPV is a sexually transmitted virus that is extremely prevalent and infects approximately 80 percent of sexually active women at some point in their lifetime.
Over the past five years, the HPV vaccine has been introduced to younger women in the United States. These vaccines are extremely effective at preventing the transmission of the viral types that they are designed to protect against, although their overall impact on the burden of precancerous and cancers of the cervix has yet to be determined. These vaccines have not been FDA-approved for women over the age of 26.

Unfortunately, as a practicing gynecologic oncologist, I still treat a significant amount of cervical cancer in my New York City practice. This is largely due to women who have not undergone proper screening. This highlights that although we have made monumental strides in the early detection and prevention of this cancer, it is still present. Signs and symptoms of cervical cancer include abnormal vaginal discharge, abnormal vaginal bleeding, including vaginal bleeding after intercourse, and pelvic pain.

If cervical cancer is diagnosed, treatment with a gynecologic oncologist should proceed. These are specialists devoted to the surgical and medical management of cervical and other gynecologic cancers. Recently, advances for the treatment of cervical cancer include surgeries to preserve fertility in younger women.

During January, medical practitioners and community organizations will highlight issues related to cervical cancer, HPV disease and the importance of early detection. The take-home message for women is: Get your Pap smear; review with your physician the use of HPV testing, and determine your path to effective cervical screening for the future; discuss any symptoms you may be having; and review the applicability of the HPV vaccine for your daughter.

Although cervical cancer is relatively uncommon in the United States, pre-cancerous changes of the cervix are not. It is through the proper management of these pre-cancerous changes that we have been able to decrease the amount of cervical cancer in our country. We eagerly await the coming news of the worldwide impact that the HPV vaccine will have rendered.

1 Feedback:

Demara said...

Article is very informative. Thanks.

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