Cervical health is an essential part of well-health screenings and can help detect cervical cancer, one of the more preventable types of cancer. January is Cervical Health Awareness Month and highlights the steps that can help prevent cervical cancer.
According to the National Cervical Cancer Coalition, more than 13,000 people are diagnosed with invasive cervical cancer every year. And while any case of cancer is one too many, cervical cancer rates were once much higher and more deadly than they are now. Cervical cancer used to be the leading cause of cancer deaths among women in the United States, but several developments have led to dramatic positive change.
Most cases of cervical cancer are caused by the human papilloma virus (HPV). According to the Centers for Disease Control and Prevention (CDC), most men and women will be infected with one of the strains of HPV at some point. Currently, 80 million Americans are infected with HPV, with 14 million additional infections yearly. In most cases, the virus will stay present in the body and will go away, like many viruses do, within a couple of years. There are more troublesome strains that will remain in the body and can cause different types of cell changes that can lead to cancer.
According to the CDC, there are a few ways the medical community can approach prevention detection, and treatment. The introduction of the HPV vaccine, regular Pap smears, and tests to detect the presence of HPV have dramatically reduced the incidence of cervical cancer in the United States.
HPV Vaccine
Development of the HPV vaccine was a game-changer for preventing this kind of disease. Nearly all cervical cancers are caused by HPV, a virus with many strains. Some strains of the virus can cause genital warts while other strains cause few or no symptoms but can lead to changes in the cervix over time that cause cancer if left undetected and untreated.
Although adults can get the HPV series of vaccinations up until age 45 (it is most recommended up until age 26), it is highly recommended for youths beginning around age 11 or 12. Receiving the vaccine before any potential exposure to HPV can prevent infection with the virus, but isn’t a treatment if the virus is already present.
Screening
Increasing attention to screening for cancerous changes in the cervical cells with Pap smears and for detection of any HPV levels in cells (two separate tests that can be done at the same visit) has upped the detection rate of more treatable precancerous changes. If cervical cell changes are detected, treatment options are available and will depend on the findings. Removal of the precancerous cells may be recommended to prevent cancerous changes. And a positive HPV test with a normal Pap smear offers valuable information that may lead to more frequent screening to catch changes early.
Talking to Patients and Families
Despite its effectiveness, rates of HPV vaccination lag behind what many medical professionals consider ideal. If patients and families in your practice seem hesitant, it might help to offer a few facts. The vaccine is to prevent cancer, but because HPV is transmitted sexually, some families relate the vaccine with condoning sex. The more you can separate the two so that the concern is for long-term health and is for potential exposure, the more success you might have. The American Academy of Pediatrics’ HPV Champion Toolkit is another resource to help increase vaccination rates which will lead to fewer cases of cervical cancer.
The most important prevention for preventing cervical cancer is to keep up with regular screenings. If you haven’t had a Pap smear in a while or have been postponing your annual visit because of a packed schedule, put it back on your high-priority, staying healthy list. Outcomes are drastically different when these changes are caught at a treatable stage.
Many adults in the United States are not getting the recommended screening tests for colorectal, breast, and cervical cancers, according to data published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. For 2013, screening for these types of cancers either fell behind previous rates or showed no improvement.
Among adults in the age groups recommended for screening, about 1 in 5 women reported not being up-to-date with cervical cancer screening, about 1 in 4 women reported not being up-to-date with breast cancer screening, and about 2 in 5 adults reported not being up-to-date with colorectal cancer screening.
The report found that colorectal cancer testing was essentially unchanged in 2013 compared with 2010. Pap test use among women aged 21 to 65 years was lower than in 2000, and the number of mammography screenings was stagnant, showing very little change from previous years.
“It is concerning to see a stall in colorectal cancer screening rates,” says Lisa C. Richardson, MD, MPH, director of CDC’s Division of Cancer Prevention and Control. “We must find new ways to make people and providers aware that getting tested for colorectal cancer could prevent cancer and save their lives.”
Researchers reviewed data from the National Health Interview Survey 2013, which is used to monitor progress toward Healthy People 2020 goals for cancer screening based on the most recent U.S. Preventive Services Task Force guidelines.
The screening data for 2013 show that 58.2% of adults aged 50 to 75 years reported being screened for colorectal cancer; 72.6% of women aged 50 to 74 had a mammogram; and 80.7% of women aged 21 to 65 had a Pap test. All of these percentages are below the Healthy People 2020 targets.
The report found that adults without insurance or a usual source of health care generally had the lowest screening test use. For example, less than one quarter of adults in these groups reported recent colorectal cancer screening, compared with more than 60% of adults with private insurance or a usual source of health care. More efforts are needed to achieve cancer screening goals and reduce screening disparities.
The authors did report some good news: the proportion of women in the highest education and income groups who were screened for breast cancer exceeded the Healthy People 2020 target, and the proportion of people aged 65 to 75 who were screened for colorectal cancer was also near the target.
Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as screening for some cancers that may be covered with no additional costs. Visit Healthcare.gov to learn more.
Despite evidence that cervical cancer screening saves lives, about 8 million women ages 21 to 65 years have not been screened for cervical cancer in the past five years, according to a new Vital Signs report from the Centers for Disease Control and Prevention (CDC). More than half of new cervical cancer cases occur among women who have never or rarely been screened.
“Every visit to a provider can be an opportunity to prevent cervical cancer by making sure women are referred for screening appropriately,” says CDC Principal Deputy Director Ileana Arias, PhD. “We must increase our efforts to make sure that all women understand the importance of getting screened for cervical cancer. No woman should die from cervical cancer.”
Researchers reviewed data from the 2012 Behavioral Risk Factor Surveillance System to determine women who had not been screened for cervical cancer in the past five years. They analyzed the number of cervical cancer cases that occurred during 2007 to 2011 from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Cervical cancer deaths were based on death certificates submitted to the National Vital Statistics System.
Key findings include:
• In 2012, 11.4% of women reported they had not been screened for cervical cancer in the past five years; the percentage was larger for women without health insurance (23.1%) and for those without a regular health care provider (25.5%).
• The percentage of women not screened as recommended was higher among older women (12.6%), Asians/Pacific Islanders (19.7%), and American Indians/Alaska Natives (16.5%).
•From 2007 to 2011, the cervical cancer incidence rate decreased by 1.9% per year while the death rate remained stable.
•The Southern region had the highest rate of cervical cancer (8.5 per 100,000), the highest death rate (2.7 per 100,000), and the largest percentage of women who had not been screened in the past five years (12.3%).
Using the human papillomavirus (HPV) vaccine as a primary prevention measure could also help reduce cervical cancer and deaths from cervical cancer. Another recent CDC study showed that the vaccine is underused; only 1 in 3 girls and 1 in 7 boys had received the 3-dose series in 2013. The HPV vaccine is recommended as a routine vaccine for children 11–12 years old. Modeling studies have shown that HPV vaccination and cervical cancer screening combined can prevent as many as 93% of new cervical cancer cases.
Even with improvements in prevention and early detection methods, most cervical cancers occur in women who are not up-to-date with screening. Addressing financial and non-financial barriers can help increase screening rates and, in turn, reduce new cases of and deaths from this disease.
Efforts to Prevent Cervical Cancer
CDC’s National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured, and underinsured women access to breast and cervical cancer screening and diagnostic services in all 50 states, the District of Columbia, five US territories, and 11 American Indian/Alaska Native tribes or tribal organizations.
To learn more about recommended ages and tests for cervical cancer screening, visit www.cdc.gov/cancer/cervical.
Women vaccinated with one dose of a human papillomavirus (HPV) vaccine had antibodies against the viruses that remained stable in their blood for four years, suggesting that a single dose of vaccine may be sufficient to generate long-term immune responses and protection against new HPV infections, and ultimately cervical cancer, according to a study published in Cancer Prevention Research.
“The latest Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention on vaccination coverage indicates that in 2012, only 53.8% of girls between 13 and 17 years old initiated HPV vaccination, and only 33.4% of them received all three doses,” said Mahboobeh Safaeian, PhD, an investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute (NCI) in Bethesda, Maryland.
“We wanted to evaluate whether two doses, or even one dose, of the HPV 16/18 L1 VLP vaccine [Cervarix] could induce a robust and sustainable response by the immune system,” she added. “We found that both HPV 16 and HPV 18 antibody levels in women who received one dose remained stable four years after vaccination. Our findings challenge previous dogma that protein subunit vaccines require multiple doses to generate long-lived responses.”
Data for this study are from the NCI-funded phase III clinical trial to test the efficacy of Cervarix in women from Costa Rica. About 20% of the women in the study received fewer than three doses of the vaccine, not by design.
The researchers looked for the presence of an immune response to the vaccine (measured by antibody levels) in blood samples drawn from 78, 192, and 120 women who received one, two, and three doses of the vaccine, respectively, and compared the results with data from 113 women who did not receive vaccination but had antibodies against the viruses in their blood because they were infected with HPV in the past.
They found that 100% of the women in all three groups had antibodies against HPV 16 and 18 in their blood for up to four years. Antibody levels were comparable for women receiving two doses six months apart and those receiving the full three doses.
The researchers also found that while antibody levels among women who received one dose were lower than among those who received the full three doses, the levels appeared stable, suggesting that these are lasting responses. In addition, the levels of antibodies in women from the one- and two-dose groups were five to 24 times higher than the levels of antibodies in women who did not receive vaccination, but had prior HPV infection.
“Our findings suggest promise for simplified vaccine administration schedules that might be cheaper, simpler, and more likely to be implemented around the world,” said Safaeian. “Vaccination with two doses, or even one dose, could simplify the logistics and reduce the cost of vaccination, which could be especially important in the developing world, where more than 85% of cervical cancers occur, and where cervical cancer is one of the most common causes of cancer-related deaths.”
In some parts of the world, including Chile and British Columbia, two doses of HPV vaccine is now the recommended vaccination program, according to Safaeian. But for a single HPV dose, “while our findings are quite intriguing and show promise, additional data are needed before policy guidelines can be changed,” she clarified. “For instance, it is important to note that persistence of antibody responses after a single dose has not been evaluated for Gardasil, the quadrivalent HPV vaccine that is more widely used in the United States and many other countries.”
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