January is National Cervical Health Awareness Month
Cervical cancer largely preventable
It’s hard to imagine that in the not too distant past, cervical cancer was a leading cause of death among women in this country. But when the Pap smear — a simple and painless test to detect changes in the cells of the cervix — was implemented as a screening tool, the incidence and death rates of the disease dropped precipitously. In 2015, according to the National Cancer Institute, cervical cancer resulted in an estimated 12,900 new cases and 4,100 deaths.
The Pap smear has been called the most successful cancer screening technique in the history of medicine. That’s understandable. The test can detect cancer in the early stages when treatment is more successful. It can also identify pre-cancerous changes in the cervix, allowing timely treatment to prevent the cancer altogether.
Cervical cancer is more common in Latinas and blacks, but black women die of it at a greater rate than any other race. It is more prevalent in middle age. According to the NCI, the median age at diagnosis is 49; the median age at death is 57.
Another major milestone in reference to cervical cancer occurred when Dr. Harald zur Hausen, a German physician, discovered that the human papillomavirus, or HPV, causes virtually all cases of cervical cancer. HPV is the most common sexually transmitted infection in the US. The third breakthrough developed in 2006 when the Food and Drug Administration licensed Gardasil, the first vaccine for the prevention of cervical cancer. While several HPV types cause cervical cancer, Gardasil is effective against HPV types 16 and 18, which account for 70 percent of all cervical cancer cases. The vaccine is given in a three-shot series over a 6-month period, and is recommended for females between the ages of 11 and 26.
In spite of the availability of a gold standard screening tool and an effective prevention method, females are not taking full advantage of the offerings. The Centers for Disease Control and Prevention found that in 2012, more than 11 percent of women reported that they had not been screened in the past five years. The percentage was higher for those without insurance (23.1 percent) and those without a regular source of care (25.5 percent).
With the advent of the Affordable Care Act, these numbers are expected to improve. Under the ACA, Pap smears are offered at no cost to consumers.
HPV vaccination has met with even less success. While roughly 91 percent of adolescents between the ages of 13 and 17 received vaccinations for measles, mumps and German measles, only 69 percent of females had completed the 3-shot series for HPV. To date, only Virginia, Rhode Island and Washington, DC require HPV vaccinations for school admission.
The attitude toward cervical cancer should not be cavalier. If left untreated, it is deadly. Women in sub-Sahara Africa — Zambia, for example — do not have the luxury of Pap smears and Gardasil. And the numbers affirm that lack. An estimated 35 new cases of cervical cancer per 100,000 are diagnosed each year and 23 per 100,000 deaths. In comparison, in the US the number of new cases and the number of deaths per 100,000 women is 7.7 and 2.3, respectively.
Below are general guidelines for cervical cancer screening recommended by the American Cancer Society. A test for HPV is now recommended in conjunction with the Pap smear for women beginning at age 30. Your doctor may recommend a different schedule for you.
Women who have been immunized against HPV should continue screening. Vaccination protects against HPV 16 and 18, which are the leading cause of cervical cancer. However, other types of HPV infections cause cervical cancer as well. Pap smears are still necessary.