The decline in cervical cancer
Largely due to prevention
January is National Cervical Cancer Awareness Month, but it doesn’t get as much fanfare as breast or lung cancer. There’s a good reason for that. While breast and lung are the first and second most common cancers in women, cervical cancer comes in at # 14. Likewise, the American Cancer Society estimates that breast and lung cancer will result in 40,920 and 70,500 deaths, respectively, in women in 2018. In comparison, cervical cancer is expected to strike 12,920 women this year and result in the death of 4,200.
The disease should not be ignored, however. Cervical cancer was the fourth most commonly diagnosed cancer in women worldwide in 2012, and resulted in approximately 270,000 deaths, according to the World Health Organization. About 90 percent of these deaths occurred in low- and middle-income countries largely because of low rates of screening and prevention.
It’s a different story in this country, however. When the Pap smear — a simple and painless test to detect pre-cancerous changes in the cells of the cervix — was implemented as a screening tool, the incidence and death rates of the disease dropped precipitously. The Pap smear has been called the most successful 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 National Cancer Institute, the median age at diagnosis is 49; the median age at death is 57. Fortunately, two-thirds of those afflicted survive five years or more after being diagnosed, and roughly 92 percent survive five years or more when detected and treated early.
Another major milestone in reference to cervical cancer occurred with the discovery that the human papillomavirus, or HPV, causes virtually all cases of the disease. HPV is the most common sexually transmitted infection in the US. It is now largely preventable through vaccination with Gardasil 9, which protects against genital warts and seven types of cancer, including cervical cancer. Generally, the vaccine is given in two shots to those under 14 and in a three-shot dose to those between the ages of 15 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 women surveyed between 2013 and 2015, almost seven percent reported that they had never had a Pap smear in their lifetime. Yet, the Affordable Care Act covers the test at no cost. Most invasive cervical cancers are found in women who have not had regular Pap smears.
The rate of HPV vaccination is also less than satisfactory but is showing improvement. In 2015, almost 63 percent of females had received one shot of Gardasil, a three-point increase from the previous year.
One word of caution. Vaccination does not exempt you from Pap smears. Gardasil 9 protects against some ─ but not all ─ of the HPV strains that can result in cervical cancer. Below are general guidelines for cervical cancer screening by the American Cancer Society. Keep in mind that the guidelines serve as a suggestion only. Your doctor may recommend a different schedule for you.
With increased adherence to the recommended guidelines and vaccination schedule, the incidence of cervical cancer should continue to decline.
Cervical cancer screening general guidelines
Age 21 | Begin Pap smears regardless of prior sexual history
Ages 21 to 29 | Repeat Pap smears every 3 years
Ages 30 to 65 | Repeat Pap smears combined with HPV testing every 5 years or continue Pap smears alone every 3 years
Age 66 and older | Discontinue screening in women who have had adequate screenings and normal results
After hysterectomy | Recommend against screening in women of any age who have had a hysterectomy with removal of the cervix