Cervical Cancer Awareness Month
A downward trend in cases
Cervical cancer might not get that much attention anymore. It now ranks as the 20th most common cancer in this country. According to the National Cancer Institute, in 2020 there were only an estimated 14,000 cases and 4,300 deaths.
But don’t let the lower numbers fool you. The overall 5-year survival rate of cervical cancer hovers around 66 percent, according to the NCI. In contrast, the survival rates for breast and uterine cancer have increased to 90 percent and 81 percent, respectively.
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. The median age at diagnosis is 50; the median age at death is 58. Fortunately, 92 percent of those afflicted survive five years or more when detected and treated early.
At one time cervical cancer was one of the leading cancer deaths in women in this country. But when the Pap smear 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.
Although the Affordable Care Act covers cervical cancer screening at no cost, not all women take advantage. Differences are noted by education, income and race. Those of higher education and income are more likely to be screened, as well as Black women. In 2018, African American women had the highest rate of screenings at 85 percent.
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 U.S. Nearly 80 million Americans are currently infected with HPV, according to the Centers for Disease Control and Prevention. Most infections resolve by themselves within two years, but one out of 10 is resistant. Every year in the U.S., HPV is estimated to cause nearly 36,000 cases of cancer in men and women.
Cervical cancer is now largely preventable through vaccination with Gardasil 9. 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. Gardasil can now be used up to the age of 45, but HPV vaccination of people in this age range provides less benefit, as more have been already exposed to the virus.
The rate of HPV vaccination is less than satisfactory, but is showing improvement. In 2017, nearly 66 percent of adolescents aged 13 to 17 years received the first dose to start the vaccine series, according to the CDC, and nearly 49 percent of adolescents received all the recommended doses to complete the series.
One word of caution. Vaccination does not exempt you from screening. Gardasil 9 protects against some ─ but not all ─ of the HPV strains that can result in cervical cancer.
The screening guidelines were changed in 2020. The starting age increased from 21 to 25, and three choices are now offered. Keep in mind that they serve as a suggestion only. Your doctor may recommend a different schedule for you.
The American Cancer Society recommends the following guidelines:
- Begin at age 25. There are three choices:
- Stand-alone HPV test every five years
- Co-test of HPV test and Pap smear every five years
- Pap smears alone every three years
- 65 and older
- Discontinue screening in women who have had adequate screenings and normal results
With increased adherence to the recommended guidelines and vaccination schedule, the incidence of cervical cancer should continue to decline.