When it comes to cancer, many cases are mysteries. It’s very difficult—even impossible—to pinpoint what leads to a malignancy. Yet there are a few cancers that clearly are linked to specific causes. Smoking contributes to lung cancer, sun damage contributes to skin cancer, and—in a stunning 99 percent of cases—human papillomavirus (HPV) is present in cervical cancer cases.
Not every woman who has HPV will develop cervical cancer; but for women who are diagnosed, HPV almost is always a contributing factor. “Up to 80 percent of sexually active women become exposed to HPV by age 50, and only a small number progress to cervical cancer,” says Dr. Andrea Stephens, an obstetrician/gynecologist on staff at St. Luke’s Hospital.
Risk factors for progression include exposure to high risk types of HPV (especially types 16 and 18), persistence of HPV for more than two years, smoking and immunosuppression (women who have other serious medical conditions or other cancers, or who are on medications after organ transplants). “The length of time for development of cervical cancer from exposure to HPV ranges from 10-20 years for most women,” Stephens notes.
The key to successful treatment and remission of cervical cancer is early detection. “Treatment is based on the extent of the disease,” says Dr. Al Elbendary, a specialist in gynecologic oncology on staff at Missouri Baptist Medical Center. “If the cancer is diagnosed in stage 1 and confined to the cervix, we typically approach treatment with surgery—usually a hysterectomy—or radiation therapy. Cancer beyond stage 1 often requires chemotherapy and radiation,” he says.
Younger women who want to preserve their ability to bear children may be candidates for a more conservative procedure, known as conization, in which only a portion of the cervix is removed. Very small cancerous lesions may be treated with a procedure called ‘radical resection of the cervix,’ which preserves the uterus, allowing women to carry pregnancies to term. “There are some situations where younger women who develop cervical cancer can be treated effectively and maintain childbearing, but those are special circumstances,” Elbendary says.
Early detection requires vaginal exams and pap smears because cervical cancer has few or no noticeable symptoms in most cases. Abnormal bleeding, bleeding after intercourse or unusual vaginal discharge should be brought to the attention of a physician, but these symptoms are usually present only in cases of advanced disease.
“Pap smears are effective at detecting even precancerous lesions of the cervix, so the pap smear is the main reason we have been successful in the United States and Western countries in controlling this cancer,” Elbendary says. Precancerous lesions or cells can be removed before cervical cancer develops. Frequency of pap smears depends on age, risk factors and individual medical history, so each woman should discuss pap smear recommendations with her physician to determine the best preventive health plan.
Both Elbendary and Stephens are proponents of the HPV vaccine as a method of preventing potential cancers. “The HPV vaccine is up to 98 percent effective, and the immunity or protection has been shown to persist for at least five years in studies,” Stephens says. “Studies of girls and women, ages 9 to 26 years old, who have been vaccinated demonstrate lower rates of progression to precancerous cell changes that are associated with development of cancer. Serious side effects of the vaccine are few, and complications after receiving the vaccine are rare. It has now been shown to be useful for boys and men ages 9 to 26, as well.”
Cervical cancer is one of the few types of cancer that can be prevented through proper preventive health care. Take advantage of this ability, and talk with your physician about vaccination and testing.