Cervical cancer is a leading cause of cancer death for women worldwide and the fourth cause of gynecologic cancer deaths in the United States. Unlike many other cancers, cancer of the cervix has a well defined, typically long premalignant phase known as dysplasia — a precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix, the opening between the uterus and the vagina.
Among American women, more than 640,000 are diagnosed annually with advanced forms of dysplasia. Screening for and treating dysplasia is the most effective way to prevent and treat cancer of the cervix. Unfortunately, most women do not avail themselves to screening. In fact, over half who develop cervical cancer have not been screened in 10 years.
Nine-five percent of cervical cancer cases are linked to the sexually transmitted virus human papillomavirus (HPV). Other factors that predispose women to developing the disease include intercourse at a young age, having multiple sexual partners and tobacco use.
While the disease is still in its premalignant or dysplastic phase, it does not cause symptoms. It's not until the disease reaches its cancerous stage that the patient will start to notice symptoms. Common symptoms are abnormal vaginal bleeding and abnormal vaginal discharge. Bleeding can range from occasional spotting to severe bleeding — or it could be limited to bleeding after intercourse. Some patients will also develop back pain or pain that shoots to the leg — a sign of very advanced cancer.
Clearly, women who have any of the above symptoms should see their gynecologist immediately for evaluation.
All women should visit their gynecologist for a screening, which includes a thorough pelvic exam and a pap smear. Typically, screenings for cervical cancer begin at age 21.
Although the exact frequency of screening is somewhat controversial, most experts would recommend an annual exam, including a pap smear, for low risk, sexually active women. Most experts would also agree that monogamous, low risk patients who have had three normal pap smears should be screened less frequently for cervical cancer. Many recommend screening every three years. Women who are at high risk for developing dysplasia and cervical cancer should be monitored more frequently.
Testing for HPV is now commercially available and may help identify women who are at high risk for developing cervical cancer. Women should ask their gynecologist if they would benefit from HPV testing and if it should be incorporated into their individual screening program.
Two vaccines are now available for HPV. Studies have shown that these vaccines are very effective in preventing viral infection. The hope is that by preventing the HPV viral infection, the incidence of both cervical dysplasia and cancer can be reduced. However, to be effective, vaccines should be given to people before they become sexually active — before they are exposed to the HPV virus.
Now more than ever, we have many weapons to prevent, detect and fight cervical cancer but women must take an active role in their healthcare to keep from becoming a statistic.
Dr. Al Elbendary, obstetrics and gynecology, is on staff at Missouri Baptist Medical Center. For referral to a physician on-staff at Missouri Baptist Medical Center, call 314-996-LIFE.