The State of The Fight
State of the Fight: Cervical Cancer 2013by Andrea P. Myers, M.D., Ph.D.
This Cervical Cancer Awareness month, I want you to remember three words: screening, screening, screening. And, if you’re the right age, one more: vaccination.
First, some facts. Cervical cancer forms in tissues of the cervix, the organ that connects a woman’s uterus and vagina. Cervical cancer was a leading cause of cancer-related death among women in the early 20th century. However, the introduction of routine screening has had a tremendous impact in the United States, reducing cervical cancer incidence and mortality by 75% and 70% respectively. Currently, around 12,000 American women are diagnosed with cervical cancer each year and around 4,700 will die from the disease. Worldwide, cervical cancer remains a leading cancer killer, particularly in areas where women do not have access to screening.
The bad news is that cervical cancer can be difficult to detect at home. Unlike, say, breast or testicular cancer, which is often detected by a lump, cervical cancer is usually slow-growing, with few symptoms (though over time women may notice abnormal vaginal bleeding, increased vaginal discharge, pelvic pain, and pain during sex).
The good news, as you’ve probably pieced together by now, is that cervical cancer can be detected with regular Pap tests. If you haven’t had one, a Pap test is a common procedure in which cells are scraped from the cervix and looked at under a microscope. The Pap test can show if you have an infection, abnormal cervical cells, or cervical cancer.
When it comes to getting a Pap test, most women can follow these guidelines: Starting at age 21, have a Pap test every 2 years. If you are 30 or older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 3 years. If you are over 65 years old, ask your doctor if you can stop having Pap tests. Of course, there are a variety of factors that influence how often you should get screened, so talk with your doctor about what is best for you.
On to vaccination. Cervical cancer is almost always caused by human papillomavirus (HPV) infection, so HPV vaccination for both girls and boys (to prevent passing the virus) is expected to further reduce this risk. The vaccines are given as three shots to protect against infection and HPV-related diseases, including cervical cancer. Two vaccines (Cervarix and Gardasil) have been shown to protect against most cervical cancers in women. One vaccine (Gardasil) also protects against genital warts and has been shown to protect against cancers of the anus, vagina, and vulva. According to the CDC, HPV vaccines offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. That’s why HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years, up through age 26.
I’m both a physician and a scientist. I was drawn to the field of cancer research after working under Dr. Jeffrey Murray on the Human Genome Project and seeing firsthand how genetic knowledge can be applied to understanding human disease. As an investigator with the SU2C’s PI3K Dream Team, our team is tasked with developing clinical techniques that may lead to therapeutic combinations in a variety of women’s cancers. I am also a physician with the Dana-Farber Cancer Institute. I see patients with advanced gynecological cancer as well as work in the lab to better understand the molecular underpinnings of these cancers to help us develop better treatments. My aim is to understand how the individual genetic aspects of one person’s cancer can direct us to the right and best therapy for that person.
Because of the benefits of cervical cancer screening, I don’t see nearly as many of these patients as I do with ovarian and endometrial cancer. But this is an important reminder that screening works! It’s also a reminder that we need to develop better screening techniques for other gynecological cancers as well. This week, a study demonstrating that DNA from ovarian and endometrial cancers can sometimes be detected from Pap specimens was published by a team including Johns Hopkins’ Dr. Bert Vogelstein, a Genomics Advisory Committee member of the SU2C Melanoma Dream Team. This may be a new research avenue to improve detection of these others important cancers too.
Overall, the best way to make an impact on the global burden of cervical cancer is to provide women all over the world better access to routine gynecological care. We also are working on improving treatments for women who do develop cervical cancer. Studies evaluating the comprehensive genome of cervical cancers are underway and results should be out soon. These may lead us to targets for therapy, beyond the current treatment options of surgery, radiation therapy, chemotherapy, or a combination of the three.
In the meantime, see your doctors regularly. Get your Pap smears. Get the HPV vaccine. Practice safe sex. Know your body. And don’t be embarrassed to talk to your doctor about the stuff happening down there, such as irregular bleeding, new discharge, or pain with intercourse. That uncomfortable conversation could save your life.