January is Cervical Cancer Awareness Month
Early Detection Increases Survival
The 
American Cancer Society's most recent 2012 estimates for cervical
cancer in the United States are:
- About 12,710 new cases of invasive cervical cancer will be diagnosed.
- About 4,220 women will die from cervical cancer.
Some researchers estimate that non-invasive cervical cancer (carcinoma in situ) is about 4 times more common than invasive cervical cancer.
Most cervical cancers begin in the cells lining the cervix. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including:
- cervical intraepithelial neoplasia (CIN)
- squamous intraepithelial lesion (SIL)
- dysplasia
These changes can be detected by the Pap test and treated to prevent the development of cancer.
Source: American Cancer Society's What is
cervical cancer webpages.
Risk Factors
A risk factor is anything that changes your chance of getting a disease such as cancer. Having a risk factor, or even several, does not mean that you will get the disease. Here are the biggest risk factors for cervical cancer:Human papilloma virus infection: The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV), a sexually transmitted infection that can cause warts in the genital area.
Smoking: Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried in the bloodstream throughout the body. Tobacco by-products have been found in the cervical mucus of women who smoke.
Immunosuppression: Human immunodeficiency virus (HIV), the virus that causes AIDS, damages the body's immune system and places women at higher risk for HPV infections. This may explain the increased risk of cervical cancer for women with AIDS.
Chlamydia infection: Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Chlamydia infection can cause pelvic inflammation, leading to infertility. Some studies have seen a higher risk of cervical cancer in women whose blood test results show evidence of past or current chlamydia infection (compared with women who have normal test results).
Diet: Diets low in fruits and vegetables are associated with an increased risk of cervical cancer and several other cancers. Also overweight women are more likely to develop adenocarcinoma of the cervix.
Oral contraceptives (birth control pills): There is evidence that taking oral contraceptives for a long time increases the risk of cervical cancer. Research suggests the risk goes up the longer a woman takes oral contraceptives, but goes back down after stopping the pill. The American Cancer Society suggests that women discuss with their doctor whether the benefits of using oral contraceptives outweigh the potential risks.
Intrauterine device use: A recent study found that women who had ever used an intrauterine device (IUD) had a lower risk of cervical cancer. The effect on risk was seen even in women who had an IUD for less than a year, and the protective effect remained after the IUDs were removed.
Multiple full-term pregnancies: Women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true.
Young age at the first full-term pregnancy: Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.
Poverty: Poverty is also a risk factor for cervical cancer. Many women with low incomes do not have ready access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers.
Diethylstilbestrol (DES): DES is a hormonal drug that was prescribed between 1940 and 1971 for some women thought to be at increased risk for miscarriages. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. This type of cancer is extremely rare in non-DES exposed women. There is about 1 case of this type of cancer in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of "DES daughters" do not develop these cancers.
Family history of cervical cancer: Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of developing the disease are 2 to 3 times higher than if no one in the family had it.
Source: American Cancer Society's What are the risk factors for cervical cancer?
webpage.
Screening Guidelines
- All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (it may be used as a part of follow-up for an abnormal Pap test).
- Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This should continue until age 65.
- Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.
- Women who are at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long term steroid use) may need to be screened more often. They should follow the recommendations of their health care team.
- Women over 65 who have had regular screening in the previous 10 years should stop cervical cancer screening as long as they haven't had any serious pre-cancers in the last 20 years. Women with a history of these pre-cancers should continue to have testing for at least 20 years after the abnormality was found.
- Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical pre-cancer (or cancer). Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the guidelines above.
- Women of any age should NOT be screened every year by any screening method.
- Women who have been vaccinated against HPV should still follow these guidelines.
Talk to your doctor about how you should be screened for cervical cancer.
Source: American Cancer Society
Cervical Cancer: Prevention and Early Detection.
Signs and Symptoms
Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until a pre-cancer becomes a true invasive cancer and grows into nearby tissue. When this happens, the most common symptoms are:
- Abnormal vaginal bleeding
- bleeding after sex (vaginal intercourse)
- bleeding after menopause
- bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual
- bleeding after douching
- bleeding after a plevic exam is a common symptom of cervical cancer, but not pre-cancer.
- An unusual discharge from the vagina -- the discharge may contain some blood and may occur between your periods or after menopause.
- Pain during sex (vaginal intercourse)
These signs and symptoms can also be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. Still, if you have any of these problems, you should see your health care professional right away -- even if you have been getting regular Pap tests.
Source: American Cancer Society
Cervical Cancer: Prevention and Early Detection - Signs and symptoms of cervical cancer.
Take action
UMClinicalStudies.org is the gateway to clinical research throughout the University of Michigan. UMClinicalStudies.org can show which studies need participants with certain characteristics or certain diseases. To look for clinical trials available at the University of Michigan, please visit:
UMClinicalStudies.org
Save the Date
University of Michigan's Free Cervical Cancer Screening
Date: Saturday, March 23rd, 2013
Time: 1 pm - 4pm
Location: Briarwood Building 2, Suite B
400 E. Eisenhower Pkwy
Ann Arbor, MI 48108
Get Directions
You may be eligible for this free screening if you:
- Are a woman aged 21 or older
- Have not had a pap test in the last two years
- Do not have medical coverage for a pap test
Sponsored by the University of Michigan Comprehensive Cancer Center, Department of Obstetrics & Gynecology, Women's Health Program, and Program for Multicultural Health.
Registration is required and will begin at the end of February. To schedule a free screening, call the Cancer AnswerLine 1-800-865-1125.
Resources
U-M Resources
U-M Comprehensive Cancer Center Gynecologic Cancer Information Guide
Gynecologic Oncology Patient Handbook
Should my daughter get the HPV vaccine?
National and Local Resources
National Cancer Institute
National Cervical Cancer Coalition
Centers for Disease Control and Prevention - HPV Vaccine Q & A
Michigan Cancer Consortium - Cervical Cancer Resources
Michigan Department of Community Health
Breast and Cervical Cancer Control Program
American Congress of Obstetrics and Gynecology (ACOG)
Association of Cancer Online Resources - ACOR
