January is Cervical Cancer Awareness Month

News

Risk Factors

Human papilloma virus infection: The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV). HPV is a group of more than 100 related viruses that can infect cells on the surface of the skin, genitals, anus, mouth and throat, but not the blood or most internal organs such as the heart or lungs. These viruses are called papilloma viruses because some of them cause a type of growth called a papilloma, which are more commonly known as warts.

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 (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped. The American Cancer Society believes that a woman and her doctor should discuss whether the benefits of using OCs outweigh the potential risks.

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 Of every 1,000 women whose mother took DES when pregnant with them, about one develops clear-cell adenocarcinoma of the vagina or cervix. (It is no longer given to pregnant women.)

Family history of cervical cancer: Cervical cancer may run in some families. If your mother or sister had cervical cancer, y our 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.

Prevention

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.

Screening Guidelines

The American Cancer Society recommends the following guidelines for early detection:

• All women should begin cervical cancer testing (screening) about 3 years after they start having sex (vaginal intercourse). A woman who waits until she is over 18 to have sex should start screening no later than age 21. A regular Pap test should be done every year. If a liquid-based Pap test is used instead, women should be tested every 2 years.
  
  
• Beginning at age 30, many women who have had 3 normal Pap test results in a row may be tested less often - every 2 to 3 years. Either the conventional (regular) Pap test or the liquid-based Pap test can be used.
  
  
• Another reasonable option for women over 30 (who have normal immune systems and no abnormal Pap results) is to get tested every 3 years (but not more frequently) with a Pap test plus the HPV DNA test. The Pap test used can be either the regular or the liquid-based Pap test.
  
  
• Women who have certain risk factors should continue getting tested yearly. This includes:
  
  • women exposed to diethylstilbestrol (DES) before birth
  • women with a history of treatment for a pre-cancer
  • those with a weakened immune system (from HIV infection, organ transplant, chemotherapy, or chronic steroid use)
  
  
  
• Women who have had a total hysterectomy (removal of the uterus and cervix) may choose to stop having cervical cancer testing, unless the hysterectomy was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) need to continue cervical cancer screening. They should continue to follow the guidelines above.
  
  
• Women 70 years of age or older who have had 3 or more normal Pap test results in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer testing. Women with a history of cervical cancer, DES exposure before birth, HIV infection, or a weakened immune system should continue to have testing as long as they are in good health.

Source: American Cancer Society: Cervical Cancer: Prevention and Early Detection - Finding and treating pre-cancerous changes

Take action

Resources

U-M Resources

U-M Comprehensive Cancer Center Gynecologic Cancer Information Guide

Cervical Cancer Information

UM Gynecology Oncology Clinic

UM Gynecology Oncology Team

Gynecologic Oncology Patient Handbook

Pap tests

UM Colposcopy Clinic

HPV Information

National and Local Resources

National Cervical Cancer Coalition

National Cancer Institute, What You Need to Know About Cervical Cancer

National Cancer Institute-HPV Fact Sheet

Centers for Disease Control and Prevention - HPV Vaccine Q & A

Michigan Cancer Consortium - Cervical Cancer Resources

U.S. Department of Health and Human Services Medicare, Cervical and Vaginal Cancer Screening

Michigan Department of Community Health Breast and Cervical Cancer Control Program

American Congress of Obstetrics and Gynecology (ACOG)

On-Line Discussion Group: GYN-ONC the e-mail discussion group for Gynecological Cancer patients and families. Hosted by the Association of Cancer Online Resources ACOR.

American Cancer Society

NCCC, National Cervical Cancer Coalition

www.womenshealth.gov

Women's Cancer Network