The good news? Cervical cancer rates and deaths have steadily declined over the years, thanks to increased awareness of the disease and its risk factors, routine screenings such as the Pap test, and the availability since 2006 of the human papillomavirus (HPV) vaccine. The bad news? The coronoavirus pandemic has caused many women to pause their routine screenings, which doctors at Miami Cancer Institute say is likely behind an increase in cervical cancer cases they’ve seen there this past year.
Cervical cancer used to be the leading cause of cancer death for women in the United States. “It’s a preventable disease,” says John Paul Diaz, M.D. , chief of gynecologic oncology at Miami Cancer Institute . “With the HPV vaccine, and routine screenings that include annual Pap tests, women should not be getting this cancer today.” Yet still, thousands do every year.
According to the American Cancer Society (ACS), 14,480 women will be diagnosed with cervical cancer this year, and 4,290 will die from the disease. Additionally, the ACS notes that:
- Cervical cancer tends to occur in midlife and is most frequently diagnosed in women between the ages of 35 and 44.
- Women who have never or rarely been screened represent more than 50 percent of new cervical cancer cases.
- Proper screening and getting the human papillomavirus (HPV) vaccine are among factors that can help prevent up to 93 percent of cervical cancers.
- HPV viruses cause the most cervical cancers.
Major risk factors for cervical cancer
HPV infection is a major risk factor for cervical cancer, according to Dr. Diaz, as is not getting regularly screened for the disease. “HPV is so common that most people get it at some point in their lives,” he says. “It usually causes no symptoms, however, so many women don’t even know they have it.” For most women, he adds, HPV will go away on its own. “If it doesn’t, there’s a chance it may eventually cause cervical cancer.”
In women who are infected with HPV, other risk factors can increase their risk of cervical cancer. They include smoking cigarettes, giving birth to many children, and longtime use of oral contraceptives such as “the Pill.”
Your sexual history – and that of your partner – can also be a risk factor, Dr. Diaz says. Being sexually active at a young age, or having many sexual partners, increases that risk. “We know HPV causes cervical cancer, and HPV is transmitted through sexual contact, so it’s important that the HPV vaccine be administered before the onset of sexual activity – typically between nine and 12 years,” he says. Even women up to age 45 can still be a candidate for the vaccine, he adds.
Cervical cancer has few warning signs
Because there are usually no signs or symptoms of early cervical cancer, it’s especially important for women to have regular check-ups and screenings. Dr. Diaz advises checking with your gynecologist if you have any of the following symptoms:
- Vaginal bleeding including bleeding after intercourse
- Unusual vaginal discharge
- Pelvic pain or pain during intercourse
If found early, cervical cancer is one of the most successfully treatable cancers, Dr. Diaz notes. The American College of Obstetrics & Gynecology  (ACOG) encourages women to begin yearly cervical cancer screenings at age 21, and earlier for women younger than 21 who are infected with HIV (human immunodeficiency virus).
Screenings for cervical cancer include cervical cytology – also known as the Pap test or Pap smear, which can find cervical precancer before it turns into cancer – and, for some women, an HPV test. These tests can help detect changes in the cells of the cervix that could lead to cancer.
The ACOG recommends more frequent cervical cancer screening for women with certain risk factors, such as:
- HIV infection
- Compromised immune systems
- Exposure in utero to diethylstilbestrol – commonly know as DES – a synthetic estrogen prescribed between 1938 and 1971 to pregnant women to prevent miscarriages or other pregnancy problems
- Previous treatment for abnormal cervical tissue or cancer
The ACOG recommendations followed a report in late 2014 by the U.S. Centers for Disease Control and Prevention (CDC), which stated that an estimated eight million American women aged 21 to 65 years hadn’t been screened for cervical cancer in the past five years.
Cervical cancer poses higher risk of death for some
Although cervical cancer remains one of the most highly preventable diseases in the U.S., some women may not realize they are at a higher risk of dying from the disease, according to researchers.
Research led by the Johns Hopkins Bloomberg School of Public Health has found that African-American women are dying from cervical cancer at a rate 77 percent higher than previous reports indicate. And, white women are dying at a rate 47 percent higher than may have been stated earlier.
What’s the reason for the higher rates? The new study excluded women who have had their cervix removed through a hysterectomy. Researchers say because these women are no longer susceptible to cervical cancer, the new estimates give a more accurate view of the number of women succumbing to the disease.
Cervical cancer can be prevented
Despite the new report, the number of deaths from cervical cancer have declined overall by more than 50 percent over the last 40 years, and the number of new cases detected each year is remaining stable, according to the ACS. Experts credit increased use of the Pap test for the number of lives being saved.
“The surest way for women to prevent a cervical cancer diagnosis is to be consistent with annual visits to their gynecologist and to get their annual screenings,” Dr. Diaz says. “The Pap smear is one of the best screening methods available for cervical cancer – it’s saved countless lives.”
Dr. Diaz also advises women to strengthen their immune system through appropriate diet, exercise, stress management and good sleep habits. “Self care is such an important part of prevention – not just for cervical cancer but for other types of cancer and disease,” he says.
More treatment options for cervical cancer
For women diagnosed with cervical cancer, there is a growing array of treatment options, according to Dr. Diaz. “The idea is to never get it but if you do get cervical cancer, there are more treatment options now than ever before,” he says. “Treatment plans take into account what stage the cancer is, the patient’s co-morbidities, future fertility, and other factors.”
Early-stage cervical cancer can usually be treated with surgery alone, Dr. Diaz says, while more advanced cancer is typically treated with some combination of radiation therapy and chemotherapy. A new study is looking at the use of immunotherapy in combination with systemic chemotherapy. “Immunotherapy has really come to the forefront in the management of cervical cancer,” he says.
Dr. Diaz is principal investigator on a clinical trial testing the efficacy of immunotherapy with poly adenosine diphosphate-ribose polymerase (PARP) inhibitors. “PARP is a type of enzyme that helps repair DNA damage in cells,” Dr. Diaz explains. “PARP inhibitors are a type of targeted therapy that work by preventing cancer cells from repairing, allowing them to die. It’s an exciting class of drugs that is already being used to treat all sorts of cancers, including ovarian, breast, prostate and pancreatic cancer.”
Another cancer drug, Tivdak (tisotumab vedotin-tftv), is the first FDA-approved antibody-drug conjugate for the treatment of cervical cancer. Dr. Diaz says it gives doctors a new weapon to fight recurrent or metastatic cervical cancer in patients who have already been treated with chemotherapy. “It works like a Trojan horse – a receptor on the outside of the agent binds with a receptor on the cancer cell, allowing the drug to be delivered.” Keytruda (pembrolizumab) has also been approved by the FDA to treat cervical cancer, according to Dr. Diaz.
“Treatment for cervical cancer is very complex, with multiple options for combination therapies,” Dr. Diaz reminds patients. “It’s especially important to seek treatment at a cancer center that specializes in cancer care for women.” Miami Cancer Institute is the largest cancer center in Florida, according to Dr. Diaz, and has the state’s largest division of gynecologic oncology. “We also have a robust portfolio of clinical trials that give patients access to new, life-saving therapies not available anywhere else.”
January is recognized as Cervical Cancer Screening Month and Cervical Health Awareness Month, by the Foundation for Women’s Cancer  and the National Cervical Cancer Coalition  (NCCC), respectively. The organizations’ public education efforts highlight advances in the prevention, detection and treatment of cervical cancer, urging girls to get vaccinated against HPV early and women to receive regular Pap tests and HPV testing when recommended.