Why vaccination and regular screening are critical for prevention of cervical disease.
Each year, more than 13,000 women are diagnosed with cervical cancer in the U.S., according to the American Cancer Society. Cervical cancer, however, is a largely preventable disease. Awareness of the disease and its causes are crucial for its prevention, and through routine screening and youth vaccination, it has the potential to be treated early.
The cervix is in the lower part of the uterus and plays a key role in reproductive health. Early cervical cancer usually doesn’t present any symptoms, which makes it hard to detect, according to the National Cancer Institute. Symptoms of cervical cancer often begin once the cancer has spread to other parts of the body. Early-onset symptoms of cervical cancer include abnormal vaginal bleeding, longer menstrual periods, bleeding between periods, pelvic pain, and more.
“Symptoms aren’t always a good way to gauge if someone may have cervical cancer, as the symptoms typically associated with the disease can also occur with other conditions and diseases,” said Fred Wyand, director of Communications of the American Sexual Health Association/National Cervical Cancer Coalition (NCCC). “Also, an early cervical cancer may not have any obvious signs or symptoms, which may show up only as the disease progresses.”
Advanced cervical cancer symptoms, according to the National Cancer Institute, include dull backache, pain in the abdomen, painful urination, and difficult and painful bowel movements and bleeding from the rectum. For disease prevention, it is encouraged by the National Cancer Institute that women (and individuals that have a cervix) follow up-to-date cervical cancer screening recommendations.
Screening for prevention
The goal of screening for cervical cancer is to find potential precancerous cervical cell changes early, when treatment can prevent cancer from spreading, according to the American Cancer Society. Cervical pre-cancers are diagnosed far more often than invasive cervical cancer.
Cervical cancer incidence rates decreased by more than half from the mid-1970s to the mid-2000s, largely due to increased disease screening rates, and these rates have stabilized over the past decade, according to the American Cancer Society. In contrast, rates declined by nearly 11% each year from 2012-2019 for women ages 20-24, most likely a reflection of the first signs of cancer prevention from Human Papilloma Virus (HPV) vaccination.
“Regular screening for cervical cancer with an HPV test and/or a Pap test is highly effective when done regularly at appropriate intervals,” said Wyand. “This might involve a Pap test every three years or an HPV test either alone or as a co-test with a Pap every five years.”
Women ages 21 through 65 should receive regular cervical cancer screening, or a Pap smear, every three years during a routine gynecologist visit, according to the National Cancer Institute. A Pap smear looks for changes in the cervix that may, in rare cases, lead to cancer. Pap smears also monitor whether a person’s cells have changed in size or shape, and determines how quickly they are growing. If a test registers change, it is possible that it is caused by HPV.
Finding cervical changes early means receiving the care needed to make sure the abnormal cells don’t become a further health issue. For women ages 30 and over, an HPV test is also recommended in addition to a Pap smear, according to the National Cancer Institute. HPV tests can pick up on many of the high-risk types of HPV that are commonly found associated with cervical cancer.
“As our understanding of cervical cancer has increased, so has the technology used to screen for and detect the disease (and the underlying HPV infections that cause it),” said Wyand. “As technology and our knowledge base evolve, the need to screen annually decreased, and now, most patients are generally checked every 3-5 years.”
It can, in fact, be harmful to screen too often. Over-screening can result in “needless referrals to biopsies for women who have HPV infections or even minor, early cell changes that are all likely to clear spontaneously,” said Wyand.
If Pap-test results do show cell changes, it is referred to as cervical dysplasia (aka precancerous cell changes, abnormal cell changes, etc.). Just because a woman has cervical dysplasia does not always mean that she will get cervical cancer. Instead, this means that a woman’s healthcare provider will closely monitor the cervix, possibly treating, to prevent further cell changes that could become cancerous over time if left unchecked.
“If an individual experiences any symptoms that are concerning, they should be sure to talk with a healthcare provider,” said Wyand. “HPV vaccination is recommended for all genders through age 26 for prevention of the disease. The vaccine is more effective when given at younger ages and can be administered as early as age nine.”
The impact of HPV
Most cases of cervical cancer are associated with certain types of HPV. About 79 million people are estimated to have an active HPV infection at any given time, according to the Centers for Disease Control and Prevention (CDC). In most cases, the virus is harmless and has no obvious symptoms, but certain high-risk types of HPV may lead to cancer.
“There are over 100 different types of human papillomavirus, or HPV,” said Wyand. “Some types of HPV can cause genital warts, and other types can cause cancer, including cancer of the cervix, vulva, vagina, penis or anus, as well as cancer in the back of the throat. The “high-risk” HPV types are linked to the development of cancer. The “low-risk” types that cause genital warts are almost never found with cancers.”
There are approximately 37,300 cases of HPV-related cancers each year in the United States including 11,100 cases of cervical cancer, according to NCCC. The CDC estimates that 90% of these cancers could be prevented with vaccination.
While HPV can cause disease, most HPV infections do not cause symptoms that are noticeable, so most people will never know they have the virus.
“With advancements in technology, medical professionals now have the ability to detect high-risk HPV types including very specifically the two oncogenic types – HPV 16 and HPV 18 – that combined are responsible for about 70% of cervical cancers globally,” said Wyand.