Since the advent of the Pap test, cervical deaths have steadily decreased since 1955, and are still continuing to decrease today [1]. The Pap test can detect abnormal cells in the cervix including precancerous lesions that may develop into invasive cancer. Today, the American Cancer Society estimates that less than 10,000 cases of invasive cervical cancer will occur in the United States in 2006 [1].
Hispanic women in the U.S. have markedly higher cervical cancer rates than their non-Hispanic white counterparts. Some estimates of cervical cancer rates in Hispanic women are nearly twice the rate of non-Hispanic white women. Women of African-American heritage experience cervical cancer at almost a 50% higher rate than white women of non-Hispanic descent [2].
Utah’s cervical cancer rates are lower than the collective United States rate. From 1994-2003, Utah women averaged an incidence rate of 6.8 per 100,000 person-years versus the United State’s average of 9.3 per 100,000 person-years [2]. When this rate is broken down into racial/ethnic groups, our state’s differences mirror the national statistics fairly closely, with Hispanic women suffering the greatest proportion of the disease burden. See figures 1 and 2 for details. Survival rates for invasive cervical cancer are very promising, ranging from 92% 5-year survival rates for detection at the earliest stage, to 73% 5-year survival rate for all stages of detection combined [1,3].
Risk factors for cervical cancer can be categorized into alterable factors and unchangeable factors. Alterable factors include unsafe sexual behaviors that lead to infection of human papillomavirus (HPV), smoking, obesity, physical inactivity, and vegetable and fruit deficient diets. Unchangeable factors include family history of cervical cancer, older age, and having already been infected with a cancer-causing strain of HPV [1,3].
Recently the FDA approved the vaccine Gardasil which has been shown to prevent four types of HPV infections, namely strains 6, 11, 16, and 18. Strains 6 and 11 cause about 90% of genital warts, while strains 16 and 18 cause around 70% of cervical cancers [3]. This vaccine is recommended for girls aged 9-11, before they become sexually active. It is recommended that females up to the age of 26 receive a “catch up” vaccine. It has not been shown to be cost-effective in women over the age of 30 [2]. Once a woman has been infected with HPV there is no cure for the infection. However, many women who become infected with HPV are able to clear the infection with no lingering effects, showing that merely being infected with HPV does not mean that cancer will develop. There is disparate information in the literature as to whether all cervical cancers are caused by an HPV infection (as the American Cancer Society states) or whether just most of cervical cancers are caused by HPV (as the National Cancer Institute states).
Regular Pap tests and vaccination are the two best ways to prevent the development of cervical cancer. The frequency of testing and ages at which testing should begin and end should be discussed with your physician. Living a safe and healthy lifestyle including practicing safe sex, maintaining a healthy weight, physical activity, eating at least five fruits and vegetables daily, and not smoking are all ways that may help prevent cervical cancer [1].
References
- American Cancer Society. Available Online at http://www.cancer.org. Retrieved on Dec 24, 2006.
- Surveillance, Epidemiology and End Results (SEER) by the National Cancer Institute http://seer.cancer.gov/fstats. Retrieved Jan 7, 2007.
- National Cancer Institute. Available Online at http://www.cancer.gov. Retrieved on Nov 27, 2006.
- Utah’s Indicator-Based Information System for Public Health: Available Online at http://ibis.health.utah.gov. Retrieved on Dec 21, 2006.
