Thursday, May 3, 2007

Cervical Cancer

Photo by: Unknown
Source: MSN Health
Author: Anna Chan

Reality CheckWorldwide, cervical cancer is second only to breast cancer as a cancer threat to women.

This year an estimated 493,000 women across the globe will be diagnosed with cervical cancer, and more than half of them will die from the disease, according to the National Cervical Cancer Coalition. In the United States, the American Cancer Society estimates that about 39,000 women will be diagnosed with cervical cancer this year, and roughly 3,700 of them will die from it. The reason for the higher death rate in developing countries is due to limited access to Pap smears, tests that allow for early intervention by detecting precancerous cells in the cervix.

Reality Check
Where there’s cervical cancer, there’s genital HPV—usually.

Millions of women are infected with sexually transmitted human papillomavirus (HPV), which is a group of many viruses, some of which can cause genital warts. Researchers have discovered HPV present in approximately 90 percent of cervical cancer tissues, according to the American Social Health Association. Of the HPV types found in those patients, Types 16 and 18 were the most prevalent. These two high-risk strains don’t cause genital warts and generally don’t display other noticeable symptoms, which can make detection of these virus types trickier. Understand, you can have an infection of high-risk HPV and never develop cervical cancer; however, cervical cancer rarely exists without HPV.

Reality Check

How genital HPV is transmitted.

Of the roughly 150 known strains of HPV, about 25 percent are genital strains, meaning they are transmitted mainly via sexual contact. However, sexual contact that transmits HPV is not limited to only penetrative sex. Since HPV infects the skin, any skin-to-skin contact around the genital areas (including the thighs and buttocks) can lead to HPV transmission. In addition, HPV 16 has been found under the nails of males, according to Nancy Dorn, MN, ARNP.

But sexual contact is not the only way HPV can be transmitted. Although rare, a mother can pass on HPV Types 6 and 11 to her infant during vaginal delivery. These strains can cause respiratory papillomatosis, which may lead to benign growths in the respiratory tract. Currently, there is no data to support the idea that a Cesarean section may prevent this type of HPV transmission.

Reality Check
An annual Pap test is the best way to prevent cervical cancer.

With the introduction of the Pap smear by Dr. George Papanicolaou more than 50 years ago, the number of cervical cancer deaths has declined steadily in the U.S.

Although the Pap smear isn’t 100 percent accurate, today a patient with abnormal results can get a follow-up HPV test. This test can determine if HPV is present, and if so, if it’s one of the high-risk strains associated with cervical cancer. Regular screenings using both tests can detect precancerous changes in cervical cells, and with treatment, it is possible to prevent these cells from turning deadly.

Reality Check
Using condoms, not smoking and eating your veggies can help lower your risk for cervical cancer.

Reducing various risk factors can play a role in preventing cervical cancer. To begin with, practice safe sex. Using a condom can help block the transmission of HPV. But it is not a foolproof method, as the virus can be present on the skin around the genitals in areas not covered by the condom. But, again, having high-risk HPV does not mean that a woman will definitely develop cervical cancer. Researchers say that in addition to high-risk HPV, other factors (such as smoking, poor diet, sexual promiscuity, among other vices) are generally present before cervical cancer develops.

New research also suggests that women infected with multiple strains of HPV are 92 to 400 times more likely to develop high-grade cervical lesions that can lead to cervical cancer.

Reality Check
Cervical cancer is more deadly for the poor and certain racial groups.

In the U.S., the groups with the highest mortality rates from this disease are Hispanics living along the Texas-Mexico border, African-Americans in the South, Native Americans in the Northern Plains, Caucasians in Appalachia, Vietnamese-Americans and Alaska Natives. The cancer also usually affects women in middle age and older. The National Cancer Institute reports that these higher death rates may be due to poor access to health care and lower education and income levels.

Reality Check

New vaccines to protect tomorrow’s men and women.

Even though cervical cancer is one of the top cancer killers of women today, a new vaccine could change that. Gardasil has been found to be 100 percent effective against four HPV types, including the troublesome Nos. 16 and 18. The Food and Drug Administration (FDA) approved Gardasil on June 8.

Manufacturer Merck & Co. advises the vaccine be administered to young girls below the age of 15, as it would be most effective before girls become sexually active and are exposed to HPV. However, there is one potential obstacle that could block the vaccine’s ability to prevent the spread of HPV and thereby lower cervical cancer rates—cost. The anticipated price is between $300-$500 for the three shots during a six-month period.

For women older than 26 who do not qualify for Gardasil, GlaxoSmithKline is working on the vaccine Cervarix, which will protect against Types 16 and 18. Cervarix is effective in females ages 15 to 55, and the FDA is expected to review and approve the vaccine by year’s end. And although no HPV vaccine is available for men right now, two drug manufacturers are currently working on vaccines for the male half of the population.

“Reality Check” columns clear up misconceptions and offer fast facts on a broad range of health topics. To learn more about cervical cancer, see the American Social Health Association's National HPV & Cervical Cancer Prevention Resource Center.

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