By Eduardo Grunvald, M.D.
January was National Cervical Health Awareness month. To put this into perspective, in 2005 an estimated 10,000 women were diagnosed with cervical cancer in the United States and 3,000 died. This could be a woman you know... maybe your wife, girlfriend, mother, sister, or daughter. Unfortunately, the rate of developing this cancer is twice as high in Hispanic women compared to non-Hispanic white women.
Cervical cancer is also the most common cause of cancer death among women in developing countries.
Education and early screening are key to preventing this unfortunate statistic.
The good news is that the risk of developing and dying from this cancer can be greatly reduced through a simple, common medical test called a Pap smear (named after Dr. George Papanicolaou, the physician who developed the procedure). Although most women are familiar with a Pap smear, most do not precisely understand what it really is or what it detects.
The cervix is the opening of the womb, or uterus. When the clinician does a pelvic exam, the cervix is visualized. A small wooden instrument and brush are used to gently scrape some cells from it, which are then “smeared” on a glass slide. This specimen is sent to the laboratory for analysis, where abnormal cells can be detected.
The key to prevention or successful treatment of cancer is early detection. Once abnormal - or precancerous - cells are found, your medical provider can recommend specific follow-up exams, further tests and treatment, or referral to a gynecologist. Note that the Pap smear is used to detect abnormal cells BEFORE they turn into cancer.
But what causes cervical cancer? A virus called Human Papillomavirus, or HPV causes almost all cases. There are approximately 100 types of this virus, but only a few cause cancer. HPV is contracted through sexual contact. Sometimes, the body can get rid of this virus on its own often without ever showing signs of its existence. But in some cases, the virus causes genital warts. Now special tests are available to detect the presence of HPV in the cervix.
Who should get a Pap smear? A girl or woman should first have this test three years after becoming sexually active, but no later than age twenty-one. Some risk factors for developing cervical cancer include a history of multiple sexual partners, known HPV infection or having sexual partners with HPV, HIV/AIDS, having other sexually transmitted infections, smoking, and having a family history of the disease.
In general, women should have a Pap smear once a year until age thirty, then every three years, unless you have risk factors. Those with risk factors may need them yearly. Women over 70 should talk to their doctors about the frequency of having Pap smears. Patients who have had their uterus and cervix removed for non-cancer reasons do not need further Pap tests.
While Pap smears and pelvic exams are performed together, they are not the same and women may need to continue to have pelvic exams. These are only general guidelines and all women should consult their doctors for definitive recommendations.
Early detection of abnormal cells in the cervix with a Pap smear can prevent death from cervical cancer. But what if one could prevent HPV infection, the major cause of cervical cancer?
Fortunately, there is a vaccine that may be available in the near future to prevent this infection. Studies have shown this immunization to be highly effective. These results are very exciting because cervical cancer could become a very rare disease, like polio or measles.
Although pelvic examinations and Pap smears may be slightly uncomfortable, they are essential to detect abnormalities before they become serious and life threatening. January was National Cervical Health Awareness month, but being aware every month may save your life, or that of a loved one.
For more information on cervical cancer, you can visit the National Cervical Cancer Coalition at www.nccc-online.org, or (800) 685-5531, and the American Cancer Society at www.cancer.org, or (800) 227-2345.
Dr. Grunvald is Assistant Clinical Professor, Department of Medicine at the Perlman Internal Medicine Group, UCSD Medical Center.