Too many women are dying of cervical cancer. Why? The problem is not enough women are following Pap smear guidelines and getting cervical cancer screening.
Cancer of the cervix can be treated — if it is caught early. But the U.S. death rate from the disease is much higher than observers had estimated, according to one study. The problem is that too many women aren’t not following Pap smear guidelines, which advice when to have cervical cancer screening, the researchers said.
In fact, black women in this country are dying of the disease at rates comparable to that of women in poor countries. Just over 10 black women die of cervical cancer for every 100,000 black women in the population. For white women, the figure is 4.7 per 100,000. Another study that analyzed data for more than 15,000 patients with advanced cervical cancer found that more than half did not receive treatment considered to be standard of care.
Other research found that having insurance makes a significant difference. Young women with insurance are more likely to follow Pap smear guidelines and get tested and receive appropriate treatment.
What causes cervical cancer?
Cervical cancer is caused by an abnormal immune response to the sexually transmitted virus HPV, or human papillomavirus. You can’t avoid HPV because condoms do not prevent it, but most people’s immune system can fight it off. When people do develop cancer from the virus, the cancer shows up 10 to 20 years after the first exposure. The incidence of cervical cancer in the United States has dropped by more than half in the past 30 years because of widespread screening. Pap smears reliably identify cervical cancers. Early research suggests that they could eventually detect cancer in the uterus and ovaries as well.
To protect yourself (or your daughter), make sure you have received the tests and vaccines for HPV on the recommended schedule. The Centers for Disease Control and Prevention recommends that 11- to 12-year-old girls get two doses of HPV vaccine, separated by 6 to 12 months. Girls and women age 13 through 26 years of age who have not yet had the two shots should get them as well. There is also a vaccine for boys.
Pap smear guidelines
You still need to get Pap smears even if you have been vaccinated since the vaccine doesn’t prevent all types of cervical cancer.
Under the current cervical cancer screening guidelines from the American Congress of Obstetricians and Gynecologists (ACOG), women should get their first Pap test at age 21. After that you should have a Pap test every three years — around age 24 and ages 27 and 30. If those three tests are normal, you can continue having a Pap test every three years, or even better, have a Pap test and an HPV test together every five years. After 65, you can stop getting the test if you’ve had normal results previously.
Women who have a total hysterectomy — which removes the uterus and cervix — for a noncancerous condition can stop having them.
Gynecologists have grown used to giving women tests every year. However, ACOG, the group of obstetricians and gynecologists, changed the cervical cancer screening guidelines because those yearly tests can lead to unnecessary and possibly harmful surgery. Young women, especially, develop abnormalities in the cervix that seem to be precancerous, but would go away if left alone. When those growths show up on a Pap tests, doctors often remove them. In the process, they may injure the cervix.
Because cervical cancer develops so slowly — over 10 to 20 years — a test every three years will catch one, the ACOG group concluded. Anyone who has had an HIV infection or any condition that could suppress their immune system should get tested more often.
If cervical cancer is caught early through a Pap smear, the dangerous tissue can be removed with a procedure called a “cone biopsy.” But if the cancer is at a later stage, more of the body will need to be removed.
M. Margaret Kemeny, MD, who runs the Queens Cancer Center of Queens Hospital, a public hospital in New York, reports that she has treated many younger women of color who had never had Pap smears and developed cervical cancer. She mentioned two patients, each with recurring cervical cancer, one Chinese, the other Hispanic. She had to remove each woman’s cervix, vagina, rectum and bladder, and insert bags that are worn outside the body to collect urine and stool. “One was 39,” Dr. Kemeny said, “and the other was 25.”
March 30, 2020
Christopher Nystuen, MD, MBA