Cervical Cancer: You Can Prevent It!

Worldwide, cervical cancer is one of the most frequent cancers affecting women, being the fourth most frequent after breast, colorectal, and lung (1). In 2020, around 600,000 new cases were diagnosed, and nearly 340,000 deaths were reported, of which 90 % occurred in low- and middle-income countries (2). 

Nearly all cases of cervical cancer are caused by Human Papilloma Virus (HPV) infections. There are low-risk HPV genotypes, which cause genital warts, and high-risk ones, which cause pre-invasive lesions that can turn into cancer. Although most HPV infections clear up on their own, and most pre-cancerous lesions resolve spontaneously, there is a risk that HPV infection may become chronic and pre-cancerous lesions, eventually progressing into invasive cervical cancer within 15-20 years. 

Prophylactic HPV vaccines are available for girls aged 11 up to 26. They protect against low-risk and high-risk HPV genotypes; some protect against more serotypes than others. For example, the 9-valent vaccine protects against 9 genotypes that cause up to 90% of cervical cancer cases (1). 

The screening test, known as the Pap smear, is a method where cervical cells are collected with a little brush and examined under a microscope. Regular assessment is essential because it allows precancerous lesions to be identified at stages where they can be easily treated. It is recommended to do it from the age of 25 every 3-5 years (3). 

Together with the Pap smear, an HPV test can be obtained in the clinician's practice. Recently, HPV self-testing has become more and more successful. The World Health Organization recommends its increased use for women between 30-60 years (4). 

In high-income countries, existing programmes enable girls to be vaccinated against HPV and women to get screened for HPV and pre-cancerous cells regularly. As a result, girls and women in higher-income countries are treated for cervical cancer adequately. In contrast, low and middle-income countries pose limited access to cervical cancer's preventative measures. Oftentimes, cancer is not identified until it has further advanced, and symptoms have developed. Additionally, comprehensive treatment options are often limited. As a result, cervical cancer cases and deaths are much more frequent in low and middle-income countries compared to those with strong cervical cancer prevention programs. 

The majority of sexually active persons get HPV at some time during their lifetime, although most never know it. The lack of awareness, coupled with the fact that pre-invasive lesions do not cause symptoms, can lead to one thinking that everything is fine. Hence, it is imperative to go to a gynecological check-up for cervical cancer screening, or do a HPV self-check according to the scheme of the country in which you are in (if applicable). 

January is Cervical Cancer Awareness month. Get vaccinated, go to the gynecologist, take care of your health! Prevent it before it is too late. According to the American Cancer Society, about 13,960 new cases of invasive cervical cancer will be diagnosed, and 4,310 women will die from cervical cancer (5). Don't be part of the statistics!

Note: The vaccination and screening recommendations outlined are based on USA guidelines. Please check your national guidelines for the Cervical Cancer prevention program and ensure to remember that age-related recommendations vary. 

Citations: 

(1) Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018;143 Suppl 2:22-36.doi:10.1002/ijgo.12611
(2) Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021:71:209–49. doi:10.3322/caac.21660.
(3) Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society.CA Cancer J Clin. 2020;70(5):321-346.doi:10.3322/caac.21628
(4) “Human Papillomavirus (HPV) Self-Sampling as Part of Cervical Cancer Screening.” World Health Organization, World Health Organization, https://www.who.int/publications/i/item/WHO-SRH-2012.
(5) American Cancer Society. Key Statistics for Cervical Cancer.
https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html

Written by Dr. Nestor Ferrer, Ob/Gyn; Edited by Dr. Luna Mehrain, MD, MSc, and Kaitlyn Gosakti