Cervical Cancer and Its Impact on African American Women

Cervical cancer forms in the tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope).

Although the rate of new cases of cervical cancer (as well as death from cervical cancer) has declined approximately 50 percent in the United States over the past three decades, the disease remains a serious health threat. Even though the mortality or death rate for African American women with cervical cancer has declined more rapidly than the rate for white women, the African American mortality rate continues to be more than double that of whites. Geographic and socioeconomic-related disparities in cervical cancer mortality (death) also exist

Who Should Get Screened…and When?

Cervical cancer is preventable and curable if detected early. Important strategies to reduce the risk of cervical cancer include screening with the Papanicolaou (Pap) and human papillomavirus (HPV) tests, as well as prevention of HPV infection with the HPV vaccine. Researchers have identified HPV, which is transmitted through sexual contact, as the main cause of cervical cancer.

• First screen -- Screening for cervical cancer should begin by approximately 3 years after first sexual intercourse or by age 21, whichever comes first.
  
  
• Women up to age 30 -- Women in this age should undergo cervical cancer screening each year. Women under age 30 have a higher likelihood than older women of acquiring high-risk types of HPV that cause premalignant cervical disease, which should be ruled out before extending the testing intervals.
  
  
• Women age 30 and older -- There are two acceptable screening options for women in this age group, says American College of Obstetricians and Gynecologists (ACOG). Under either option, women may not need annual screening:
  
  
  • Testing using cervical cytology alone. If a woman age 30 or older has negative results on three consecutive annual cervical cytology tests, then she may be rescreened with cervical cytology alone every 2-3 years.
  • The combined use of a cervical cytology test and an FDA-approved test for high-risk types of HPV - Under this option women receive both a cervical cytology test and a genetic test that looks for certain high-risk types of the human papillomavirus (HPV) known to cause cancer (HPV DNA test). Once women test negative on both tests, they should be rescreened with the combined tests no more frequently than every 3 years. If only one of the tests is negative, however, more frequent screening will be necessary. (The combined testing is not appropriate for women under age 30, since they frequently test positive for HPV that will clear up on its own.)
  • Exceptions -- More frequent cervical screening may be required for higher-risk women who are infected with HIV, are immunosuppressed (such as those receiving kidney transplants), were exposed to DES (diethylstilbestrol, a hormone that was prescribed for pregnant women in the 1950s and early 1960s and lead to birth defects) or were previously diagnosed with cervical cancer.
    
  • Women 65 to 70 years of age who have had at least three normal Pap tests and no abnormal Pap tests in the last 10 years may decide, upon consultation with their healthcare provider, to stop cervical cancer screening.
    
    
• Women who have had a total hysterectomy (removal of the uterus and cervix) do not need to undergo cervical cancer screening, unless the surgery was done as a treatment for cervical pre-cancer or cancer.
  
  
• Other Annual Exams Continue -- Regardless of the frequency of cervical cancer screening, annual gynecologic examinations, including pelvic exams, are still recommended.
  

Vaccine to Prevent Cervical Cancer

You have probably heard a lot about the relatively new vaccine to prevent human papillomavirus (HPV), which we now know is a pre-cursor to cervical cancer. The vaccine called Gardasil protects against certain types of the HPV virus and is manufactured by Merck & Co. Gardasil is designed to prevent infection with HPV types 16, 18, 6, and 11. HPV types 16 and 18 cause about 70% of HPV-related cervical cancer cases.

Currently, this vaccine is approved for females aged 9 to 26 and several states have proposed legislation requiring school aged girls to get vaccinated prior to enrolling in classes. This proposed mandated vaccination has been very controversial.

If you have an adolescent daughter or you are a young women aged 18-26, I urge you to discuss the Gardasil vaccination with your doctor.

References:

(1) National Cancer Institute: A Snapshot of Cervical Cancer, Dec 2007
(2) The American College of Obstetricians and Gynecologists (ACOG) has issued a new, evidence-based practice bulletin, "Cervical Cytology Screening."

Author: David P. Pryor MD, MPH