January is Cervical Cancer Awareness Month

Introduction

Cervical cancer, also known as cancer of the cervix, affects cells located at the point where the uterus joins the vagina. In 2009, over 11,270 new cases of invasive cervical cancer are projected to be diagnosed in the United States. Cervical cancer was once the leading cause of cancer death for women in the United States. However, during the past four decades, incidence and mortality have declined significantly, primarily because of the widespread use of the Papanicolaou (Pap) test to detect cervical abnormalities.

The increased use of the Pap test (also known as a Pap smear), a screening procedure that permits diagnosis of preinvasive and early invasive cancer means early detection and intervention. While the death rate continues to decline by about two percent a year, death rates are higher in African-American women than white women for cancers of the cervix and screening is essential to lower these numbers.

In an effort to increase public awareness about cervical cancer, UPMC Cancer Centers joins other organizations nationwide to promote Cervical Cancer Awareness Month in January. UPMC developed these pages as a resource for learning more about cervical cancer.

Cervical cancer risk factors

Anything that increases a person's chance of developing a disease is called a risk factor. Researchers believe that, in many cases, cervical cancer develops when two or more risk factors act together. Though the precise cause of cervical cancer is unknown, the following risk factors may increase the likelihood of developing cancer of the cervix:

• Infection from the human papillomavirus (HPV) – The greatest risk factor for cervical cancer is having this sexually transmitted virus, often passed to partners who are under age 18 for their first encounter or if they have had numerous partners.
• Age – The average age of women newly diagnosed with cervical cancer is between 50 and 55 years, though this cancer can appear in women as young as in their twenties. The risk of developing cervical cancer does not go down as women age.
• Sexual behavior – Intercourse at an early age, having many sexual partners, and/or having unprotected sex at any age can increase the risk.
• Smoking – Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs. Women who smoke are twice as likely as nonsmokers to get cervical cancer.
• HIV – Testing positive for the virus that causes acquired immunodeficiency syndrome (AIDS). A cervical precancer might develop into an invasive cancer faster than it normally would.
• Nutrition – Diets low in fruits and vegetables are associated with an increased risk of cervical cancer and several other cancers.
• Family history – Women whose mother or sisters have had cervical cancer are more likely to develop the disease themselves. Some researchers suspect this familial tendency is due to an inherited condition that makes some women less able to fight off HPV infection than others.
• Diethylstilbestrol (DES) – DES is a hormonal drug that was prescribed between 1940 and 1971 for some women thought to be at increased risk for miscarriages. Of every 1,000 women whose mother took DES when pregnant with them, about one develops clear-cell adenocarcinoma of the vagina or cervix. (It is no longer given to pregnant women.)
• Low socioeconomic status – Women who do not have ready access to health care services, including Pap tests and treatment of precancerous cervical disease, are at an increased risk.

Cervical cancer facts

• Cancer of the cervix can be discovered early with a Pap test and pelvic exam, conducted yearly beginning at age 18. Some researchers estimate that noninvasive cervical cancer (carcinoma in situ) is about four times more common than invasive cervical cancer.
• Precancerous changes of the cervix usually do not cause pain. Symptoms of invasive cervical cancer can include abnormal bleeding or vaginal discharge.
• Only a few HPV virus types cause warts that become cancerous. A new kind of Pap smear (liquid) can better determine the results and help eliminate false negatives.
• While there is some statistical evidence that long-term oral contraceptive (OC) use for five or more years may slightly increase the risk of cancer of the cervix, there is no definitive link between using OCs and an increase in the risk of cervical cancer. Research is underway to resolve this issue.

Cervical Cancer Screening Guidelines

• Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age.
• Screening should be done every year with regular Pap tests or every two years using liquid-based tests.
• At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years. However, doctors may suggest a woman get screened more if she has certain risk factors, such as HIV infection or a weakened immune system.
• Women 70 and older who have had three or more consecutive normal Pap test results in the last ten years may choose to stop cervical cancer screening.

Sources: American Cancer Society; National Cancer Institute; Centers for Disease Control and Prevention;

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