Screening and getting the vaccine for cervical cancer are two of the ways to help combat it.
Dr. Sanchita Yadalla, an obstetrician-gynecologist at Medical Center Hospital ProCare Women’s Clinic, said cervical cancer is the third most common gynecological cancer diagnosis.
According to the Centers for Disease Control and Prevention website, each year in the United States, about 13,000 new cases of cervical cancer are diagnosed and about 4,000 women die of it.
“Hispanic women have the highest rates of developing cervical cancer, and Black women have the highest rates of dying from cervical cancer,” the site detailed.
The state Department of Health and Human Services recognized January as Cervical Cancer Awareness Month.
In Africa and Central America, cervical cancer is the leading cause of cancer-related deaths among women, Yadalla said.
“In terms of cancer deaths, it was 11th amongst all the cancer in women and ninth amongst all of the cancers for mortality. Incidence has decreased, though, more than 50% in the past 30 years because of the screening, which is a Pap smear. But it’s much more common, particularly in countries who don’t have the screening. Out of the patients who do get diagnosed with cervical cancer, 50% of them have never had a Pap smear. That tells you that screening saves lives and it helps to catch the disease early. Ten percent of them did not have the Pap smear in the five years before the cancer diagnosis. They would have had time if they had come in and had the Pap smear done to catch it earlier, when it was in the earlier phase, that pre-cancer phase,” Yadalla said.
Overall risk in the U.S. is decreasing, but the risk is high in immigrants who lacked health care and those who are uninsured, Yadalla said.
“Over the years, we have seen a dramatic decrease in cervical cancer. However, rates have recently leveled off,” Faith Sandberg-Rodriguez, associate commissioner of Family Clinical Services at the Texas Health and Human Services Commission,” said in a news release.
“Half the cervical cancer cases we see today occur among women who have never or rarely been screened. We are encouraging Texans to turn that trend around by resolving to prioritize cervical health. Routine cervical cancer screening is the most effective way to detect cancer early, and the first step is talking with your doctor,” she added in the release.
Cervical cancer is the third leading cancer diagnosis in women ages 20-39 and the fifth in women ages 40-49.
According to the Texas Cancer Registry, there were 1,395 new cases of cervical cancer in Texas women in 2019, the release said.
The Centers for Disease Control and Prevention recommend cervical cancer screenings for women ages 21–65.
Yadalla said the main cause of cervical cancer is the Human Papilloma Virus, or HPV.
“It is central to the development of the cancer and it can be detected in 99% of the cervical cancers. In the era of HPV vaccination, most experts expect a decrease in the incidence of cervical cancer. So by some of their estimates if a vaccination rate of 70% is achieved worldwide, we would expect a decrease of 350,000 new cases per year and of 180,000 deaths per year. That’s our goal … In Australia … the vaccination rate is more than 70% and they have 38% reduction in the high-grade dysplasia. Dysplasia is a pre-cancer. … Out of all the states, Connecticut has about a 60% vaccination rate. It’s one of the highest in the country and there they have had 18% reduction in high-grade, pre-cancer or dysplasia,” Yadalla said.
In Ector County, they have to raise the vaccination and screening rate. Yadalla said there are multiple reasons why people don’t get the vaccine or screening.
“The latest data that I was reading is the vaccination as well as screening rate (has gone down) a little bit during the COVID time. People just didn’t come because they didn’t want to come out of the house. They only came in when they needed the health care absolutely for a emergency situation. But there is still a good amount of people in our community who are there illegal, who are uninsured, who are single moms and just so busy they do not have the time to be able to take the time for themselves,” Yadalla said.
She added that there are so many variables as to why women are not getting screened.
“Our goal is to get the rate of the screening HPV vaccination as high as possible for our county,” Yadalla said.
Some of the risk factors for cervical cancer include early sexual activity, multiple sexual partners, high-risk sexual partner, history of sexually transmitted diseases, someone who has had vulvar or vaginal cancer, because those are also caused by HPV, she said.
“So someone who has had those, they are also at risk for having cervical cancer,” Yadalla said.
Having your first child at an early age, someone with three or more children and lower socioeconomic status are also factors.
She added that it is more common in the non-white population and patients who are on oral contraceptive pills, immunosuppressed people and people with chronic illnesses like HIV are also at risk.
No genetic predisposition has been clearly identified for cervical cancer. Patients who are younger than 21 have a great, effective immune response that can clear HPV in about eight months or so and can decrease the viral load to an undetectable level in eight to 24 months.
The virus is categorized in high grade and low grade. The two most checked for viruses are HPV 16 and 18.
“If someone has this on a Pap smear, we definitely keep a close eye on that patient’s Pap smear and we’ll do certain testing if necessary,” Yadalla said.
If a pre-cancer is diagnosed, a portion of the cervix is removed through a procedure called a Loop electrosurgical excision procedure, or LEEP.
“If someone does have a cancer, the only choice that they have is a hysterectomy and it’s done by a specialist surgeon. They’re called a GYN oncologist; not the general gynecologist like myself. … They not only take out the uterus, cervix, ovaries and tubes, they take out lymph nodes and everything … Those patients sometimes … need chemotherapy. Sometimes they need radiation; sometimes they need all of it. (The) survival rate depends on what stage they are diagnosed in; how much spreading someone had. Our goal is to definitely prevent that cancer from happening and remove first of all detect pre-cancerous lesions and remove those before they have a chance to become cancerous lesions,” Yadalla said.
In years past, when a young girl, 12 or 15 years old, went to a gynecologist, she got a Pap smear. Now guidelines recommend doing a Pap smear at age 21 whether someone is sexually active or not. Someone who is immunocompromised may need one earlier.
They do the Pap smear and HPV swab.
Between the ages of 21 to 29, a Pap smear is done and if it is abnormal HPV testing is done. But if it’s normal, they can come every three years for a Pap smear.
“But between age 30 to 65, the Pap smear and HPV testing is recommended to be done every five years. But if they don’t get HPV testing done, then just the Pap smear alone every three years,” Yadalla said. “Once a pap smear is not recommended anymore for someone who has had normal Pap smears, no history of abnormal Pap smears, of pre cancer or cancer, it’s not necessarily because now we are doing HPV testing. When you do HPV testing, you can stretch out the Pap smear to at least three years to five years. Someone who is 65 and above, as long as they have never had an abnormal Pap smear, as long as they have had documented normal Pap smears in the past 10 years, and normal Pap smears within first five years, you can discontinue performing the Pap smear after a 65.”
But if a 65-year-old woman comes in who has not had a Pap smear, one should be performed because you don’t know their status or history.
Someone who has had a hysterectomy may still need to have a Pap smear and HPV test because vaginal cancer, for example, is caused by the same virus.
