Women have the Pap test screening to thank for this reduction. It is likely to become even less threatening over the next 50 years. This additional reduction is due to the introduction of a vaccine that has the potential to prevent more than two thirds of all cases of invasive cervical cancer worldwide.
The cervix is the passage that leads from the vagina to the uterus. Cervical cancer is usually a slow process that starts with abnormal changes known as dysplasia. Eventually, cancer cells begin to form and spread more deeply into the tissue of the cervix and surrounding areas.
There are usually no symptoms. Left undetected, cervical cancer was once a major cause of death for American women. It still is in many developing countries. The cervical cancer death rate in the United States fell by 74 percent between 1955 and 1992 and continues to decline at a rate of about 4 percent a year. In terms of saving lives, the Pap test is a notable success–the most effective of all cancer screening tests.
Another major advance came about two decades ago when strong links were found between cervical cancer and the human papillomavirus (HPV), usually manifested as genital warts. Of more than 100 types of HPV, most are harmless. A few “high risk” types of HPV have been found in at least 99 percent of cervical cancers. Infection with HPV is now considered the number one risk factor for cervical cancer.
Today, a test to detect HPV is often used as a follow-up when abnormalities are detected on a Pap smear. It can also be used as a screening test on its own, and, in one recent study, it was nearly twice as effective as the Pap test in detecting early cervical cancer. Efforts to prevent HPV are central to the battle against cervical cancer.
The most recent breakthrough came in June of 2006 when the FDA approved Gardasil, a vaccine that has been found effective in preventing the two strains of HPV most frequently found in cervical cancer. As such, it was the first anti-cancer vaccine. Gardasil has been found effective in preventing genital warts caused by HPV types 6 and 11 and in preventing precancerous cell changes caused by HPV types 16 and 18.
Early Action Necessary
The catch is that the vaccines are effective only for prevention–before an abnormal Pap test occurs. For that reason, the American Cancer Society recommends that the vaccine be routinely administered to 11- and 12-year-old girls–or even as early as age 9, according to a doctor’s discretion. By immunizing females before sexual activity has started, health officials believe they can dramatically reduce the incidence of cervical cancer.
Catch-up vaccinations are also recommended for females age 13 to 18 who have not previously been immunized. Studies are being done to determine the benefit of immunization for adults age 18 and over. The vaccine cannot be used for treatment once precancerous changes have started to occur. At this time, any girl who is preparing to head off to college and has not had the vaccine should talk with her doctor or pharmacist and get the vaccine.
HPV is the most common sexually transmitted disease. An estimated 80 percent of women have been infected by age 50. It usually goes unnoticed and may clear on its own within a year or two. Most genital warts are caused by low-risk types of human papillomavirus. The high risk types often show no visible signs except for the precancerous changes in cervical cells. This is why Pap smears are very helpful in catching the early stages of the disease.
HPV is difficult to prevent since it is passed by skin-to-skin contact as well as by sexual intercourse. While condoms provide some protection, the virus can be passed by contact with the skin of the genital or anal area that is not covered by a condom. Except for avoiding all genital contact with another person, there’s no sure way of avoiding an HPV infection.
Major risks for HPV, which are also risks for cervical cancer, include:
• Having sex at an early age
• Having numerous sexual partners
• Having sex with someone who has had multiple sexual partners
Young women, age 20 to 24, are the most likely age group to be infected with HPV. Uncircumcised males tend to have a higher risk of passing along an infection. Not all women who have had an HPV infection go on to develop cervical cancer. Other factors that make a woman vulnerable to cancer include:
SMOKING: Smokers have a risk double that of non-smokers. As with many other cancers, the combination of smoking with other risk factors may trigger cell changes that lead to cancer.
WEAKENED IMMUNITY: The immune system offers important protection against cancer. When immunity is weakened by illness or by HIV/AIDS, the risk of cervical cancer increases.
OTHER STDs: Infection with chlamydia, gonorrhea, syphilis (as well as HIV/AIDS) increases the risk of acquiring HPV and of developing cervical cancer.
MULTIPLE PREGNANCIES: The increased risk may result from greater sexual exposure and risk of HPV infection but also because of hormonal changes and weakened immunity during pregnancy.
LONG-TERM USE OF ORAL CONTRACEPTIVES: Women who use oral contraceptives for 10 years or longer have up to four times the risk of other women.
LOW SOCIOECONOMIC STATUS increases the risk, in part because of reduced access to health care services.
FAMILY HISTORY: If a member of your immediate family has cervical cancer, your risk is increased two- to three-fold.
To assess your own risk of cervical cancer, a personalized risk assessment is available online at http://www.yourdiseaserisk.harvard.edu. The website is full of useful information about risk and prevention. Please note that over the years, even women who are careful to avoid risk factors can develop cervical cancer. This is why steps 2 and 3 are important.
Once it becomes widely used, the vaccine will reduce many of the above risks. But the vaccine does not protect against all causes of cervical cancer. Screening with the Pap test or HPV test is recommended once a year for all women starting about three years after they start having sexual intercourse, but no later than age 21. After age 30, depending on risk factors and results of tests, some women can have screening every two or three years.
Get Vaccinated
A vaccine called GARDASILâ is available to prevent development of the four most common strains of HPV. By preventing the most common HPV strains, the vaccine will greatly reduce, but not eliminate the risk of cervical cancer. GARDASILâ is given as 3 injections over 6 months. It is now available at many physician offices as well as at our pharmacies (Bremo, Bremo LTC and Henrico).
Girls and women ages 9 to 26 should get the vaccine. For those who are beyond teen years, GARDASILâ works when given before having contact with HPV Types 6, 11, 16, and 18. Those who have already been infected with HPV can still benefit from GARDASILâ because it is unlikely that you have been infected with all 4 types of the virus covered by the vaccine.
Adults (over 18) may receive the vaccine at the pharmacy without a written prescription. Any female under 18 who would like to have the vaccine administered at the pharmacy may have the doctor call a prescription to the pharmacy for administration. The most common side effects associated with GARDASILâ are redness and soreness at the injection site. Other mild problems include mild-moderate fever (100-102°F) and itching at the injection site. These symptoms should not last long and go away on their own.
Get Regular Pap Smears
Since even the most careful woman can develop the disease, early detection is also important. If HPV or abnormal cells are detected on examination, the disease can be prevented by early treatment. Annual gynecologic exams are essential in this level of prevention. In fact, even if you avoid the risks and get vaccinated against HPV, there is some possibility of still developing cervical cancer. Annual exams will continue to be important despite the availability of the HPV vaccine.
Immunization and Pap smears now offer women a way to gain the upper hand on cervical cancer. Women need only take advantage of these tools to help conquer the risks of cervical cancer.
Most insurance companies cover the HPV vaccine. It is always wise to check first with your insurance company about their coverage and policy. The price of prevention with the vaccine and annual Pap smears is far less that the cost of managing the condition.
Please call the pharmacists at Bremo and Henrico Pharmacies if you have further questions.
· Bremo Pharmacy 804-288-8361
· Henrico Pharmacy 804-285-7730
Michelle Herbert Thomas, PharmD, CDE
Clinical Director
Richmond Apothecaries, Inc.
