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Cervical screening through regular Pap smears, as well as the HPV vaccine, are both incredible tools in the prevention of cervical cancer. When it comes to risk reduction for cancer development, women should be educated by their health care providers that prevention is indeed the best medicine.
By Maura Fox, OMS-III
University of New England College of Osteopathic Medicine
The average number of cervical cancers occurring in the United States is close to 12,000 new cases each year, with 91 percent being caused by the human papilloma virus (HPV). The most common symptoms associated with cervical cancer are postcoital bleeding, bleeding between periods, unusual vaginal discharge and associated pelvic or back pain.
Unfortunately, presentation of these symptoms typically occurs at a more advanced stage of the disease. In order to successfully fight cervical cancer, it’s vital to catch it early, or take the appropriate measures to prevent it in the first place.
HPV vaccination and regular screenings can significantly lower one’s risk for cervical cancer development.
There are multiple strains of HPV, ranging from those that cause warts, to the high-risk strains 16/18, which are linked to multiple types of cancer. Vaccines protect against the high-risk strains. The CDC recommends HPV vaccination for females between the ages of 9-26, ideally receiving the vaccine between the ages of 11-12. It’s important to educate patients and their parents that the vaccine only works if the person is not already infected with HPV, stressing the importance of vaccination prior to onset of sexual activity.
If a Pap shows abnormal cells, specifically ASCUS, a high-risk HPV test will be conducted. If the high-risk HPV test comes back as positive, a colposcopy of the cervix is done. While a Pap is adequate for screening, a colposcopy is the gold standard for diagnosis and next steps.
The results from colposcopy classify varying degrees of cervical intraepithelial neoplasia (CIN), on a scale from the low-grade lesions of CIN 1, to high-grade lesions of CIN 2 and CIN 3. LSIL is not equivalent to CIN 1 histologically, neither is HSIL equivalent to CIN 2 or 3. Recent data suggests that CIN 1 uncommonly progresses to CIN 2 or 3, at least within the first 24 months. Common practice is to monitor and repeat screening in ASCUS or CIN 1 in 6-12 months, to see if the lesions have regressed or persisted. CIN 2 or CIN 3 lesions are treated a bit more aggressively. There are several methods to remove them, such as cryotherapy, laser ablation, cold-knife conization and loop electrosurgical excision procedure (LEEP). Both the LEEP and cone biopsies are beneficial for diagnosis but can also accurately remove the precancerous or early cancerous areas.
Education from health care providers about the Pap result is important. Realizing that most people infected with HPV do not go on to develop cancer can help ease any anxieties a person may have. A prospective study of Brazilian women with LSIL found that more than 90% regressed within 24 months. It’s important to make the necessary lifestyle and dietary changes to bolster one’s immune system so that the body can fight off the infection. The immune response plays an important role in clearing most infections, but some do persist, which is why we have screening tools in place to catch lesions early before they progress to more invasive stages of disease.
Although it’s comforting to know that our immune system has the ability to clear HPV, it’s important to not rely on this, and instead aim to be proactive against the virus through prevention. The high-risk strains of HPV are largely preventable via the vaccine. The CDC also recommends lowering your risk of contracting HPV by using condoms during sex, limiting the number of sexual partners, as well as not smoking. It’s been shown that quitting smoking may help the body more effectively get rid of HPV after contraction.
Abnormal Pap test results are common. Test abnormalities such as dysplasia or precancerous cells do not always indicate having cervical cancer. The average time course from CIN 3 progressing to invasion is estimated at ten years, providing many opportunities for these lesions to be detected and be treated. Detecting cervical abnormalities at an early stage is the best-case scenario, as it can be dealt with using minimally invasive measures before cancer develops.
Cervical screening through regular Pap smears, as well as the HPV vaccine, are both incredible tools in the prevention of cervical cancer. When it comes to risk reduction for cancer development, women should be educated by their health care providers that prevention is indeed the best medicine.
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