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Published: Wednesday, January 9, 2008
By Robert F. Elder, M.D., Center for Women & Children’s Health
Cervical cancer was once the leading cause of death in women in the United States. Cervical cancer can be prevented if pre-cancers are found by a Pap test and treated. During the past 40 years, there has been a decline in cervical cancer due primarily to the use of the Pap test, which detects cervical abnormalities and cancer. However, despite intense efforts to promote Pap smears in the United States, high rates of cervical cancer persist among African American and Hispanic women.
Almost 50 percent of women diagnosed with cervical cancer have never had a Pap test. A study conducted by the Centers for Disease Control and Prevention from 1998 until 2002 observed nearly 60,000 cases of cervical cancer. The study revealed that African American women had a 50 percent greater incidence of cervical cancer compared to Caucasians. Hispanic women had a 60 percent greater incidence of cervical cancer compared to non-Hispanic women.
Greater disparities were seen among older women. In the 50 to 64 age group, African American women had a 67 percent greater incidence, Hispanic women 89 percent and Asian women 34 percent greater incidence as compared to Caucasian women. The Southern region of the United States, as a whole, had the highest incidence of cervical cancer of any other region.
Many women may not be getting screened regularly due to a number of reasons—a few of which are
Inadequate follow up after an abnormal Pap test result is decidedly a contributing factor for the increase in the number cases of cervical cancer.
Human Papillomavirus (HPV) has been associated with 70 percent of cervical cancer diagnoses. A breakthrough vaccine, Gardasil, that prevents two strains of HPV recently was approved by the Food and Drug Administration (FDA). HPV is sexually transmitted and causes an infection that then causes cervical cell changes leading to cervical cancer. The Federal Advisory Committee on Immunization Practices (ACIP) has recommended that the vaccine be routinely given to females aged 11 to 12 and as early as age nine years at the discretion of doctors. Typically, the vaccine is offered to females up to age 27; however, women should review their options with their healthcare provider.
Although this is an important advancement in women’s health, routine gynecological examinations, which include Pap screening, remain the best tool in early detection against cervical cancer. In general, regular Pap tests are recommended for all women. Specific guidelines from the American Cancer Society (ACS) are listed below. The American College of Obstetricians and Gynecologists (ACOG) guidelines vary slightly and can be found at http://www.acog.org.
|American Cancer Society|
|When to Start||Approximately 3 years after onset of vaginal intercourse, but no later than age 21|
|Intervals||Annually; every 2-3 years for women with ≥ 3 negative cytology tests*|
|If liquid-based cytology used||Every 2 years; every 2-3 years for women with 3 negative cytology tests*|
|If HPV testing used||Every 3 years if HPV negative, cytology negative|
|When to stop||Women ≥ 70 years with ≥ 3 recent consecutive negative tests and no abnormal tests in prior 10 years|
|Post total hysterectomy||Discontinue if for benign reasons and no prior history of high grade Cervical Intraepithelial Neoplasia (CIN)|
*Some exceptions apply (e.g., women who are immunocompromised, have a history of prenatal exposure to DES, etc.). See guidelines for details.
Source: Obstetrics & Gynecology 2007;109:360-370; Cancer 2002; 52: 342-362; ACOG 2003; 102: 417-427
“Even though we have made great progress in the prevention, screening, early detection and treatment of cervical cancer, the need for patients to have regular, annual visits with their physician cannot be overemphasized. It is important to reach all segments of the population, especially those underserved or uninsured women not receiving care at this time.
Although the cervical cancer vaccine is strongly recommended for females aged 11 to 12, it is not intended to replace appropriate screening guidelines nor “safe sex” programs. Some physicians may elect to screen more aggressively.”
For more information, visit the Center for Women & Children's Health. To request an appointment, call 1.877.UT.CARES (1.877.882.2737).
About the Author
Robert F. Elder, M.D., is the associate professor and chairman of the Department of OB/GYN and the medical director for the University of Tennessee Medical Center’s Center for Women & Children’s Health.