By LEENA KAMAT, MD
It's January and cervical health awareness month! The purpose of this article is to highlight the facts of one of the most preventable cancers... cervical cancer. It is the most common gynecologic cancer worldwide and most frequent cause of cancer-related death in women less than age 35.
There are five main types of cancer that affect a woman's reproductive organ: cervical, uterine, vaginal and vulvar. Cervical cancer arises when there are abnormal cells in the cervix, which is the lower narrow end of the uterus.
Approximately 13,000 women in the United States are diagnosed with cervical cancer, which is the easiest gynecologic cancer to prevent with vaccination and appropriate screening. It is also highly curable when found and treated early.
All women are at risk for cervical cancer and it most often occurs in women over age 30. Almost all cervical cancers are caused by the human papillomavirus (HPV). HPV is a common virus passed from one person to another during sex. Most sexually active people will have HPV at some point in their lives, but few women will get cervical cancer. Other risk factors that increase the chance for cervical cancer include smoking and HIV.
There are many types of HPV with more than 150 strains. The two main types of HPV are cutaneous and mucosal. Cutaneous (skin) HPV cause warts on the skin. Mucosal (genital) HPV affects the anal/genital area and can also infect the lining of the mouth/throat. There are low-risk and high-risk genital HPV types. The high-risk types are linked to causing cancer. HPV vaccine can prevent infection with the high-risk types and are effective when given at a younger age (around ages 11 or 12). As of 2017, Gardasil 9 is the only HPV vaccine available in the U.S.; it helps prevent infection by many high-risk types that cause about 90% of cervical cancers.
There are two tests that can either help prevent cervical cancer or diagnose it early: the Pap smear and HPV test. The Pap smear, which is performed by your primary physician or OB/GYN and recommended for women aged 21-65, looks for pre-cancers or cell changes in the cervix (it does not diagnose any other gynecologic cancer). The HPV test looks for the HPV virus and can be done at the same time as the Pap test, with the same swab or second swab. The pap test is one of the most effective cancer screening tests available. The frequency for Pap tests may vary depending on the clinician's discretion but typically occurs every three years if results are normal.
Cervical cancer typically does not cause symptoms unless advanced in stage at which point symptoms can include vaginal bleeding/discharge, pelvic pain, or pain during intercourse. Cervical cancer is generally a slow developing disease, and if not detected early, may spread to other parts of the body.
Radiology plays a role in cervical cancer once it is detected. The clinician may order a body CT, body MRI, or PET/CT scan to help determine if the cancer has spread. Of the imaging modalities offered, a pelvic MRI is the best imaging modality to assess pelvic spread of disease since it provides information that may alter treatment management. Depending on the extent of the cancer, which can be evaluated with MRI, treatment can include hysterectomy, radiation therapy and/or chemotherapy.
Since it is one of the most preventable, curable cancers, no woman should die from cervical cancer. I encourage women to undergo regular Pap tests for screening and receive the HPV vaccination if they're able to.
Leena Kamat, MD, is a board certified diagnostic radiologist, sub-specialized in breast imaging for Radiology Specialists of Florida at Florida Hospital. She earned her medical degree at the University of Florida, College of Medicine and following graduation completed her residency at the University of South Florida and a fellowship in breast imaging at the Moffitt Cancer Center.
Dr. Kamat has a passion for self-development and learning about human behavior that allows her to grow as a person and become a better version of herself. Her favorite quote is "Be kind whenever possible. It is always possible." - Dalai Lama