Cervical Health Awareness Month brings attention to necessary screenings

January marks Cervical Health Awareness Month, which brings attention to common diseases of the cervix — cervical cancer and HPV specifically — and the people affected by and measures that can be taken to prevent them.

Cervical cancer can affect people of all ages and is the fourth most common cancer among women in the world. HPV16 and HPV18 are associated with nearly half of all high-grade cervical pre-cancers, according to WHO.

Healio spoke with Ritu Salani, MD, director of gynecologic oncology at UCLA and a board-certified gynecologic oncologist, about the basics of screening, signs of cervical cancer and ways the disease can affect the everyday lives of those diagnosed.

Healio: What are the signs of cervical cancer?

Salani: There are two ways to think about this. There is a screening test for cervical cancer, so oftentimes, precancerous lesions or even early-stage cancer, may be detected by Pap testing or HPV testing on routine examination. But when cancer is more advanced, or if it’s not detected via screening, common signs may include abnormal vaginal bleeding. This most commonly occurs after sexual activity. There can also be a malodorous discharge. In more advanced settings, there may be pelvic pain or even leg pain.

Healio: How prevalent are cervical cancer and HPV and does that prevalence differ with age?

Salani: Cervical cancer is the fourth most common cancer globally, but the United States actually has a lower incidence. This is a testament to Pap testing, HPV testing and even HPV vaccination.

HPV infection is prevalent. Most people, both males and females, will have HPV exposure at some point in their lifetime. The big difference regarding HPV and cervical cancer is when the infection persists — then it can start causing problems. Most people will clear the HPV infection. Those who don’t clear it have a higher risk for developing cervical cancer.

The prevalence does differ with age. We’re more likely to acquire HPV at younger ages, but we’re also more likely to clear it at younger ages. Cervical cancer is a disease of younger women, with the average age being about 49 years.

Healio: How effective are the treatments for cervical cancer and HPV?

Salani: There is no treatment per se for HPV itself. The best thing is to reduce the risk of HPV with the HPV vaccination, which has been shown to be very effective. Getting it at younger ages, with the ideal ages in the 11- to 13-year range, is the most optimal time to get the vaccination.

Cervical cancer treatments range in effectiveness, and this depends on what stage you’re diagnosed in and how aggressive the cancer is. When caught in early stages, survival or outcomes from treatment are highly successful. But unfortunately, many cases are caught in more advanced stages, and then the cure rates go down. So, the more advanced it is, the lower the cure rates, and the more treatment that may be needed.

We’re making progress: In the last 2 years, we’ve had a couple of FDA approvals for new therapies that are improving survival outcomes, but we still have a long way to go, especially for those patients who have advanced or recurrent disease.

Healio: What should health care providers know before screening a patient?

Salani: There are a lot of guidelines on cervical cancer screening. Unlike a mammogram, which is just an order and you show up and get a test done, cervical cancer screening requires an examination, and it is a sensitive examination. Not everybody does this examination. It’s important for both doctors and patients to know that they need to have the testing done by someone who’s proficient in a pelvic examination, that they’re doing the right thing with the HPV testing plus/minus cervical cytology, which is looking at the cells of the cervix. HPV testing is by far more accurate.

The most important thing is the interpretation of the results. Positive HPV presence or abnormal cells warrant further evaluation, and that is so important for doctors to know. It’s also important for patients to get their results, so that they don’t just assume no news is good news, and they understand what they mean.

Screening can vary. If a patient has a completely normal screening negative for HPV, they can have a 5-year interval between repeat testing. That’s because the risk of developing cancer is so low, it’s negligible, and they don’t need additional screening, which can lead to unnecessary costs. That’s nice because it can take off one more thing to do and it’s an anxiety-inducing examination. But it’s important that if screening tests are abnormal, that you have appropriate follow-up. Most cases of cervical cancer develop because of failure to screen or failure to act appropriately on abnormal tests. Most people will start testing at either age 21 or 25, depending on different guidelines. The important thing is to be screened regularly, up until age 65. After age 65, screening can be discontinued if it’s been normal for the prior 10 years.

Healio: How can the effects of cervical cancer affect the everyday lives of patients?

Salani: Cervical cancer is preventable, and so developing this cancer, to me, is just a failure of the health care system. This can be a devastating disease. Even when caught in early stages, having a diagnosis of cancer is traumatizing. The important thing is that these are typically, but not always, younger women who may have careers, young families, fertility concerns, and having a diagnosis of cervical cancer can impact that, so prevention or early management is key.

But even if patients are cured, there are lasting impacts from cervical cancer treatments. Having a diagnosis of cancer could have lasting impacts on fertility, sexual health and normal psychological well-being. That’s not specific to cervical cancer, but it does include it. So, it can have impacts that are far-reaching even beyond the diagnosis or treatment of cervical cancer. It can also impact the lives of their loved ones: caregivers, children, etc. So, it’s an important disease to prevent, because we have opportunities to prevent it, but it does require a whole team of people to take care of patients once they’ve been diagnosed.

Healio: Is there anything else you’d like to highlight about this topic?

Salani: The most important thing is to know that there are ways to prevent cervical cancer. It is so important to have screening as everyone is at risk and this is not a disease that affects a certain population. Making sure that everyone is up-to-date with screening guidelines is critical. If there’s an abnormal test, it’s so important to get appropriate follow-up. Lastly, I’d like to highlight the importance of the HPV vaccination, which can not only help reduce the risk of developing cervical cancer but can also reduce the risk of getting other HPV-associated cancers and reduce the risk of genital warts.

References:

• Cervical cancer. www.who.int/news-room/fact-sheets/detail/cervical-cancer. Published Feb. 22, 2022. Accessed Jan. 20, 2023.
• Cervical health awareness month – January 2023. nationaltoday.com/cervical-health-awareness-month/. Accessed Jan. 20, 2023.