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No One Needs To Get Cervical Cancer, But 4,000 In U.S Die Annually: Get Screened, Get Vaccinated, Don’t Smoke!!

The specialist:

A director of the Division of Gynecologic Oncology at Mount Sinai, Linus Chuang is a surgeon who specializes in women’s cancers of the cervix, ovaries and uterus. During his 21-year career, Chuang has treated hundreds of patients with cervical cancer.

Who’s at risk:

January is cervical cancer awareness month, part of a global initiative to promote regular pap smears and to eradicate cervical cancer.

“This is a cancer that we can prevent and eventually wipe out through early detection,” says Chuang. “Globally, cervical cancer is probably the most common cancer killer of women, but the incidence has decreased dramatically in the United States thanks to routine pap smears.”

Of the 253,500 women who die of cervical cancer every year, about 4,000 are American.

 

Cervical cancer affects the lower part of the uterus or the cervix, usually as the result of infection by the human papilloma virus (HPV).

“HPV can cause a precancerous condition called cervical dysplasia, in which the cells on the surface of the cervix grow abnormally,” says Chuang. “The immune system often clears HPV and even low-grade dysplasia, while high-grade dysplasia is more dangerous because it can progress to cervical cancer and spread by invading the lymphatic channels.”

 

For most patients, the progression from HPV infection to cervical dysplasia and then cervical cancer takes many years, making more possible for doctors to detect the disease while it is still pre-cancerous and prevent it from developing.

“At this point, cervical cancer in this country is most common among women who don't get pap smears or see their ob-gyn regularly,” says Chuang. “With pap smears and the new HPV testing, we can do very thorough screening and prevent the cancer entirely.”

 

LEARN MORE ABOUT HPV

The most important risk factor for cervical cancer is HPV, an extremely common virus mostly spread through sexual contact; as much as 75% of all Americans have been carriers of HPV, with the vast majority of people clearing the virus. Other groups at an elevated risk of having HPV progress to cervical cancer are people who have sex earlier in life or numerous sexual partners, smokers, HIV-positive patients, and immunosuppressed patients.

 

Signs and symptoms:

One of the challenges posed by cervical cancer is that it often gives no warning signs until it has already advanced.

“Some women experience vaginal bleeding and pain, especially after sexual intercourse,” says Chuang. “However, earlier cervical cancer usually has no symptoms — that's why regular checkups are so important for early detection.”

Regular pap smears and HPV screening are the key to catching the disease while it's still pre-cancerous.

“Right now doctors recommend annual pap smears for women age 21-30, with HPV screening as a secondary diagnostic called for by atypical pap smear results,” says Chuang. “When the HPV test comes back positive, we can test to see if it’s high or low risk HPV.”

 

After age 30, pap smears can fall back to once every three years if HPV screening is included; women can stop getting pap smears after age 65 if they have no abnormal results.

“Cervical cancer is unusual because we can catch it early, prevent it and cure it," says Chuang, “Really no one in this country should have cervical cancer anymore.”

Traditional treatment:

The main planks of fighting cervical cancer are prevention and early detection.

 

“If you go to the doctor regularly, get vaccinated and don’t smoke, then you have done everything possible to prevent cervical cancer,” says Chuang, “We’ve made a lot of progress, but the main reason we still see cervical cancer is lack of regular medical care, either due to difficulty of access or because the patient just doesn't want to go.” It’s important to have pap smears done at regular intervals to protect against any errors in detection.

 

When pap smear results come back as abnormal, the next step is to figure out if the abnormality is due to temporary inflammation, infection, or pre-cancerous dysplasia.

“The doctor does a cervical biopsy called a colposcopy that searches for abnormal cells and identifies whether any dysplasia is mild, moderate, or severe,” says Chuang, “We respond to mild dysplasia by watchful waiting, and even moderate dysplasia can regress back to normal.” Since aggressive treatment can affect fertility, it is only recommended to younger patients in severe cases.

 

Even high grade dysplasia can be treated with great success. “Removing the abnormal part of the cervix is about 90% effective,” says Chuang, Larger lesions require a biopsy and must be done in the operating room with general anesthetic.

Research breakthroughs:

The biggest breakthrough in the fight against cervical cancer is the HPV vaccine. “The vaccine available is a preventive tool, which means it’s best given before the first sexual relationship,” says Chuang, “We recommend the HPV vaccine for women 11-26, and we now also recommend it for men.”

 

What you can do:

Get screened. If you stick to regular ob-gyn visits, pap smears, and HPV testing, your chance of getting cervical cancer is much less than 1%.

Get vaccinated. The HPV vaccine protects again as many as four strains of the virus, including the two strains that account for 75% of all cervical cancers.

Don’t smoke. The link between smoking and cervical cancer might seem counterintuitive, but smoking is the No. 1 promoter of the progression of cancer cells.

Get informed. Two reliable sources of information are the National Cancer Institute (www.cancer.gov) and the Women’s Cancer Network (www.scn.org)

 

Questions for your doctor:

For every woman, the essential question is “How often should I have a pap smear?” If you've been diagnosed with cervical dysplasia, be sure to ask, “What are my treatment options?” For some women, the key followup is, “Can I protect my fertility?” Many women with early cervical cancer can go on to carry a pregnancy.

By the numbers: (from the National Cervical Cancer Coalition)

About 11,000 Americans a year are diagnosed with cervical cancer; about 4,000 die.

11% of American women do not receive regular pap smears.

473,000 cases of cervical cancer are diagnosed worldwide, leading to 253,500 deaths a year.

85% of cervical cancer cases occur in developing countries.

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