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Is Cervical Cancer On Its Way Out? by Karen Reed-Matthee

Could the story of cervical cancer end as happily, at least in this country, as that of polio? Medical victories in the campaign against this particular gynecological cancer certainly make the question worth posing.

Less than a lifetime ago, cervical cancer was a leading cause of death of American women. Then came the Pap smear, a simple test introduced in the 1950s to detect the disease and its precursors. By the early 1990s, the incidence of cervical cancer had dropped dramatically — by as much as 74 percent. And now, with the availability of a vaccine to protect girls against strains of the human papillomavirus that cause the majority of cervical cancers, the rate is expected to decline even further.

These advancements, coupled with better screening methods and the possible introduction of a vaccine with broader HPV coverage, a vaccine now in the final stages of testing, cervical cancer in the U.S. may indeed become as rare as polio.

Still, due to the dormant nature of the sexually transmitted HPV virus which can take years before causing genital warts or, in the worst-case scenario, cancer, the true efficacy of the vaccine won’t be known for some time.

“It may take 20 years before we really start to know,” says Dr. Barbara Goff, professor and director of gynecologic oncology at the University of Washington. It will take at least that long, she adds, before the girls vaccinated against the HPV virus reach their forties, the average age range for women diagnosed with cervical cancer.

In 2006, the FDA approved the vaccine Gardasil (a set of three shots given over six months) for girls and women aged 9 to 26. Of the 100-plus types of HPV, 15 strains are considered cancer causing. Gardasil protects against four strains, two that cause 70 percent of cervical cancers and two that cause 90 percent of genital warts. Controversial from the get-go because it was most recommended for 11- to 12-year-old girls, before they become sexually active, the furor over the vaccine gained steam in August after the release of a study on side effects of Gardasil.

While the government report published in the Journal of the American Medical Association concluded that Gardasil’s safety record is in line with that of other vaccines, some serious complications occurred among the more than seven million recipients of the new vaccine nationwide. Those included at least 20 deaths and two cases of Lou Gehrig’s disease, but it was impossible to determine if any of the complications were caused by the vaccine, the study said.

The most common medical problems after vaccination with Gardasil were fainting episodes and an increased risk for potentially fatal blood clots, which the study found may be related to obesity and the use of oral contraceptives. Still, although the study was largely favorable to Gardasil, the authors noted that analysis was based on adverse event reports, the majority of which were filed by the vaccine’s manufacturer, Merck & Company, to a voluntary government database, and did not provide enough information for adequate follow-up.

Dr. Goff says the vaccine poses minimal risk, and believes that vaccinating males would also cut down on the transmission of HPV viruses. “Even though it’s not FDA-approved, I personally vaccinated my own son. I gave him the choice and he chose to get the vaccine.”

Kymmberly Myrick had her 12-year-old daughter vaccinated with Gardasil, even though she “isn’t the first to jump into vaccines.” It was her own experience with cervical cancer that ultimately convinced her the vaccine was an important safety measure for her daughter.

In 2007, at age 43, Myrick received abnormal Pap smear results and after further testing was diagnosed with cervical cancer. Less than nine months before, her Pap had been normal. “The recommendation was to have a Pap every two years and I had forgotten how far back I’d had it. It was just dumb luck on my part. I didn’t feel any symptoms ... it came out of left field.”

Myrick underwent a radical hysterectomy and has now moved on from having Pap smears every three months to once a year. “I encourage my friends to continue to have an annual Pap,” she says. “It can happen so quickly.”

It’s estimated that about 11,270 cases of invasive cervical cancer will be diagnosed in the U.S. this year, according to the American Cancer Society. About 4,070 women will die from cervical cancer nationwide during 2009. In the ongoing battle to defeat the disease, prevention remains the key, says Dr. Goff.

“Now we actually have the HPV test … a test that screens for the high-risk strains,” she says. “Women over 30 can be screened with the Pap smear and the HPV test. If both are negative, then they only need to be screened every three years.”

Before age 30, Goff notes, a woman tested for HPV is more likely to have a false positive result. Most sexually active people will contract HPV. “But by the time we’re 30, it’s likely our immune systems will have cleared the virus,” Goff says. After age 30, she adds, a positive HPV test means we are more likely to develop precancerous cervical cells.

In the event that both tests are positive, a closer examination of the cervix and possibly a biopsy would follow, Goff says. If one is positive and one negative, more frequent testing may be in order, as well as a more thorough exam by a gynecologist.

If precancerous cervical cells are caught early, a simple but uncomfortable procedure to burn away infected cells followed by more frequent Pap smears normally keeps cancer at bay. If not treated promptly, the disease develops silently, without pain or other noticeable symptoms, until vaginal bleeding indicates its presence. Once the cancer invades the surrounding tissues, treatment options range from surgery and possibly hysterectomy to chemotherapy and radiation.

“We’re seeing a huge explosion of new drugs that work on a special pathway, but none of them are frontline yet,” Goff says. Unlike radiation or chemotherapy, targeted therapeutics block the growth of cancer cells without harming normal cells.

Meanwhile, the search for a better vaccine against cervical cancer continues. At the University of Washington, an expanded vaccine that would protect against 90 percent of HPV strains that can cause cancer is in the final stages of testing, says Goff. “It’s exciting…Clinical trials are underway right now. It’s not far away.”

For more information about cervical cancer, visit the American Cancer Society Web site at www.cancer.org.

Karen Reed-Matthee is cofounder and editor-at-large of Seattle Woman.

©Copyright 2009, Caliope Publishing Company