Cervical cancer, Pap tests, genital warts

Your health and safety are extremely important. Everyone deserves good health and a good life.

Scope of cervical cancer problem

Cervical cancer is the second most common form of cancer in all women (after breast cancer), and the most common in younger women. In the year 2000, the American Cancer Society estimates that there will be 12,800 new cases of cervical cancer in the United States.

It also used to be one of the most deadly cancers, but that has changed in the U.S. as a result of the Pap test, arguably the most effective cancer test of any kind. Because of the Pap test, deaths from cervical cancer declined 74 percent between 1955 and 1992, and the death rate continues to decline at a rate of about 2% a year. Cervical cancer is still the leading cause of cancer deaths worldwide.

Regular Pap tests allow doctors to catch cervical cancer in its early stages, or even while the cells are only in a precancerous state. When it is detected early, the survival rates for women with cervical cancer are very good. For example, though the overall five-year survival rate for cervical cancer is 69 percent, if the cancer is caught early it is nearly 100 percent.

Today, there is no reason for any woman to die of cervical cancer. And with regular Pap tests, virtually no woman would.

What is cervical cancer?

The cervix is the lower part of the uterus (womb) that connects it to the vagina. Cervical cancer begins in the lining of the cervix and, if untreated, may spread deeper into the cervix (invasive cervical cancer) and to other parts of the body.

Cervical cancers do not form suddenly. There is a slow, gradual change from a normal cervix to precancer to cancer. Some women with precancerous changes of the cervix will develop cancer. This usually takes several years but sometimes can happen in less than a year. For some women, precancerous changes may go away without any treatment. More often, these precancers are treated and true cancers are prevented.

What puts women at risk for cervical cancer?

Several factors increase a woman's risk of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease.

• Human papillomavirus (HPV) infection
  
  The most important risk factor for cervical cancer is infection by human papillomavirus. HPVs are a group of more than 80 types of viruses that may cause warts and other types of cell changes in various parts of the body.
  
  About 30 strains of HPV can be passed sexually and infect genital organs and the anal area. Condoms do not fully prevent transmission of HPV.
  
  When HPV infects the skin of the genital organs and anal area it may cause raised bumpy warts. The particular strains that cause genital warts rarely develop into cancer and are called "low risk" viruses.
  
  Other sexually transmitted HPVs have been linked with genital or anal cancers in both men and women. These "high risk" HPV types can cause pre-cancerous cell changes on the cervix or vagina that are not visible and cause no symptoms. Over time and without treatment, these pre-cancerous cell changes may develop into cervical or vaginal cancers.
  
  
• Smoking
  
  Smokers are about twice as likely as nonsmokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that are absorbed by the lungs and carried in the blood stream throughout the body.
  
  
• Human Immunodeficiency Virus (HIV) infection
  
  HIV is the virus that causes AIDS. HIV damages the body's immune system, which may cause the body to be more susceptible to HPV infection and less able to destroy cancer cells. In women with HIV infection, a cervical pre-cancer might develop into an invasive cancer faster than it normally would.
  
  
• Diet
  
  Diets low in fruits and vegetables are associated with an increased risk of cervical cancer and several other cancers.
  
  
• Age
  
  The average age of women newly diagnosed with cervical cancer is between 50 and 55 years. The risk of developing this cancer is very low among girls less than fifteen, but unlike many cancers that rarely affect young adults, cervical cancer can affect women in their twenties and late teens. Many older women do not realize that they have the highest risk of developing cervical cancer, and that it is important for them to continue having Pap tests.
  
  
• Reduced access to healthcare
  
  Many women with low incomes do not have ready access to adequate health care services, including Pap tests and treatment of pre-cancerous cervical disease. Such women may also be undernourished, which may play a role in increasing their risk.
  
  
• Race and ethnicity
  
  African American, Latino, Vietnamese and Native American women have cervical cancer death rates that are significantly above the national average. These associations may be partly related to greater poverty and reduced access to preventive health care in these populations.
  
  
• Oral contraceptives
  
  No definite evidence exists linking the use of oral contraceptives with cervical cancer. There is some statistical evidence that long-term oral contraceptive (OC) use may slightly increase the risk of cancer, but the jury is still out.

The Women's Cancer Network has a cancer risk survey that you can take anonymously online. The survey covers breast, cervical, ovarian, and endometrial cancers. Be aware, though, that the survey was designed for heterosexual women and defines "sexual intercourse" and "sexual partners" as contacts with men.

Are lesbian and bisexual women at greater risk for cervical cancer?

We do not have enough information to know for sure. Lesbians and bisexual women may be at less risk of acquiring HPV if they have less sexual intercourse with men. However, many lesbians and bisexual women do or have had sexual intercourse with men. Furthermore, HPV is transmitted between women during sex.

There is evidence that lesbians and bisexual women are less likely seek routine health care because of the discomfort of coming out to health care providers and less access to health insurance. Additionally, because lesbian and bisexual women are less likely to need birth control, they are less likely to have regular gynecological check-ups and Pap tests. For these reasons, lesbians and bisexual women may be at greater risk for cervical cancer as precancerous cervical cell changes would be less likely to be detected at earlier, more treatable, stages.

Symptoms

Symptoms can include spots of blood on your underwear, pain during or bleeding after penetrative sexual activity and unusual vaginal discharges. Sometimes there are no symptoms until the cancer has progressed, underscoring the importance of regular Pap tests.

Diagnosis

The Pap test is simple, quick and usually not painful, although it may be uncomfortable. Your health care provider uses a speculum to hold open the vagina while swabbing the cervix to collect a sample of cells. These samples are then smeared on glass slides and sent to be examined under a microscope. Results are generally available in 1-2 weeks.

If your Pap test comes back with abnormal results, your doctor may perform a colposcopy (your cervix is examined through a device called a colposcope that magnifies the view of the cervix) and/or a biopsy. If these tests show cancer, further tests are necessary to determine if the disease has spread to other organs.

Treatment

Cervical cancer is treated primarily by surgery, radiation and chemotherapy. If the cancer is only on the outer wall of the cervix, doctors can often remove the area surgically with relative ease. If it has spread to the uterus or other organs, a hysterectomy or other surgery may be necessary. Radiation can also be very effective. Chemotherapy may be part of the treatment, if the cancer has spread.

How to reduce your risk for cervical cancer

• Have a Pap test at age 18 (or when you become sexually active, whichever comes first) and every year for three years. If you have had three negative annual Pap tests in a row, your health care provider may recommend that you have it somewhat less often (every 2-3 years) depending upon your risk.
  
  
• Try to limit your risk of contracting HPV, a virus that can cause cervical cancer, by limiting the number of your sexual partners and by delaying the age at which you become sexually active.
  
  
• Don't smoke cigarettes.
  
  
• Eat a diet high in fruits and vegetables and low in fat.