Columns

Cervical Cancer Prevention – We Can Do This!

By: Sharon Sutherland, MD • Posted on August 02, 2022

Cervical Cancer Prevention – We Can Do This!

In 2018, the World Health Organization (WHO) announced a global call to action to eliminate cervical cancer. Over 14,000 U.S. women are diagnosed with cervical cancer each year, and only 67% of these women survive for at least five years after diagnosis.

Cervical cancer strikes women in the prime of their life, as it is commonly diagnosed between the ages of 35 and 65. Black and Hispanic women have higher death rates from cervical cancer as they are more likely to present in later stages of cancer.

No woman should die from cervical cancer! We have the tools and the know-how to eliminate it. WHO advocates three actions to eliminate cervical cancer in our families and in our communities.

1. HPV vaccination to prevent cancer

Human papillomavirus (HPV) vaccination lowers risks of the following cancers in women and in men:

  • Cervical
  • Vaginal
  • Vulvar
  • Oropharyngeal
  • Anal
  • Penile

As nearly all cervical cancer is caused by HPV, the most powerful action that we can take is to vaccinate all at-risk persons between the ages of 9 and 44 years old. Full vaccination prior to first sexual contact reduces the risk of developing high-grade precancerous lesions of the cervix by more than 90%. For persons who are vaccinated after they have become sexually active, the vaccine lowers the risk of high-grade precancerous lesions of the cervix by 44-61%.

Most insurances now cover HPV vaccination, and it is a routine part of well-child care. Adults up to age 44 should check with their insurance company regarding out-of-pocket cost of the vaccine; in some cases, it is fully covered and easily accessed by an appointment at a local drugstore.

2. Screening for cervical cancer

A 2019 study showed that 25% of U.S. women were overdue for cervical cancer screening, and that number is even higher now due to the COVID pandemic. The goal of screening is to identify women at risk for high grade pre-cancer of the cervix, which can usually be cured with an in-office procedure or same day surgery.

Treatment of high-grade pre-cancerous lesions prevents cancer and preserves the uterus for future childbearing. If women do not get screening tests when indicated, it is likely that high-grade precancerous lesions can grow undetected and turn into cancer, requiring removal of the uterus or treatment with chemotherapy and radiation.

For healthy women who have no history of precancerous lesions or high-risk HPV infection, Cleveland Clinic recommends cervical cancer screening tests on the schedule listed below. This is a general recommendation, and you and your provider may decide that more frequent testing is indicated based on your personal risk factors. Women who have abnormal Pap tests and/or positive tests for high-risk HPV will need more frequent testing until cleared by their provider.

  1. Ages 21-29: Pap test every 2-3 years
  2. Ages 30-65: Pap test and high-risk HPV test every 4-5 years

It is important to note that an exam with a vaginal speculum does not count as a Pap test. For example, Pap tests are not performed in emergency departments, express or urgent cares or with STD testing. If you are uncertain about when you had your last Pap test, please check your medical record. If you cannot find a normal test result within the time window noted above for your age, please make an appointment for screening promptly.

Who is at high risk for cervical cancer?

Women with certain medical conditions or taking certain treatments are at higher risk for cervical cancer. These include:

  • Exposure to DES (diethylstilbestrol) in utero
  • HIV (human immunodeficiency virus) infection
  • History of an organ or stem cell transplant

Women receiving certain drugs to treat rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, cancer, pulmonary disease and other conditions are also at higher risk for cervical cancer due to a weakened immune response against HPV infection.

Check your medications to see if you currently take a drug that may suppress your immune response. If your medical history or medications put you at higher risk, you should discuss your situation with your provider to determine what screening schedule is recommended for you.

3. Drugs that suppress immune response

abataceptbudesonidedactinomycinixekizumabmycophenolatesecukinumab
adalimumabcertolizumabdexamethasoneinfliximabnatalizumabsirolimus
anakinrachlorambuciletanerceptleflunomideplatinumtacrolimus
apremilastcyclophosphamideeverolimusmercaptopurineprednisolonetocilizumab
apremilastcyclosporinefluorouracilmethotrexateprednisoneustekinumab
azathioprinedaclizumabgolimumabmuromonabrituximabvedolizumab


Diagnosis and treatment of high-grade precancerous lesions

Pap and HPV tests screen for abnormalities, and in most cases, colposcopy is needed to diagnose the grade of precancerous lesion. Colposcopy involves placing a speculum in the vagina, applying medication, and looking closely at the cervix with a special microscope.

Once a woman is diagnosed with a high-grade precancerous lesion of the cervix, treatment involves removing a thin layer of the outside of the cervix. Treatment can be done with local anesthesia or with general anesthesia, based on a woman’s preferences and the nature of the lesion. Treatment with the LEEP (loop electrosurgical excision procedure) employs a wire loop that is heated by electrical current, while treatment with a cold knife cone biopsy employs a scalpel to remove the high-grade precancerous lesion.

After either treatment, a woman must abstain from using tampons or having intercourse for four weeks to allow proper healing, however can resume all other activities as usual. After treatment, women with high-grade precancerous lesions need ongoing surveillance as the high-grade precancerous lesion may recur.

Be Strong, Be Healthy, Be In Charge!

-Sharon Sutherland, MD

References:
  1. https://www.who.int/initiatives/cervical-cancer-elimination- initiative
  2. https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html
  3. https://seer.cancer.gov/statfacts/html/cervix.html
  4. https://www.cdc.gov/vaccines/vpd/hpv/hcp/vaccines.html
  5. Suk R, Hong Y, Rajan SS, Xie Z, Zhu Y, Spencer JC. Assessment of US Preventive Services Task Force Guideline–Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019. JAMA Netw Open. 2022;5(1):e2143582. doi:10.1001/jamanetworkopen.2021.43582
  6. https://my.clevelandclinic.org/health/diagnostics/4267-pap-smear
  7. https://my.clevelandclinic.org/health/diagnostics/4044-colposcopy
About Sharon Sutherland, MD

Sharon A. Sutherland, MD joined Cleveland Clinic in 2003, and in 2011 was appointed the Quality Improvement Officer for Obstetrics/Gynecology and Women's Health Institute at Cleveland Clinic.

Dr. Sutherland is certified by the American Board of Obstetrics and Gynecology. Dr. Sutherland has a special interest in minimally invasive gynecology procedures, including operative hysteroscopy and treatment of cervical dysplasia. She mentors ob/gyn residents, and she is a Clinical Assistant Professor at Case Western Reserve University Cleveland Clinic Lerner College of Medicine.



Related Articles