A widely reported study found that cervical cancer mortality was higher and the racial disparity between black and white women greater than previously reported.1 The study omitted from the mortality estimates those women who had undergone hysterectomies, usually involving removal of the cervix.
With the new HPV vaccine that covers 9 types of the virus, potentially up to 80% to 90% of the HPV types that cause cervical cancer could be prevented. Now more than ever, it is very important to pursue a higher rate of vaccination for girls in the United States.— Anna Beavis, MD, MPH
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The study also found that cervical cancer mortality increased with age, which may cause some patients to question whether they need to alter their screening frequency or continue past age 65. The study’s lead author, Anna Beavis, MD, MPH, told The ASCO Post, “It is important to recognize that older women are still at risk and to make sure women are appropriately screened within the guidelines.” Dr. Beavis is Clinical Fellow with the Kelly Gynecologic Oncology Service, Johns Hopkins Hospital, Baltimore.
USPSTF Guidelines
The U.S. Preventive Services Task Force (USPSTF) “recommends screening for cervical cancer in women aged 21 to 65 years with cytology (Pap smear) every 3 years or, for women aged 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.”2 In addition, the USPSTF “recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.” Screening is also not recommended “in women who have had a hysterectomy and who do not have a history of a high-grade precancerous lesion (cervical intraepithelial neoplasia grade 2 or 3) or cervical cancer.”
“If a woman has a high-risk biopsy, for example, that is treated with an excisional biopsy—something we do for high-grade cervical dysplasia—she is usually followed for 20 years after that, regardless of her age at that diagnosis,” Dr. Beavis noted. “The screening guidelines are for those at low risk; for woman identified to be at high risk, they need to undergo increased screening.”
Daughters and Granddaughters
Women at high risk for cervical cancer, “because it is mediated by a sexually transmitted virus, would be essentially any women with an increased number of partners, a history of sexually transmitted disease, or anything that increases sexual activity. But really all women are at risk,” Dr. Beavis said. “If any woman has ever had an abnormal Pap smear, it is important that she continue care with a gynecologist.”
These risk factors “reflect mostly women who right now would not be eligible for the HPV vaccine, but who potentially have daughters and granddaughters who are eligible for the HPV vaccine,” Dr. Beavis noted. “With the new HPV vaccine that covers 9 types of the virus [Gardasil 9], potentially up to 80% to 90% of the HPV types that cause cervical cancer could be prevented. Now more than ever, it is very important to pursue a higher rate of vaccination for girls in the United States,” she added.
“As a gynecologic oncologist, the most important thing that I want women to understand is that this is a preventable cancer and also a treatable cancer if a woman has a biopsy that shows she has cervical cancer,” Dr. Beavis stressed. “Women who are diagnosed with cervical cancer should seek out care from a trained gynecologic oncologist who is well equipped for the specialist level of care that a patient would need with a diagnosis.” ■
Disclosure: Dr. Beavis reported no potential conflicts of interest.
References
2. U.S. Preventive Services Task Force: Cervical cancer: Screening. Available at www.uspreventiveservicestaskforce.org. March 2012 (update in progress).
