Cervical Cancer

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Cervical Cancer

NIH - Medical Encyclopedia Cervical Cancer

"Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. … Worldwide, cervical cancer is the third most common type of cancer in women. … Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the cervix's surface: squamous and columnar. The majority of cervical cancers are from squamous cells. The development of cervical cancer is very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears … Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. … Almost all cervical cancers are caused by HPV (human papillomavirus). … Other risk factors for cervical cancer include: • Having sex at an early age • Multiple sexual partners • Sexual partners who have multiple partners or who participate in high-risk sexual activities • Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1970s to prevent miscarriage • Long-term use of birth control pills (more than 5 years) • Weakened immune system • Infections with genital herpes or chronic chlamydia infections • Poor economic status (may not be able to afford regular Pap smears)."

Highlighted Article

Prevalence of HPV Infection Among Females in the United States (JAMA. 2007)

"Results The overall HPV prevalence was 26.8% … among US females aged 14 to 59 years … HPV prevalence was 24.5% (19.6%-30.5%) among females aged 14 to 19 years, 44.8% (36.3%-55.3%) among women aged 20 to 24 years, 27.4% (21.9%-34.2%) among women aged 25 to 29 years, 27.5% (20.8%-36.4%) among women aged 30 to 39 years, 25.2% (19.7%-32.2%) among women aged 40 to 49 years, and 19.6% (14.3%-26.8%) among women aged 50 to 59 years. There was a statistically significant trend for increasing HPV prevalence with each year of age from 14 to 24 years … followed by a gradual decline in prevalence through 59 years … HPV is common among females in the United States. Our data indicate that the burden of prevalent HPV infection among females was greater than previous estimates and was highest among those aged 20 to 24 years."

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Cervical Cancer

General Information

NEWS:

Cervical cancer survivors prone to other cancers "Women who survive cervical cancer are at increased risk for developing other cancers decades later, according to a report in the Journal of the National Cancer Institute. The increased cancer risk is primarily seen in women who were treated with radiation therapy and involves organs that lie near the cervix."

Doctors Warn on Wide Use of Cervical Cancer Vaccine " 'At this stage, vaccination can still be considered experimental,' said Dr. Karen McCune, an associate professor of obstetrics and gynecology at UCSF, who co-authored the editorial. 'To be discussing mandatory vaccination when the main clinical trials are still ongoing seems extremely premature. We're feeling like the enthusiasm is driving policy rather than data.' "

ARTICLES:

HPV vaccine: a cornerstone of female health.

HPV Vaccination — More Answers, More Questions "The availability of a "cancer vaccine" has elicited enormous enthusiasm from the medical community and the public, culminating in advocacy for mandatory vaccination against human papillomavirus (HPV) and a recommendation from the Centers for Disease Control and Prevention (CDC) that 30 million girls and women between the ages of 11 and 26 years in the United States be vaccinated.1 … Investigators in these trials have hit their mark soundly: the vaccine showed significant efficacy against anogenital and cervical lesions related to vaccine type in women with no evidence of previous exposure to vaccine-specific types; the vaccine also appeared to be safe. … In analyses by lesion type, the efficacy appears to be significant only for grade 2 cervical intraepithelial neoplasia; no efficacy was demonstrable for grade 3 cervical intraepithelial neoplasia or adenocarcinoma in situ. … If grade 3 cervical intraepithelial neoplasia or adenocarcinoma in situ were the most relevant outcome, evidence was insufficient to infer the effectiveness of vaccination. … Why is vaccine efficacy modest in the entire cohort? One factor is the apparent lack of efficacy among subjects with evidence of previous exposure to HPV types included in the vaccine. The FUTURE II trial showed no effect of vaccination up to month 12, perhaps owing either to preinvasive lesions or to vaccine-type HPV infections that were present at enrollment. Therefore, vaccination before the onset of sexual activity seems to be preferable. In contrast to the CDC's guidelines, the American Cancer Society does not recommend universal vaccination among women between 18 and 26 years of age, citing probable diminished vaccine efficacy as the number of lifetime sexual partners increases.10 … Another factor explaining the modest efficacy of the vaccine is the role of oncogenic HPV types not included in the vaccine. … What do these results mean for cervical-cancer screening? Screening should continue in all vaccinated women, given the cumulative lifetime risk of exposure to other oncogenic HPV types and the unknown duration of anti-HPV immunity. … HPV vaccination has the potential for profound public health benefit if the most optimistic scenario of effectiveness is realized."

Human Papillomavirus Vaccine — Opportunity and Challenge "In this issue of the Journal, we publish three Original Articles,1,2,3 two Perspective articles,4,5 two editorials,6,7 a letter to the editor,8 and an audio interview9 on the subject of human papillomavirus (HPV). We bring together this unique body of information in response to the enormity of the health problems that stem from HPV and the broad interest that has been kindled by the possibility of preventing HPV-related cervical cancer and other anogenital conditions through vaccination. The HPV vaccine is the first vaccine explicitly designed to prevent cancer induced by a virus. … It is difficult to show that an intervention prevents cancer, given the relatively long induction phase between exposure to an inducing agent and development of disease. Thus, key surrogate markers, in this case cervical intraepithelial neoplasia grades 2 and 3, were used so that data could be gathered in a timely fashion. However, correlation with the ultimate outcome — cancer prevention — will require the long-term observation of a large number of treated women. We must also carefully monitor for unintended adverse consequences of vaccination. For example, when selective immunologic pressure is applied with vaccination, the potential exists for nonvaccine-related strains to emerge as important oncogenic serotypes."

NIH - Cervical Cancer Fact Sheet

JOURNAL ARTICLES:

Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women's sexuality. (Eur J Cancer Care (Engl). 2007) "The findings demonstrate that cancer treatment can result in a number of late physical effects, including bladder and bowel dysfunction. Moreover, the physical problems led to sexual difficulties experienced several years after treatment. Concerns were expressed by patients about perceived psychosexual difficulties encountered as a result of treatment. In conclusion, the study raises issues associated with the management of late treatment effects and its impact on sexuality."

Biochemical prognostic factors and risk of relapses in patients with cervical cancer. (Gynecol Oncol. 2007)

Brain metastasis from cervical carcinoma. (Int J Gynecol Cancer. 2007)

Cervical intraepithelial neoplasia: risk factors for persistence and recurrence in adolescents. (Eur J Gynaecol Oncol. 2007)

[Detection and typification of human papilloma virus in pre cancerous cervical lesions.] (Rev Med Chil. 2007) "A unique HPV subtype was found in 76% of women. Fourteen percent had an infection with multiple subtypes and in 10%, the viral genotype was not identified. The most common subtypes found were HPV 16, HPV 52 and HPV 53. Conclusions: There is a high rate of infection with HPV with a high oncogenic risk among these women."

Hawaii Cohort Study of Serum Micronutrient Concentrations and Clearance of Incident Oncogenic Human Papillomavirus Infection of the Cervix. (Cancer Res. 2007) "The degree to which the resolution of human papillomavirus (HPV) infection parallels exposure to other factors, particularly those related to nutritional status, is a relatively unexplored area of research. We established a cohort of women for long-term follow-up to examine the association of serum retinol, carotenoid, and tocopherol concentrations with the clearance of incident cervical HPV infection. … Results from this investigation support an association of micronutrients with the rapid clearance of incident oncogenic HPV infection of the uterine cervix."

High grade cervical lesions are caused preferentially by non-European variants of HPVs 16 and 18. (Int J Cancer. 2007)

High human papillomavirus oncogene mRNA expression and not viral DNA load is associated with poor prognosis in cervical cancer patients. (Clin Cancer Res. 2007)

Human papillomavirus infection: epidemiology and pathophysiology. (Gynecol Oncol. 2007)

Human papillomavirus subtype 16 is common in Pakistani women with cervical carcinoma. (Int J Infect Dis. 2007)

Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update. (Int J Cancer. 2007)

Integration of human papillomavirus type-16 and type-18 is a very early event in cervical carcinogenesis. (J Clin Pathol. 2007)

Intracranial metastases from carcinoma of the cervix. (Singapore Med J. 2007)

Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study (BMJ 2007)

Long-term outcome and prognostic factors in patients with cervical carcinoma: a retrospective study (International Journal of Gynecological Cancer 2007)

Lower red blood cell folate enhances the HPV-16-associated risk of cervical intraepithelial neoplasia. (Nutrition. 2007) "CONCLUSION: To our knowledge, this is the first study reporting an independent association of folate with risk of having CIN >/=2 in a population tested extensively for HR-HPV and CIN that also adequately controlled for several other micronutrients and known risk factors for CIN. Our findings suggest that improving the folate status in HR-HPV-infected women may reduce the risk of CIN and thus the risk of cervical cancer. Folate supplementation should be tested as a means of reducing the risk of developing CIN >/=2 in women exposed to HR-HPV, especially HPV-16."

Patients with malignant or pre-malignant cervical lesion have increased risk of becoming hepatitis B carrier. (J Exp Clin Cancer Res. 2007) "Our study suggests that a common immunological mechanism is involved in eradication of HBV and HPV infections and inherent immuno-deficiency might lead to an association of HBV carrier status with cervical carcinoma."

Population-based study of human papillomavirus infection and cervical neoplasia in Athens, Greece. (Epidemiol Infect. 2007) "Our results indicate that HPV infections, especially those with HPV-16, represent a significant public health concern in Greece."

Prevalence of human papillomavirus types in women screened by cytology in Germany. (J Med Virol. 2007)

Prognosis of Early Cervical Cancer (FIGO Stages IA2, IB, and IIA) in Northern Norway Predicted by Malignancy Grading Score and Objective Morphometric Image Analysis. (Int J Gynecol Pathol. 2007)

Prospective malignancy grading of invasive squamous carcinoma of the uterine cervix. Prognostic significance in a long-term follow-up. (Anticancer Res. 2007)

Quadrivalent Vaccine against Human Papillomavirus to Prevent High-Grade Cervical Lesions (NEJM 2007) "Background Human papillomavirus types 16 (HPV-16) and 18 (HPV-18) cause approximately 70% of cervical cancers worldwide. A phase 3 trial was conducted to evaluate a quadrivalent vaccine against HPV types 6, 11, 16, and 18 (HPV-6/11/16/18) for the prevention of high-grade cervical lesions associated with HPV-16 and HPV-18. … Conclusions In young women who had not been previously infected with HPV-16 or HPV-18, those in the vaccine group had a significantly lower occurrence of high-grade cervical intraepithelial neoplasia related to HPV-16 or HPV-18 than did those in the placebo group. (ClinicalTrials.gov number, NCT00092534 [ClinicalTrials.gov])"

Retrospective study of the prevalence of high-risk human papillomaviruses among Croatian women. (Coll Antropol. 2007)

Sexual Function after Radical Hysterectomy for Early-Stage Cervical Cancer. (J Sex Med. 2007)

Sexual morbidity in very long term survivors of vaginal and cervical cancer: A comparison to national norms. (Gynecol Oncol. 2007)

Staging of carcinoma of the uterine cervix and endometrium. (Eur Radiol. 2007) "CT and MR imaging are widely used as comprehensive imaging modalities to evaluate tumor size and extent, and nodal involvement. MR imaging is an excellent modality for depicting invasive cervical carcinoma and can provide objective measurement of tumor volume, and provides high negative predictive value for parametrial invasion and stage IVA disease. In contrast, endometrial cancer is surgically staged. Beside recognition of the important prognostic factors, including histologic subtype and grade, accurate assessment of the tumor extent on preoperative MR imaging is expected to greatly optimize surgical procedure and therapeutic strategy."

The natural history of cervical HPV infection: unresolved issues (Nat Rev Cancer. 2007)

Type-Specific Persistence of High-Risk Human Papillomavirus Infections in the New Independent States of the former Soviet Union Cohort Study. (Cancer Epidemiol Biomarkers Prev. 2007)

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