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 Articles

[Clearance, persistence and recurrence of HPV infection.] (Gynecol Obstet Fertil. 2008) “The longitudinal studies show that "recurrent" HPV infections offer no evidence that the recurrent episode is correlated with reemergence of the same strain or another strain of the same genotype (wild or variant), but the sequential detection of other HPV type is common. The studies offer no evidence of competition between HPV types but frequently show an increased risk of acquisition of new HPV types in patients already infected compared with those who are HPV-negative.”

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:

Caution Urged Over Large-Scale HPV Vaccination Programs

Cervical cancer shots less cost-effective with age “An expensive vaccine aimed at preventing cervical cancer makes sense for young teens when it comes to cost-effectiveness, but not for women in their 20s, contends a new report.”

Drug Makers’ Push Leads to Cancer Vaccines’ Fast Rise “Merck’s vaccine was studied in clinical trials for five years, and Glaxo’s for nearly six and a half, so it is not clear how long the protection will last. Some data from the clinical trials indicate immune molecules may wane after three to five years. If a 12-year-old is vaccinated, will she still be protected in college, when her risk of infection is higher? Or will a booster vaccine be necessary? Some experts are concerned about possible side effects that become apparent only after a vaccine has been more widely tested over longer periods. And why the sudden alarm in developed countries about cervical cancer, some experts ask. A major killer in the developing world, particularly Africa, where the vaccines are too expensive for use, cervical cancer is classified as very rare in the West because it is almost always preventable through regular Pap smears, which detect precancerous cells early enough for effective treatment. Indeed, because the vaccines prevent only 70 percent of cervical cancers, Pap smear screening must continue anyway. “Merck lobbied every opinion leader, women’s group, medical society, politicians, and went directly to the people — it created a sense of panic that says you have to have this vaccine now,” said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School. Dr. Harper was a principal investigator on the clinical trials of both Gardasil and Cervarix, and she spent 2006-7 on sabbatical at the World Health Organization developing plans for cervical cancer vaccine programs around the world. “Because Merck was so aggressive, it went too fast,” Dr. Harper said. “I would have liked to see it go much slower.” “

Early Sex Doesn't Predict HPV Infection: Study Fuels Debate Over the Best Vaccination Strategy

Higher anaphylaxis rates after HPV vaccination: CMAJ study “The estimated rate of anaphylaxis in young women after human papillomavirus (HPV) vaccination was significantly higher – 5 to 20 fold – than that identified in comparable school-based vaccination programs …”

Small Cell Cervical Cancer Usually Has Poor Prognosis “Small cell carcinoma of the cervix is rare compared to other cervical cancers, but the outlook for patients with this disease is poor, Utah-based researchers report in the June issue of Obstetrics and Gynecology.”

ARTICLES:

Addressing Questions about Gardasil

Health and Economic Implications of HPV Vaccination in the United States

Human Papillomavirus Vaccination — Reasons for Caution “Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer. Several strains of human papillomavirus (HPV) can cause cervical cancer, and two vaccines directed against the currently most important oncogenic strains (i.e., the HPV-16 and HPV-18 serotypes) have been developed. That is the good news. The bad news is that the overall effect of the vaccines on cervical cancer remains unknown. As Kim and Goldie1 point out in this issue of the Journal, the real impact of HPV vaccination on cervical cancer will not be observable for decades. … With so many essential questions still unanswered, there is good reason to be cautious about introducing large-scale vaccination programs. Instead, we should concentrate on finding more solid answers through research rather than base consequential and costly decisions on yet unproven assumptions.”

JOURNAL ARTICLES:

Anaphylaxis following quadrivalent human papillomavirus vaccination (CMAJ 2008) “Interpretation: Based on the number of confirmed cases, the estimated rate of anaphylaxis following quadrivalent HPV vaccine was significantly higher than identified in comparable school-based delivery of other vaccines. However, overall rates were very low and managed appropriately with no serious sequelae.”

[Clearance, persistence and recurrence of HPV infection.] (Gynecol Obstet Fertil. 2008) “The longitudinal studies show that "recurrent" HPV infections offer no evidence that the recurrent episode is correlated with reemergence of the same strain or another strain of the same genotype (wild or variant), but the sequential detection of other HPV type is common. The studies offer no evidence of competition between HPV types but frequently show an increased risk of acquisition of new HPV types in patients already infected compared with those who are HPV-negative.”

High HPV 16 viral load is associated with increased cervical dysplasia in Honduran women. (Am J Trop Med Hyg. 2008)

Human Papillomavirus, Cervical Cancer, and the Vaccines. (Postgrad Med. 2008)

Incidence, mortality, and prognostic factors of small cell carcinoma of the cervix. (Obstet Gynecol. 2008)

International Correlation between Human Papillomavirus Prevalence and Cervical Cancer Incidence. (Cancer Epidemiol Biomarkers Prev. 2008)

Is viral status needed before vaccination? (Vaccine. 2008)

Natural history and epidemiology of HPV infection and cervical cancer. (Gynecol Oncol. 2008)

Persistent Human Papillomavirus Infection and Cervical Neoplasia: A Systematic Review and Meta-Analysis (American Journal of Epidemiology 2008)

Prevalence of human papillomavirus types in cervical and oral cancers in central India. (Vaccine. 2008)

Rapid clearance of human papillomavirus and implications for clinical focus on persistent infections. (J Natl Cancer Inst. 2008)

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