Lyuba Levine, MD
DHR Health Women’s Institute for Gynecologic Oncology
Cervical cancer is the fourth most frequent cancer in women, with an estimated 604,000 new cases worldwide in 2020. Of the estimated 342,000 deaths from cervical cancer in 2020, about 90% of these occur in low- and middle-income countries. Cervical cancer is a disease that strikes over 14,100 American women each year.
A large majority (more than 95%) of cervical cancer is due to the human papillomavirus (HPV). Most sexually active women and men will be infected at some point in their lives, and some may be repeatedly infected. HPV eventually clears up in more than 90% of the infected population.
Although most HPV infections clear up on their own, and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic, and pre-cancerous lesions may progress to invasive cervical cancer.
It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Women living with HIV are six times more likely to develop cervical cancer compared to women without HIV, and an estimated 5% of all cervical cancer cases are attributable to HIV.
Symptoms of early-stage cervical cancer may include:
- irregular blood spotting or light bleeding between periods in women of reproductive age
- postmenopausal spotting or bleeding
- bleeding after sexual intercourse
- increased vaginal discharge, sometimes foul smelling
As cervical cancer advances, more severe symptoms may appear, including:
- persistent back, leg, or pelvic pain
- weight loss, fatigue, and/or loss of appetite
- foul-smell discharge and vaginal discomfort
- swelling of a leg or both lower extremities
Diagnosis of cervical cancer must be made by having a biopsy. The treatment plan depends on the stage of the disease, and options include surgery, radiotherapy, and chemotherapy.
The global strategy toward eliminating cervical cancer as a public-health problem recommends a comprehensive approach to cervical cancer prevention and control.
Screening allows pre-cancerous lesions to be identified at stages when they can easily be treated.
Cervical cancer screening involves testing for HPV infection to detect pre-cancer and cancer, followed by treatment, as appropriate. When screening detects an HPV infection or pre-cancerous lesions, these can easily be treated and cancer can be avoided. Screening can also detect cancer at an early stage when treatment has a high potential for cure.
There are currently four vaccines that have been prequalified by the World Health Organization, all protecting against HPV types 16 and 18, which are known to cause at least 70% of cervical cancers. The latest 9-valent vaccine protects against five additional oncogenic HPV types, which cause 20% of cervical cancers.
HPV vaccines work best if administered prior to exposure to HPV. Therefore, to prevent cervical cancer, the WHO recommends vaccinating girls ages 9 to 14 years, when most have not started sexual activity. Some countries have started to vaccinate boys, as the vaccination prevents HPV-related cancers in males, as well.
HPV vaccination does not replace cervical cancer screening. Regular screening is needed to identify and treat cervical pre-cancer and cancer to reduce cervical cancer incidence and deaths.
For more information or to speak to one of our experts, please call the DHR Health Women’s Institute for Gynecologic Oncology at 956-362-2465.
