Cervical Cancer

Happy Monday, and welcome to Medical Mondays!

January is Cervical Cancer Awareness Month, so I figured it might be a good idea to cover this topic!

Cervical cancer is the third most common gynecologic cancer diagnosis and cause of death among gynecologic cancers in the U.S.

Although it has a lower incidence and mortality rate than uterine cancer and ovarian cancer, it remains the second most common type of cancer + cause of cancer deaths in countries that don’t have access to cervical cancer screening + prevention programs.

Risk Factors

• Early onset of sexual activity
• Multiple sexual partners
• A high-risk sexual partner (e.g. a partner with multiple sex partners and/or known HPV infection)
• History of sexually transmitted infections (e.g. Chlamydia, genital herpes)
• History of vulvar or vaginal neoplasia/cancer
• Immunosuppression (e.g. from HIV)
• Early age at first birth (< 20 yo)
• Increasing parity (3+ full-term births)
• Low socioeconomic status

Human papillomavirus (HPV) is the main cause of cervical cancer (detected in 99.7% of cervical cancers).

Symptoms

Early cervical cancer usually produces no symptoms. If seen, however, the most common symptoms are:

• Irregular or heavy vaginal bleeding
• Postcoital bleeding (bleeding after sexual intercourse)

Individuals with advanced disease might experience pelvic or lower back pain, which may travel down the back side of lower extremities.

Screening Recommendations & Methods

• Currently, the recommendation is to start screening no earlier than the age of 21 in asymptomatic, immunocompetent women, regardless of sexual activity, in an interval of every 3 years.

Cervical cancer screening has vastly decreased both the incidence and the mortality from cervical cancer by detecting precancerous lesions and early-stage disease. Screening methods include the Papanicolaou (Pap) test and testing for high-risk types of HPV.

• Pap test: samples cells from the cervix + vagina, and can identify abnormal cells
• HPV testing: identifies most high-risk HPV types
• Co-testing (Pap test + HPV testing): may detect earlier cervical abnormalities than the Pap test alone, but also leads to an increased rate of follow-up testing (colposcopy) and doesn’t appear to affect mortality

Prevention

Gardasil (quadrivalent HPV vaccine) targets HPV subtypes 6, 11, 16 and 18.

Cervarix (bivalent vaccine) targets HPV types 16 + 18.

• Subtypes 6 + 11 have been known to cause genital warts, whereas 16 and 18 have been found in over 70% of all cervical cancers)

The HPV vaccine is 3 vaccine doses given over a minimum of 24 weeks. The minimum interval between the first two doses is 4 weeks, and the minimum between the second + third doses is 12 weeks.

• Gardasil or Cervarix is recommended for females aged 11-12 for the prevention of cervical, vaginal + vulvar cancers. The quadrivalent HPV vaccine is also recommended for the prevention of anal cancer and genital warts in females.
  • Catch-up vaccination is also recommended for females aged 13-26 years old who haven’t been previously vaccinated, or haven’t complete their vaccine series.
• Gardasil is recommended in males aged 11-12, and for males aged 13-21 who haven’t been previously vaccinated or haven’t completed the three-dose series.
  • For males who have sex with males, vaccination is recommended through age 26 for those who haven’t been previously vaccinated.

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Disclaimer: The information in this post was gleaned from UpToDate articles and other med school resources. This is where I reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)