Almost 13,000 cases of invasive cervical cancer are diagnosed each year, with over 4,000 women dying from the disease. However, pre-cancers are diagnosed far more often than invasive cancer. Since the adoption of the Pap smear, the incidence of invasive cervical cancer has dramatically decreased over the past 30 years.

Risk factors

Almost all cases of cervical cancer are caused by HPV. Other risk factors include: smoking, immunosupression (especially HIV), Chlamydia infection, obesity, long term oral contraceptive use, multiple full term pregnancies, age under 17 at first full term pregnancy, poverty, maternal use of DES and a family history of cervical cancer.

Guidelines

Cervical cancer screening guidelines have changed over recent years. The US Preventive Services Task Force and the American Cancer Society guidelines recommend a Pap smear every 3 years in women 21-65 years of age. HPV testing combined with Pap smear every 5 years in women aged 30-65 years is now also considered an adequate alternative for those preferring a longer screening interval.

The American Society for Colposcopy and Cervical Pathology has released guidelines for the management of abnormal results.

HPV

Human papilloma virus (HPV) is a large family of viruses which cause papillomas or warts on different body sites. Some types affect the skin, lips and tongue while others affect the genitals. Those that are uncommonly linked to cancer are called ‘”low risk”, while those known to cause cancer are termed “high risk”. About two thirds of cervical cancer are caused by the high risk types 16 and 18.

There is no cure for HPV. Early detection and treatment is the key to cervical cancer prevention. Last year the FDA approved HPV testing alone or in combination with a Pap smear in women 25 years and older.

HPV Vaccination

HPV vaccination is now available. Gardasil and Cervarix prevent HPV types 16 and 18 which are responsible for 70% of cervical cancers. Prevention to some of the other HPV types is also provided. The American Cancer Society recommends vaccination for girls 11-12 years old. Newer generation vaccines protect against more HPV types.  The Advisory Committee on Immunization Practices now recommends vaccination in females 13-26 years old and males 13-21 years old.

Despite recommendations from the Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists, only about half of girls 13-17 years old received at least one dose of the vaccine. Only a third received the three recommended doses. Evidence suggests that two doses may be as effective. Recent studies show that even one dose could prevent the majority of cervical cancers.

A new study shows decreased HPV infection rates in teen girls. According to CDC Director Dr. Tom Frieden, “This report shows that HPV vaccine works well, and the report should be a wake-up call to our nation to protect the next generation by increasing HPV vaccination rates.”

What can you do?

• Know the guidelines
• Get screened
• Get your pathology report
• Ask questions

With Medicare now covering Pap smear and HPV testing in women 30-65 years old, there is no reason to delay.

ABOUT DR. MICHAEL MISIALEK

Dr. Michael Misialek currently serves as Associate Chair of Pathology at Newton-Wellesley Hospital, Newton, MA. He is the Medical Director of the Vernon Cancer Center, Chemistry Laboratory and Point of Care Testing. He practices in all areas of pathology in a busy community hospital. Holding an academic appointment at Tufts University School of Medicine as a clinical assistant professor of pathology, he regularly instructs medical students and pathology residents. Dr. Misialek is a strong advocate for pathology and is very active in the College of American Pathologists (CAP), serving on the Personalized Healthcare Committee, the political action committee PathPAC, the CAP Foundation and as chair of the Massachusetts delegation in the CAP House of Delegates. He is an inspector with the CAP and has conducted several domestic and international hospital laboratory inspections.

He received his MD from the University of Massachusetts, did an internship in internal medicine at Boston Medical Center and completed his residency in anatomic and clinical pathology at the University of Massachusetts Medical Center. He did a fellowship in general surgical pathology at the University of Florida and is board certified in Anatomic and Clinical Pathology.