Life-saving Measure – New Vaccine Can Prevent Development of Cervical Cancer

In the 1940s, cervical cancer was a leading cause of cancer-related death for women in the U.S. But today, thanks to Papanicolaou or Pap smears, in which a sample of cervical cells is examined under a microscope to detect abnormalities or pre-cancerous and cancerous cells, the mortality rate has been significantly reduced.
However, the National Institute for Health says more than 4,000 women in the U.S. will die from the disease this year, and the cancer still presents a deadly threat throughout the world, especially in developing countries.
“Hundreds of thousands of women across the globe die of cervical cancer every year,” said Dr. Tashanna Myers, a surgical oncologist with Baystate Medical Center, adding that half of her patients with the disease come from other countries.
The cancer is caused by strains of human papillomavirus, commonly referred to as HPV, which are transmitted through sexual contact. There are more than 40 types of HPV that can be sexually transmitted and affect the genital area, and although the body often eradicates the virus, if it fails to do so, it can lead to serious health issues.
“As people get older, their body’s ability to clear the virus decreases, and precancerous cells can turn cancerous,” Myers explained.
Indeed, the Centers for Disease Control and Prevention says HPV is the most common sexually transmitted infection in the U.S. There are about 14 million new genital HPV infections diagnosed each year, with approximately 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of them occurring in 15- to 24-year-olds.
Fortunately, in 2006, the U.S. Food and Drug Administration approved a vaccine, called Gardasil, that can prevent cervical cancer. The vaccine was designed to be effective against HPV strains 16 and 18, which cause approximately 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of cervical cancers, as well as HPV strains 6 and 11, which cause approximately 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of genital warts. It also protects against the development of vulvar, vaginal, anal, and oropharyngeal (in the lining of the inside of the mouth and throat) cancers that are caused by HPV.
Last year, the FDA approved an updated version of the vaccine called Gardasil 9 that protects against nine types of HPV and approximately 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of cervical cancers, while still providing protection against genital warts and the other more rare forms of cancer noted above.
Dr. Carole Kohen Diniak, a pediatrician at Western Mass Pediatrics in Holyoke, said its use has been approved for girls and young women ages 9 through 26 and boys between the ages of 9 and 15.
“It’s important for all teenagers to be fully vaccinated before they are exposed to HPV, because it is spread by sexual contact,” she said. “And, in addition to girls, it’s important for boys and young males because it provides an additional line of defense for women and prevents them from developing genital warts; the warts are not precancerous, but they are painful and often difficult to treat.”
She added that the CDC estimates that over half of all sexually active men and women will become infected with HPV at some time in their lives if they are not vaccinated.
Kohen Diniak usually begins talking to parents about the vaccine when their children are 11 or 12.
“I tell them cervical cancer is a very common cancer in women who are not vaccinated, and this is the first time in history that a vaccine can indirectly prevent cancer,” she told HCN. “It’s a judgment call as to when to administer it, but you want to have children fully protected before they become sexually active, and if boys are vaccinated, they can’t carry the virus to their future wives.”
Although some people hypothesize that giving young people the vaccine will lead to increased sexual activity, Kohen Diniak said studies show no evidence to support that belief.
“It’s like any other vaccine; the timing of when parents decide to have their children get it is their own decision, but it is 97 to 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} effective in preventing cervical cancer,” she noted.
The level of explicitness she provides parents, preteens, and teens is based on the questions they ask. However, every parent whose child receives the vaccine is given a vaccine information statement provided by the CDC, which can be helpful because it gives them the opportunity to read about things they might not be comfortable discussing in front of their children.
“Almost every parent is receptive to the vaccination,” Kohen Diniak said, noting that it is administered in three doses, several months apart. “The only difference is the age at which they want their child to receive it.”

Silent but Deadly
Cervical cancer begins in the cervix, the narrow organ at the bottom of the uterus that connects to the vagina. And although most cases are caused by the human papillomavirus, there is a 10-year incubation period from the time a woman is exposed to it.
In the early stages, there are no signs of the disease, and symptoms appear only when the cancer becomes invasive. They can include abnormal vaginal bleeding, a malodorous discharge, pain during intercourse, or bleeding after it.
The CDC says the best thing women who are too old for the vaccine can do is to take a proactive stance against the disease by having Pap smears beginning at age 21, coupled with an annual HPV test when they reach age 30.
If cancer is detected, it is always overwhelming, and Myers said a diagnosis of cervical cancer causes many women to feel shame in addition to other emotions, which stems from the fact that having multiple sex partners is a risk factor.
“I have 21- and 22-year-olds with cervical cancer who feel shame in a way that patients with ovarian or uterine cancer don’t experience,” she told HCN, adding that it is unwarranted since a person can have one sexual partner and become infected with HPV. “Our culture sexualizes this disease and the vaccine, but not all cancer diagnoses from HPV are sexual. Some are in the head and neck.”
Still, the prognosis for surviving cervical cancer is excellent if it is caught in the early stages. If it is diagnosed in stage 1, women can have a simple hysterectomy, and if they are of childbearing age, they can choose a trachelectomy, also known as a cervicectomy, which is a surgical removal of the uterine cervix, a fertility-sparing option.
If there is a visible tumor, a radical hysterectomy may be required. Chemotherapy and radiation may also be needed if the cancer has advanced into surrounding tissue and the surgeon can’t get a clear margin around it. A clear margin is defined as a section of tissue around the cancer that does not contain any cancerous cells.
“There are times when it’s not possible to get a clear margin, and cancer is left behind that we are unable to get,” Myers explained.
But, overall, the cure rates are high: 90{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for patients with stage 1, 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for patients with stage 2, and 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} for patients with stage 3.

Making Progress
Today, the combination of the Pap smear and the HPV vaccine has dramatically reduced the incidence and outcome of cervical cancer for women in this country. However, taking every preventive measure possible is important, and since smoking is associated with the disease, it should be avoided.
But the good news is that cervical cancer is highly treatable in the early stages, and women who catch it in time can expect a good quality of life.
Medical science has come a long way since the ’40s in tackling this killer, and as research leads to new medical advances, the likelihood of women having to cope with the disease will continue to decrease.