January is national Cervical Health Awareness Month in the United States.  A woman in the United States has a ~1 in 72 lifetime risk (1.6%) of developing cervical cancer, and around 13,000 women are diagnosed annually. The rates are much higher worldwide, with over 500,00 cases being diagnosed across the globe in 2012, leading to over 250,000 deaths. Cervical cancer remains a leading cause of mortality in women, though it is largely a preventable disease. Public health initiatives seek to educate the public about preventive measures and methods of early detection in efforts to reduce disease associated morbidity and mortality.

Most cases of invasive cervical cancer are caused by high-risk strains of human papilloma virus (HPV). There are over 60 types of HPV, with about 20 known to cause cancer.  HPV16 and 18 are the most common strains associated with cervical cancer.  Vaccination against HPV can prevent most cases of cervical cancer.  It is recommended that both boys and girls undergo vaccination, as HPV is also implicated in penile cancer, anal cancer, and some types of oropharyngeal cancer. The currently approved HPV vaccines protect against HPV 16, HPV 18, as well as some other high-risk strains of HPV.  The CDC recommends that boys and girls age 11-12 receive two vaccinations 6-12 months apart. Individuals over the age of 14 require 3 doses, given in 6-month intervals. The CDC provides details regarding administration for those over age 21 or who are immunocompromised.

Early diagnosis of cervical cancer is key to survival.  Screening with Papanicolaou (Pap) smears is the most efficacious method to facilitate early detection of cervical cancer.  Pap smears are recommended every 3 years for women age 21 and older.  At age 30, a combined Pap smear/HPV test may be offered in some cases.  In some women with abnormal findings, more frequent screening may be indicated.  This should occur on an individualized basis at the direction of the patient’s provider.  The decision to stop screening in elderly patients is also an individualized decision and should be discussed with the patient’s provider. 

Read more:

Harrison’s Principles of Internal Medicine, 20e: Chapter 66: Prevention and Early Detection of Cancer: Cervical Cancer

Harrison’s Principles of Internal Medicine, 20e: Chapter 85: Gynecologic Malignancies

Centers for Disease Control and Prevention: HPV