CERVICAL CANCER CAN BE PREVENTED
YET 13,000 WOMEN A YEAR STILL GET IT
While one of the singular achievements of American medicine in recent years has been to reduce the largely preventable incidence of cervical cancer, 13,000 women nevertheless will come down with it this year mainly because they have not had a Pap smear to detect it.
As the disease ordinarily takes about 10 years to progress, "cervix cancer happens to be a cancer that you can use screening techniques to try to pick up early" and treat, says Dr. Ursula Matulonis, of Boston's Dana-Farber Cancer Institute. Globally, about 40 percent of the 500,000 women stricken with the disease will die for lack of a proper medical treatment, she says. That's because women in some countries do not routinely get Pap smears and when the transmitting agent, human papillomavirus(HPV), infects the cervix it does not get treated because of society's inadequate medical infrastructure. When the disease is undetected and allowed to grow, the victims will suffer pain and bleeding as the cancer spreads. It is caused by one of the 75 types of HPV, a ubiquitous virus that is present in both men and women and which causes 95 percent of the cancers.
Compared to other forms of cancer, the cervical form is still a relatively rare tumor, Dr. Matulonis says. Ovarian cancer afflicts 25,000 American women annually; breast cancer, 180,000 women; and lung cancer about 200,000 women. Since the cervical form can be detected early and treated successfully, the number of women who have Stage IV cervical cancer "should be zero," she says. Even though the death rate from cervical cancer has been declining by 4 percent a year, the grim news is that, according to the National Cervical Cancer Coalition of West Hills, Calif., more than 4,000 American women die of the disease annually. Many of them are of the 11 percent of U.S. women who do not have Pap screenings.
The Pap test is used by gynecologists to detect any premalignant or malignant cells gathered from the outer opening of the cervix and examined for abnormalities. In general, observes Wikipedia, the test is recommended for women aged 25 to 65 who have had sex. "Most women contract HPV soon after becoming sexually active. It takes an average of a year, but can take up to four years, for a woman's immune system to control the initial infection. Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the woman stress and result in further tests and possible treatment," Wikipedia says.
"It's important for folks to know that you do not have to have intercourse to spread the virus, but that the virus could be spread just by skin-to-skin contact," Dr. Matulonis warns, explaining that the virus "probably gets into the cervix cells just by small breaks in the skin." Dr. Matulonis made her comments in an interview with law Professor Diane Sullivan for the Comcast SportsNet broadcast "Educational Forum," produced by the Massachusetts School of Law at Andover. "Worldwide, HPV is the most common sexually transmitted infection in adults," Wikipedia reports, noting that more than 80 percent of American women will have contracted at least one strain of HPV by age fifty.
"Accordingly, public health officials in Australia, Canada, Europe, and the United States recommend vaccination of young women against HPV," Wikipedia notes. As the vaccine only covers some strains of HPV, medical authorities still urge regular Pap smear screening even after vaccination. Doctor Matulonis says the vaccine is essentially mimicking the virus, giving the individual a fraction of the virus so that one's immune system can mount a response "to certain proteins that are present in that virus." She goes on to say, "It's important to remember that for any vaccine to work properly and effectively that that vaccine is given to somebody before they're exposed to the virus."
Tracing the progress of the disease, Dr. Matulonis says (1) the first piece of HPV's wrongdoing is the person becoming infected; (2) the virus persistently stays with the cervix cells; (3) the individual reaches a point of preinvasive disease, "meaning not quite cancer but the step just before it," where preinvasive changes take place on the cervix; and (4) invasive cervical cancer. In all, the process takes about 10 years to become cancerous.
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