Somewhere in the world, a woman is dying of cervical cancer. In fact, a woman dies of cervical cancer almost every 2 minutes. According to the World Health Organization (WHO), it is the second leading cause of female cancer mortality worldwide, with 288,000 deaths and 510,000 cases each year. The National Institutes of Health reports that in the United States, 11,270 new cases of cervical cancer were diagnosed in 2009; in that same year, 4070 women died of the disease. Unlike most cancers, which still have us searching for their causes, how to prevent them, and how to diagnose them before they become life threatening, we have essentially found these answers when it comes to cervical cancer.
Advances in screening and the approval of vaccines against the human papillomavirus (HPV), which causes 70% of cervical cancer cases, have brought us to a turning point with cervical cancer, just as the Papanicolaou (Pap) test did in the 1940s. Although Georgios Papanicolaou invented the Pap smear in the late 1920s, it did not find acceptance in the medical community until the 1940s, at which time there were approximately 26,000 US cervical cancer deaths per year. Just 40 years ago, cervical cancer ranked as the number one cause of cancer death for women. Campaigns in the United States to increase awareness of the need for yearly Pap smears have contributed to a 638% drop in cervical cancer death. Yet, in low-income countries where Pap smears are far from routine, WHO reports that cervical cancer remains the leading cause of cancer death among women.
Who Gets Cervical Cancer?
According to the Centers for Disease Control and Prevention (CDC), 6 of every 10 cases of cervical cancer occur in women who have never had a Pap smear or any cytological test within the past 5 years. A Pap smear detects changes in the cells of the cervix associated with precancerous and cancerous states. The test does not detect HPV, a group of more than 40 virus strains that can infect the genitalia, mouth, and throat. Although we primarily associate just two strains of HPV—16 and 18—with cervical cancer, according to the National Cancer Institute (NCI), these two cause only 70% of cases. The remaining 30% are attributable to other HPV strains with high cancer-causing potential, including types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 73.
The American Council on Science and Health estimates that more than 5 million people in the United States become infected with HPV annually. The rate of new HPV infection is highest among sexually active adolescents, but the immune system in this demographic often clears the infection within 1 to 2 years, making cervical cancer rare in women aged <21 years.
In 2006, the FDA approved Gardasil, a vaccine that prevents infection with cancer-causing HPV strains 16 and 18 and strains 6 and 11, which cause 90% of genital warts. Gardasil is approved for females and males aged 9 to 26 years and is administered in 3 doses over 6 months. Giving the vaccine to boys and young men helps reduce the spread of certain HPV types and protects them against 90% of cases of genital warts. While Gardasil is not approved to prevent HPV-related cancers in males, evidence shows the virus is responsible for some cases of penile, anal, and head and neck cancers in males.
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