The fight against cervical cancer
Air Force Staff Sgt. Ashley Williams, the 633rd Surgical Squadron women’s health NCO, assists a patient during a routine Pap test at Langley Air Force Base, Virginia. (U.S. Air Force photo by Airman 1st Class Kaylee Dubois)
FALLS CHURCH, Va. — With battles raging in the war against cancer, health care experts are seeing progress in at least one fight: cervical cancer. This disease is much easier to cure when it’s found and treated early, according to the Centers for Disease Control and Prevention. And the health care arsenal includes very effective weapons to detect and even prevent it.
“In the United States, cervical cancer survival rates are among the highest in the world,” said Army Capt. Patricia Dominguez, a family medicine obstetrics physician at Tripler Army Medical Center in Hawaii, citing a study published in December by the National Institutes of Health. For women in other parts of the world, Dominguez said, cervical cancer is the second leading cause of cancer deaths.
The cervix is the cylinder-shaped, lower part of the uterus. It connects the uterine cavity to the vaginal canal. “The cervix is the gateway for menstrual flow,” Dominguez said, “and it’s also the outlet for babies once it’s completely dilated during childbirth.”
The Pap test, also known as the Pap smear, detects cervical cancer. The health care provider swabs the cervix for a cell sample, which is sent to a lab to be studied for signs of abnormal growth. Most women should have their first Pap smear at age 21, Dominguez said, regardless of how old they are when they become sexually active. But women with impaired immune systems should start receiving screenings before age 21 if they are sexually active.
If the Pap test results are negative – meaning, no signs of abnormal cells – women should plan to be retested every three years until age 30. Then, women getting a Pap test should add a test that checks for strains of human papillomavirus, or HPV, Dominguez said. While HPV is common, only a small fraction of women infected with this virus will develop cervical cancer, she said. But that’s no reason to become complacent.
“Almost all cervical cancer is HPV related,” said Dr. Bruce McClenathan, medical director of the Defense Health Agency immunization regional office at Fort Bragg, North Carolina.
Women ages 30 to 65 with negative results for both the Pap and HPV tests should plan to be tested every 5 years, Dominguez said. Women older than 65 may no longer need either test if previous results have been negative for several years, or they’ve had their cervixes removed because of noncancerous conditions, such as fibroids.
If a woman’s Pap test comes back positive, that doesn’t mean she’ll develop cervical cancer. The abnormal cells that were detected may clear on their own without any treatment. Dominguez said the usual protocol is to repeat the Pap test a year later or do a colposcopy, a procedure to examine the cervix, vagina, and vulva.
If the abnormal cells are persistent, they can be removed to prevent the possibility of spreading, usually using a thin wire loop with a low-voltage electrical current. This approach is called LEEP, or loop electrosurgical excision procedure.
Left alone, abnormal cells may eventually progress to cancer. The good news is the cells are slow-growing, so it can take a decade or longer for this to happen, according to the CDC.
This doesn’t mean that cervical cancer isn’t dangerous. “The American Cancer Society estimates 12,820 new cases of invasive cervical cancer were diagnosed in 2017, eventually leading to about 4,210 deaths,” said Lt. Cmdr. Matthew Behil, department head of San Onofre Branch Medical Clinic, Naval Hospital Camp Pendleton, California.
The San Onofre clinic now has the highest cervical cancer screening rate among the 13 clinics of the Navy hospital, Behil said, at almost 86 percent. But it took a concerted effort to achieve that goal. From June through August 2016, San Onofre ranked at the bottom, with a screening rate of 58.7 percent of its patient population pool.
“We focused on being proactive about scheduling appointments,” Behil said. Those efforts included telephoning women to set dates for Pap and HPV tests, and following up with those who made appointments but didn’t keep them. The clinic has shared its best-practices approach with others and has also applied it to other health-screening measures. In November, the Navy hospital received a Military Health System High Reliability in Healthcare Award in the health care quality and patient safety category.
As for preventing cervical cancer, experts say the HPV vaccine is safe and also highly effective in preventing the virus, which causes most cervical cancer. Despite these benefits, “only about 42 percent of females and 28 percent of males in the recommended age groups have received all the recommended doses,” Dominguez said.
Health care experts believe increasing those numbers is critically important. Widespread HPV vaccination “would have huge potential” to reduce cervical as well as other types of cancer, McClenathan said.