A recent study has shown vaccinations for the human papillomavirus (HPV) are already having an impact in lowering cervical cancer rates in young women, but annual screenings remain a vital component in reducing risk, says an expert at a top American hospital, Cleveland Clinic, marking Cervical Cancer Awareness Month in January.
Long-lasting infection with certain types of HPV is the main cause of cervical cancer. It is the fourth-most common cancer among women worldwide, according to the World Health Organization, and around 570,000 women are diagnosed with cervical cancer every year, and 311,000 die from the disease annually. However, cervical cancer is preventable, and also very treatable, especially if caught early, says Sudha Amarnath, MD, a radiation oncologist at Cleveland Clinic.
“The types of HPV that cause cervical cancer are called ‘high-risk types’ and the HPV vaccines protect against the most common high-risk types, as well as some of the low-risk types that cause other health issues,” says Dr. Amarnath.
Commenting on the vaccine’s effectiveness, she points to a recent observational study published in The Lancet towards the end of 2021 that monitored the effects of the immunization program introduced for young girls in England, UK, in 2008. Overall, the researchers reported observing a substantial reduction in cervical cancer and pre-cancers, particularly in the girls who had been administered the vaccine between ages 12 to 13 years.
Dr. Amarnath, who was not involved in the study, says, “These are very positive real-world findings, but more research is needed and regular screenings for cervical cancer remain vital, even in countries that have immunization programs in place. We must remember that the uptake rate of the vaccine in the population makes a difference, and regular screenings will always be needed in those individuals who elect not to be vaccinated. In the case of the US, the uptake rate for this vaccine is 50-70% in adolescents.”
She points out that the vaccines are not just for women, and the vaccine has been shown to be as effective in men in large, randomized trials. In addition to transmitting the disease, men are also at risk of other health issues caused by strains of the HPV virus such as head and neck cancers.
Cervical cancer can develop slowly over many years, with pre-cancerous cells becoming cancerous, which is why screening is vital, says Dr. Amarnath. She adds that for women who are at normal risk, regular screening should start from the age of 21 and continue until the age of 65, in accordance with the US Preventative Task Force recommendations.
“The most common screening tests are pap smears, which involve swabbing from the cervix to collect cells that are then analyzed for the presence of high-risk HPV types in cells and pre-cancer changes in the cervical cells,” she says.
In women aged 21-29, pap smears are recommended ever three years, whereas from ages 30-65, patients can either get a pap smear alone every three years or high-risk HPV testing alone every five years or co-testing (high-risk HPV testing and pap smear) every five years.
She adds, “According to the recommendations, women above the age 65 do not need routine pap smears because the risk is lower if they have never had an abnormal pap smear. However, women at any age can develop cervical cancer, so it is important to see a gynecologist if there are any gynecological symptoms.”
Regarding treatments, Dr. Armanath says that in the initial stages, surgical removal of the cancerous tissue or radiation therapy may be prescribed. Cleveland Clinic cites a five-year survival rate of more than 90% if it is caught in the earliest stage. Later-stage treatment options can include surgery, radiation, and chemotherapy.
