Cervical cancer or cancer of the opening to the uterus (womb) was the cause of many deaths prior to the 1940’s.  It was in 1945 that the Pap test (smear) was developed.  The Pap test is done by swabbing the cervix to look for abnormal cells that could potentially be cancerous or malignant.  The Pap test, part of the well woman preventative examination, can be live saving.  If the abnormal cells are discovered in time before they progress the disease process can be treated.   In 2005, 10,370 U.S. women were diagnosed with cervical cancer and of these 3,710 died. 

            Cervical cancer is a disease that takes years to develop.  Prior to actually having cervical cancer, a patient will have stages of pre-cancer.  It generally takes between fifteen and twenty years to progress from an early pre-cancer of the cervix to cervical cancer.  There are different stages of cervical pre-cancer or cervical dysplasia (abnormal cells).  Dysplasia can be grouped into mild, moderate, severe or carcinoma-in-situ (localized cervical cancer).   The Pap test is evaluated using a system called the Bethesda system so that a uniform system can be used among healthcare providers.   Using the Bethesda system, a mildly abnormal Pap test will show a low grade or mildly abnormal cells.   The moderate and severe Pap test will show a high grade lesion where more of the cells are involved in the abnormal process.  In carcinoma-in-situ or localized cancer, there are actual cancer cells that are contained near the surface of the cervix. 

            Since the advent of the Pap test in 1945, medical science has come a long way in determining the cause of the cervical cancer.  Cervical cancer and pre-cancer are related to environmental causes.  The risk factors for most cases of cervical cancer and pre-cancer include having multiple sexual partners; sexual intercourse at a young age (usually before age 18); cigarette smoking and harboring the HIV.  Almost all cases of cervical cancer and pre-cancer are associated with a virus called the human papilloma virus or HPV.

The Human Papilloma Virus, Genital Warts and Cervical Cancer

            The HPV is a virus that is transmitted sexually and affects both men and women.   The virus is very common, being one of the most common sexually transmitted diseases. In 2005, 20 million Americans had genital HPV and there are 6 million new cases diagnosed annually.   Multiple types of the HPV exist.  In most healthy individuals, the body’s immune system can fight off the HPV.    Some types  of HPV cause a more serious disease process than others.  In addition to causing cervical cancer/pre-cancer, the HPV causes genital warts or condyloma acuminata.   Genital warts are flesh-colored growths that occur anywhere in the genital region of both sexes.  When they are large, they resemble cauliflower. Some individuals infected with the HPV will not be aware of it unless they have genital warts and/or abnormal cervical cells because the virus can lay dormant in the body.  Since some individuals are not aware they harbor the virus, it can be transmitted unknowingly. 

Helping to Prevent Cervical Cancer

            Because of the widespread prevalence of HPV and its potentially serious consequences,  a vaccine has been developed that is protective against specific types of the human papilloma virus.   The vaccine known as Gardasil (Merck Co.)  has been available in the United States for approximately one year.  The four types of HPV that are covered by Gardasil include types 6, 11, 16 and 18.  The majority of genital warts are caused by types 6 and 11 and most types of cervical cancer are caused by types 16 and 18.  Gardasil targets these four types.

            Gardasil  is indicated for females only between the ages of  9 and 26 years of age.  The injection is given in a series of three shots beginning at month one, then two months later and then the third injection is given six months after the first one.  In order to receive maximum protection, all three injections must be given.  For the female patient between ages 9 and 26 who has not been infected with the HPV, she can receive up to 95% protection against the four types of HPV.   For the patient who has been exposed to the virus, she can still be protected up to approximately 75%.

Treatment for Genital Warts and Abnormal Cervical Cells

            It is important to note that Gardasil is not the  treatment for already existing cervical cancer/precancer and genital warts.   Gardasil is a preventative mechanism.  Treatment for genital warts include excision (cutting) the warts off,   lasering (burning); freezing them and medical treatment with different topically applied  medications.

            The stage and the extent of the cervical cancer/precancer dictates the type of  treatment required. Once abnormal cells are found on a Pap test, a patient should see her clinician for follow-up.  Sometimes, a repeat Pap test will be all that is necessary.  An additional test called a colposcopy  can be done which uses a large microscope to examine the cervix.  The cervix can be stained to make the abnormal cells visible and a biopsy (removal of a piece of tissue) can be performed.   Treatment includes freezing the abnormal cells, burning them or removing the portion of cervical cells that are abnormal.  In some cases of cervical cancer, a hysterectomy (removal of the uterus)  is required. 

            Cervical cancer/pre-cancer and genital warts are known to be associated with the HPV.  Routine Pap tests are necessary to detect the disease process.  Condom usage is helpful in preventing the transmission of the HPV.  It is recommended that once a patient becomes sexually active she should make an appointment to see her health care provider to help maintain optimum health.

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