January is Cervical Cancer Awareness Month A perfect opportunity to raise awareness about cervical cancer, options for effective screening, and HPV vaccination. By Kelly Holland, RN, Leslie Bradford, MD, MMP Division of Gynecology Oncology In 1928, cytopathologist George Papanicolaou, presented “New Cancer Diagnosis”, a short manuscript outlining his theory that malignant cells, sampled from vaginal fluid, demonstrated certain, identifiable characteristics that distinguished them from benign, non-cancerous processes.1 Papnicolaou then partnered with pathologist Herbert Traut to further refine the process of performing and fixing the “smear”. Nearly a century later, the basic premise of the “Pap smear” - analysis of exfoliated cells - serves as the basis for large-scale cervical cancer screening. With the institution of cervical cancer screening, the incidence of cervical cancer in the US has decreased by over 50%.2 Effective screening for cervical cancer has reduced the risk of death (mortality) by more than 80% among screened women.3 Globally, cervical cancer is the second most common cancer and second leading cause of cancerrelated mortality among women.4 While cervical cancer incidence and cancer-related mortality has decreased dramatically in high-income countries with national screening programs and/or robust healthcare infrastructure, 80% of cases occur in middle- and low-income countries lacking these resources. A well-organized program is an essential component of cervical cancer screening. Even in the US, black women over the age of 50 are disproportionately affected by cervical cancer, with an incidence of 12.4 cases per 100,000.2 There have been multiple studies demonstrating the pitfalls of current cervical cancer screening strategies in the US, reporting that 11% to 51% of women diagnosed with cervical cancer had never had prior screening, and 19% to 36% did not have screening between 3-5 years before their cancer diagnosis.2 Under-screened populations include women who have immigrated to the US, minorities, low socioeconomic status, women with multiple chronic conditions, and/or women lacking medical insurance. The Role of HPV Three decades ago, human papillomavirus (HPV) was discovered by Harold zur Hausen, a German virologist (2008 Nobel Laureate in Medicine), and colleagues. This has led to a rapid advancement and improvement in our understanding of the virus and its role in the development of invasive cervical cancer. Notably, the association between certain high-risk, or oncogenic, strains of HPV (hrHPV) and cervical cancer is now well established, with HPV infection implicated in over 99% of squamous cervical cancers.5 Papillomaviruses are ubiquitous. There are more than 100 HPV subtypes, but not all infections result in invasive carcinoma. For instance, HPV 6 and 11 are considered low risk subtypes that can cause condyloma. Other low risk strains include 42, 43, and 44. Fourteen high-risk subtypes have been identified that can cause cervical cancer, including types16,18,31,33,34,35,39,45,51,52,56,58,59,66,68,70.
HPV testing compared to conventional cytology HPV testing and typing as a primary method of screening is now recognized as an alternative to Continued next
