Expert Says New Cervical Cancer Screening Guidelines Coming

The good news with cervical cancer? The number of new cases diagnosed each year continues to decline, thanks in large part to the introduction in 2006 of the first vaccine against the human papillomavirus (HPV), the leading cause of cervical cancer.

The bad news? Still not enough people are receiving the vaccine, leaving millions of women still at risk for developing the disease. The American Cancer Society (ACS) says cervical cancer will afflict roughly 14,000 women in the U.S. this year and will prove fatal for close to a third of those diagnosed with aggressive late-stage disease.

Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44, the ACS says, with the average age at diagnosis being 50, and it rarely develops in women younger than 20. The ACS also says that cervical pre-cancers are diagnosed far more often than invasive cervical cancer.

According to research from the World Health Organization (WHO), “persistent HPV infection of the cervix (the lower part of the uterus or womb, which opens into the vagina – also called the birth canal), if left untreated, causes 95 percent of cervical cancers.”

Resource editors spoke with Thomas Morrissey, M.D., director of gynecologic oncology at Lynn Cancer Institute, established at Boca Raton Regional Hospital, which is part of Baptist Health. Dr. Morrissey says there are currently six different HPV vaccines available globally and each is “highly safe and remarkably effective” in providing long-lasting immunity.

Thomas Morrissey, M.D., director of gynecologic oncology at Lynn Cancer Institute, established at Boca Raton Regional Hospital

RESOURCE: Have there been any noteworthy recent developments regarding cervical cancer?

Dr. Morrissey: Most noteworthy over the last 10 to 15 years has been the significant decrease in cervical cancer and precancer in the U.S., mostly due to uptake of the HPV vaccine, which has made a huge difference already and will continue to help reduce the prevalence of cervical cancers and precancers. There have been some exciting recent developments in terms of using newer medications and newer strategies with chemotherapy and radiation therapy. A few trials in the past few months have shown that for patients with locally advanced cervical cancer, chemotherapy with radiation treatment or using the immunotherapy drug pembrolizumab in combination with radiation may lead to even better outcomes than what we have now. Gynecologic oncologists are still figuring out how best to integrate this knowledge into the treatment of new patients diagnosed with cervical cancer.

RESOURCE: How does HPV actually increase one’s risk for cervical cancer?

Dr. Morrissey: HPV is a DNA virus that is passed primarily through sexual activity but can also be spread through skin-to-skin contact with a person infected with the virus. It’s extremely common – approximately 80 percent or more of people in the U.S. are exposed to HPV at some point in their lives. For most people, their body sees it as a viral infection and clears it or suppresses it to undetectable levels. In other people, however, for reasons we don’t yet understand, certain strains of the virus can stick around, especially in the cervix. These can cause precancerous changes that, if unchecked by your body’s immune system, can go on to form cancer.

RESOURCE: Is cervical cancer an aggressive, fast-growing cancer?

Dr. Morrissey: No, it actually develops slowly. It is generally accepted that it takes at least five years for cervical cancer to develop. At least half of the patients now presenting with cervical cancer have not had a gynecologic exam or a pap smear in the past five years.

RESOURCE: What are the most common symptoms to watch for?

Dr. Morrissey: Classic symptoms of cervical cancer include regular or heavy bleeding, especially after exercise or intercourse, constant vaginal discharge, and pelvic pain and pressure. These symptoms usually indicate cancer that’s fairly advanced. Most of the time, cervical cancers can be caught in a precancerous stage or at a very early stage, when there might not be any symptoms at all. That’s why regular screenings are so important.

RESOURCE: At what age should women be getting screened for cervical cancer?

Early detection is so important, too. Ideally, you want to catch cervical cancer in the precancerous stage or early stage when it is much more treatable. There are different schools of thought on this but the ACS recommends starting Pap tests at age 25, as it’s very rare for women under age 25 to have cervical cancer. The American Society of Obstetricians and Gynecologists recommends starting screenings after age 21 and getting screened every three years with just the Pap test and not the HPV test. Then, between the ages of 30 and 65, as long as your results are normal, you would get a Pap test with an HPV test every three to five years. In the foreseeable future the recommendation will be to replace the venerable Pap test – which for generations has been the gold standard for early detection of cervical cancer and saved many thousands of lives – with a swab-based HPV test, which may be better at preventing cervical cancers than a Pap test done alone and does not add more unnecessary tests for women. However, the HPV test isn’t yet available in some areas of the country.

RESOURCE: Why should a cervical cancer patient seek treatment at Lynn Cancer Institute?

Dr. Morrissey: With any kind of cancer diagnosis, a patient wants to go to a cancer center that has a lot of experience in the latest techniques as well as a great track record and success rate in taking care of their particular type of cancer. In addition to state-of-the-art techniques and technology, Lynn Cancer Institute has a highly experienced team of physicians from gynecologic oncology, radiation oncology and medical oncology, all of whom have years of experience caring for patients with gynecologic cancers. Also, as part of Baptist Health Cancer Care, we’re able to get consensus recommendations from our multidisciplinary tumor board. Getting treatment recommendations from our panel of experts ensures that patients get the best possible treatment approach and the greatest chance to beat their cancer, which is what we’re all striving for.

RESOURCE: How is cervical cancer typically treated at Lynn Cancer Institute?

Dr. Morrissey: Treatment of cervical cancer is fairly standardized, depending on what stage it is at diagnosis. We follow state-of-the-art treatment guidelines established by the National Comprehensive Cancer Network (NCCN) as well as those from the MSK Cancer Alliance, which both Lynn Cancer Institute and Miami Cancer Institute are proud to be a part of. Small or microscopic cancers of the cervix are most often treated and cured surgically. Cancers that are too large for surgery are treated with chemotherapy and radiation according to standard protocols, using the latest treatment technologies.

RESOURCE: How can a woman reduce her risk for developing cervical cancer?

Dr. Morrissey: As I’ve noted, the HPV vaccine is highly effective, reducing the risk of cervical cancer by 99 to 100 percent. Also, it is very safe with no significant side effects and it provides immunity for years, as 17-year data on the vaccine has shown. Everyone should be getting the vaccine – people reading this, their children and their grandchildren. If there was a shot that could prevent you from developing one of the most common and deadliest female cancers, wouldn’t you want to protect yourself? Other than the vaccine, abstinence is always an option. And some people believe barrier contraception can be helpful but I would caution them that it’s not foolproof. I wouldn’t recommend doing that instead of getting the vaccine. Also, smoking makes things worse in terms of HPV’s ability to trigger precancerous changes at the cellular level.

RESOURCE: Have most people eligible to receive the vaccine been willing to get it?

Dr. Morrissey: There have been numerous focused efforts to increase HPV vaccine uptake in the target pediatric/adolescent population, which is boys and girls and young adults between the ages of nine to 26. The American Academy of Pediatricians currently recommends that boys and girls between 11 and 15 get the vaccine – particularly 11- to 12-year-olds, who most likely are not yet sexually active. Also, if the vaccine is given at age 11 to 15, only two shots are required; children over the age of 15 need a three-shot series. Currently, uptake of the HPV vaccine is at 70 percent here in Florida. The WHO and ACS want to try to increase uptake as much as possible – to at least 80 percent both in Florida and worldwide.

RESOURCE: What else should people know about cervical cancer?

Dr. Morrissey: Cervical cancer is a very preventable disease, especially now that we’ve had a highly effective vaccine for the past 17 years. Women should stay up to date with their Pap test screenings and have regular follow-ups with their gynecologist. New guidelines are being rolled out on this but women should now be getting an HPV test at the same time as their Pap test, using the Pap test specimen. If the Pap test cells are normal and the HPV test is negative, then there’s a negligible chance of that patient developing cancer over the next five years. Women over 30 with normal cells and a negative HPV test will be advised to wait five years for their next Pap test but they still need to follow up with their gynecologist annually for regular exams and stay up to date with other health care screenings.