The latest on cervical cancer prevention and treatment

With the Pap test to detect cancerous cells, an effective HPV vaccine, advanced treatment options, and clinical trials that continue to look for a cure, the fight against cervical cancer has never looked more promising. All of this depends, however, on being aware and taking advantage of the potentially life-saving options available.

The Pap test

“Despite being around for more than 80 years, the Pap test (or Pap smear) is still the gold standard in cervical cancer detection,” said Katherine Hicks-Courant, MD, a Penn Medicine gynecologic oncologist at the Ann B. Barshinger Cancer Institute. “A Pap test—a screening test you get during a visit with your OB/GYN or primary care provider—is the best way to find cancerous or precancerous cells in the cervix early when the chance for successful treatment is very high.”

However, guidelines change periodically, and you may not need to be screened as often as you have in the past. The changes can be a bit confusing and could leave you feeling uncertain about what to do.

What is a Pap test?

A Pap test is a screening for cervical cancer that looks for abnormal cells in the cervix—the lower end of a woman’s uterus—and is usually done during a pelvic exam.

“To collect these cells, your health-care provider gently opens your vagina with a tool called a speculum to see your cervix and uses a soft, narrow brush or tiny spatula to collect a small sample of cells. The process only takes a few minutes. The cells are sent to a laboratory to check for any cancerous or precancerous cells,” explained Hicks-Courant.

Precancerous cells can be caused by the human papillomavirus (HPV), a common sexually transmitted infection. Approximately 80 percent of people will be carriers at some point in their lives. An HPV test can provide more information about the cells from your cervix and is often done along with the Pap test. It can show whether you have a type of HPV that causes cervical cancer.

Cervical cancer screening guidelines

Several respected health organizations, including the United States Preventive Services Task Force (USPSTF) and the American Cancer Society, develop recommendations on how often people should be screened for cervical cancer and which tests are appropriate, depending on your age and health history. Talk to your health-care provider about how often you need to get a Pap test or a Pap and HPV test. Most women can follow these recommendations from the USPSTF:

• Ages 21 to 29: should get a Pap smear every three years. Even if you are sexually active you don’t need a Pap test before age 21.
• Ages 30 to 65 should get:
  • A Pap test every three years, or
  • An HPV test every five years, or
  • A Pap test and HPV test together (called co-testing) every five years
• Older than 65: should talk to their health-care provider to see if screening is still necessary. You may no longer need a Pap and HPV if you’ve been screened regularly and had normal results.
• Women who have had a total hysterectomy do not need to get a Pap test, unless they have other risk factors.

Risk factors and testing frequency

If you have certain risk factors for cervical cancer, your doctor may recommend more frequent Pap tests, regardless of your age. These risk factors include:

• You’ve had cervical cancer
• You had a recent abnormal Pap test or biopsy result
• You are HIV positive
• You have a weakened immune system

An HPV vaccine to prevent cervical caner

“Almost all cervical cancer is associated with HPV and there is a vaccine to protect against it. It is recommended that girls and women (boys too!) ages 9 to 45 years get vaccinated,” emphasized Hicks-Courant.

The 9-valent vaccine is approved for use in girls and boys age 9 to 26 to prevent HPV. An improvement over the 4-valent vaccine, this vaccine covers more strains of HPV which can cause cervical dysplasia and cancer. It has the potential to reduce dysplasia and cancer by more than 99 percent. The Centers for Disease Control (CDC) has also approved the vaccine for adults up to age 45 after discussion with their physician. Your physician is always your best source for the latest recommendations based on your personal health history.

Surgical advancements

Recent clinical trials have focused on surgical management of cervical cancer. The standard surgery currently involves a radical hysterectomy, where the tissue surrounding the cervix is removed. A clinical trial examined an open surgery compared to minimally invasive surgery, and found that open surgery was better than minimally invasive surgery for cervical cancer specifically. An open radical hysterectomy has been established as the standard of care for patients with cervical cancer who are able to have surgery. Continued trials are focusing on preserving the ability to have children and reducing complications from this procedure. More to come!

New treatment options

Several clinical trials are exploring the addition of chemotherapy to radiation for treatment of advanced cervical cancer. Additional chemotherapy agents are being added to current treatments to improve survival and reduce the risk of recurrence. These trials have shown some promise. Less toxic chemotherapy regimens are also being explored.

Treatments that target specific aspects of cancer cells have been a focus in cervical cancer research as well. The addition of bevacizumab (Avastin) to chemotherapy has improved the survival for women with advanced or metastatic cervical cancer. New immunotherapy treatments, including activated T cells that can recognize and kill cancer cells, therapeutic vaccines, and immune checkpoint inhibitors, have shown promise. Pemborlizumab (Keytruda) is approved for the treatment of metastatic or recurrent cervical cancer that expresses certain immune markers.

Clinical trials help lead to cures

Researchers across the country and the world are actively looking for better treatments and cures for cervical cancer. In order to find new treatments, clinical trials are needed. Sometimes a clinical trial may be right for you. Ask your doctor about any trials that you may be eligible for. It may not only help you, but others, as well.

Cervical cancer symptoms

If you experience any of the cervical cancer symptoms listed below, do not wait for the recommended screening time to be checked. Talk with your health-care provider right away.

• Abnormal vaginal bleeding (after sex, after menopause, between periods, longer/heavier than usual periods)
• Unusual discharge from the vagina
• Pain during sex

Screening saves lives

“No one questions the importance of cervical cancer screening. It’s one of health care’s best success stories—cutting the death rate from the disease in half,” said Hicks-Courant. “So don’t miss out on this potentially life-saving opportunity. Talk to your doctor about when you should get Pap and HPV screening tests.”