Transcript Cervical Cancer - Caitlin L. Richman, CHES

Cervical Cancer
Caitlin Richman
Epidemiology 4010
What is Cervical Cancer?

Let’s start first by defining cancer in general. Cancer is a disease in
which abnormal cells have uncontrolled growth in the body. The cancer
is named by the part of the body where it starts, even if it spreads to
other body parts later. There are three ways cancer can spread through
the body and they are through tissue, the lymph system and the blood.

Cervical cancer is when the cancer starts in cervix. For a brief
description of the anatomy of the cervix, the cervix is the lower, narrow
end of the uterus. The cervix connects the vagina and the birth canal to
the upper part of the uterus. The uterus is where a baby grows and
develops when a woman is pregnant.

Research has shown Cervical cancer is the easiest gynecologic cancer
to prevent by utilizing regular screening tests and follow ups. Other
gynecologic cancers include Ovarian, Uterine, Vaginal and Vulvar
cancer. When found and treated early, cervical cancer can be highly
curable.
Stages of Cervical Cancer






Cervical cancer is broken up into 4 stages.
Stage 0- Carcinoma in situ, abnormal cells are found in the
innermost lining of the cervix. These abnormal cells can become
cancer and spread to nearby tissue.
Stage I- in stage I cervical cancer, cancer is found in the cervix only.
Stage I is divided into stages IA and IB based upon the amount of
cancer that has been found.
Stage II- in stage II cervical cancer, the cancer has spread beyond
the cervix but not to the pelvic wall or to the lower third of the
vagina. Stage II is also divided into 2 parts, IIA and IIB based upon
how far the cancer has spread.
Stage III- Stage III cervical cancer has spread to the lower third of
the vagina and/or to the pelvic wall and is causing kidney issues.
Stage IV- in Stage IV of cervical cancer the cancer has spread to
the rectum, bladder or other parts of the body. Stage IVA is when
cancer has spread to the bladder, rectum or nearby organs and
Stage IVB is when the cancer has spread to other parts of the body
such as the bones, liver, lungs or lymph nodes.
Stages of Cervical Cancer
Stage I- IA and IB
Stage II- IIA and IIB
Copyright 2012 Terese Winslow LLC
Stages of Cervical Cancer
Stage IV- IVA and IVB
Stage III- IIIA and IIIB
Copyright 2012 Terese Winslow LLC
History of Cervical Cancer





Cervical cancer was first recorded by the Greek physician, Hippocrates
in 400BCE. When he identified it, he declared it to be incurable. As a
result, many women died from this disease for over 25 centuries.
In 1905, radical hysterectomies were used to treat cervical cancer
patients, surgically removing the uterus, cervix and surrounding lymph
nodes.
Dr. Hans Hinselmann invented the colposcope in 1925. this tool allowed
doctors to examine the cervix closely to monitor and observe
abnormalities so that some cancers could be found in time for surgery to
be successful.
In 1928, Georgios Papanikolaou could identify abnormal, possibly
cancerous cells taken from the surface of the cervix. This was when the
real progress began to fight against this cancer.
In 1943, the “Pap smear” was introduced by Papanikolaou as a part of
routine testing and it has helped save many lives around the world. It has
been estimated that if a woman's cervical cancer is diagnosed by a Pap
smear, rather than before the symptoms appear, she has a 92% chance
of a full recovery.
History of Cervical Cancer





It was noted in the early 20th century that epidemiologists thought
that cervical cancer acted more like a sexually transmitted
disease.
In 1983, this observation was backed up when researchers found
that most cervical cancers contained DNA from the human
papillomavirus, and a link was established.
In 1999, the FDA approved a new DNA based test to better detect
the high risk strains of HPV that are known to cause cervical
cancer.
In 2006, the first HPV vaccine was FDA- approved which has
helped decrease the HPV and cervical cancer in women and
girls.
In 2011, a CDC committee recommended that boys should also
get an HPV vaccine to help prevent the spread of HPV to women,
and protect against anal, penile and oral cancer.
Symptoms of Cervical Cancer



Especially early on, cervical cancer may not cause any visible or
noticeable signs or symptoms.
When cervical cancer advances, it may cause bleeding or
discharge from the vagina that is abnormal. An example of this is
bleeding after sex.
Below, I have added a chart from the Centers for Disease Control
and Prevention that lists all the gynecologic cancers and their
corresponding symptoms for reference.
Centers for Disease
Control and
Prevention (2013,
September 3)
Significance of Cervical Cancer

For women in the United States, cervical cancer used to be the
leading cause of death. In the past 40 years, the number of
cases of cervical cancer and the number of deaths from
cervical cancer have significantly decreased.

What is the reason for this decrease? The decrease is result of
many women getting regular Pap tests, which finds cervical pre
cancer before it turns into cancer. There are also vaccines that
have been widely utilized to help prevent the onset of cervical
cancer.

Cervical cancer is the second most common cancer in women
worldwide.

All women are at risk for cervical cancer, most often, it occurs in
women over the age of 30 and each year an estimated 12,000
women get cervical cancer in the United States.
Statistical Data for Cervical Cancer in
the United States


So far, 2010 is the most recent year that statistical numbers are
available.
Prevalence- the number of existing cases of cervical cancer
in the United States.


There were approximately 250,000 cervical cancer survivors living
in the United States as of January 2010.
Incidence- The number of new cases of cervical cancer in a
population during a certain period of time.



In 2010, 11,818 women in the United States were diagnosed with
cervical cancer.
3,939 women in the United States died from cervical cancer in
2010.
It has been estimated that in 2013, 12,340 new cases of cervical
cancer will be diagnosed in women in the United States and an
estimated 4,030 women in the U.S. will die from cervical cancer.
CDC Statistics for Cervical
Cancer (2014)
Contributing Factors to Cervical Cancer




The main cause of almost all (99.7%) cervical cancers is
Human Papillomavirus (HPV).
HPV is a common virus that a person most commonly
acquires through sexual activity. It can however be
transmitted by skin to skin contact with an area of the body
infected with HPV.
While at least half of sexually active people will obtain HPV in
their lives, few women will get cervical cancer.
HPV usually causes no symptoms so it can be very hard to tell
if you have it. Some HPV will go away on its own, but if it does
not and there is a persistent high risk infection present as well,
there is a chance that over time it may cause cervical
cancer.
Contributing Factors to Cervical Cancer







More risk factors for cervical cancer include:
Aging- the persistent high risk infection rate for women older than 55 is
50%, compared with a persistent rate in women younger than 25 of 20%,
like mentioned previously, an HPV infection along with another persistent
high risk infection can lead to cervical cancer.
Sexual activity- early onset of sexual activity, high risk sexual partners,
multiple sexual partners and failure to use a condom.
Suppressed immune system- A weakened immune system caused by
diseases or infections such as HIV or drugs, puts women at a higher risk for
HPV infection, ultimately leading to cervical cancer.
Smoking- smoking exposes the body to cancer causing chemicals and
weakens the immune system. It also increases the risk of squamous cell
cervical cancer for women.
First full-term pregnancy at a young age- this risk factor in women
younger than 17 nearly doubles the risk of developing cervical cancer
cancer later in life when compared to women who were 25 and older
when they have their first full term pregnancy.
Family history of cervical cancer- a women who has a sister or mother
with cervical cancer has 2 to 3 times the risk of getting cervical cancer
than women without a family history of cervical cancer.
Contributing Factors to Cervical Cancer





Multiple full term pregnancies- women with 3 or more full term
pregnancies have an increased risk for developing cervical cancer.
Possible reasons include hormonal changes and weaker immune systems
during pregnancy due to age.
Chlamydia infection- there is a higher relative risk of cervical cancer in
women whose blood results show current or past infection with
chlamydia.
Diet and weight-a diet full of fruits and vegetables have been shown to
help prevent cervical cancer. Being overweight places women at a
higher risk for developing cervical cancer.
Diethylstilbestrol (DES)- is a medicine given to some pregnant women in
the US from 1940 to 1971 that has been shown to increase the risk of a
rare form on cervical cancer in women whose mother took DES while
pregnant.
Oral contraceptives- research has shown that long term use of oral
contraceptives increases the risk of getting cervical cancer.
Epidemiological studies have shown that the risk increases with duration
and decreases after use ceases. After 10 years of cessation, risk returns
back to normal.
Descriptive Epidemiology of Cervical
Cancer




The descriptive epidemiology for the personal variables of cervical cancer
include sex, age, race or ethnic group.
Cervical cancer is a cancer only present in women, due to the fact it begins
in the cervix, an anatomical body part that only women have.
Although all women are at risk, cervical cancer is most commonly found
among women over the age of 30 years old.
It is reported by the Centers for Disease Control and Prevention (CDC) that
more black and Hispanic women develop cervical cancer than women of
other races or ethnicities. It is hypothesized that this is because of decreased
access to Pap testing or follow-up treatment.
I have included a
graph to visualize
the HPV
Associated
cervical cancer
rates by race and
ethnicity in the
U.S.
This graph was adapted
from Centers for Disease
Control and Prevention
(CDC). Human
papillomavirus–associated
cancers—United States,
2004–2008. MMWR
2012;61(15):258–261.
Descriptive Epidemiology of Cervical
Cancer



The descriptive epidemiology for the time variables include short or
long term trends in health and disease.
It has been reported that cervical cancer’s incidence and mortality
rates have been declining in most developed countries since the
1960s. This reduction is due to the widespread screening practices as
well as an increasing level of gynecological and obstetrical care
being offered to women.
Although there have been overall declines reported for the crude/
age adjusted incidence and mortality rates in western countries for
cervical cancer, there have been increases reported among young
women. This increase is reflected upon changes in sexual habits
(more sexually active, starting at a younger age, preventative
measures such as condoms are not being utilized) and increased
transmission of HPV in younger generations. Preventative health
education, screening tests and preventative vaccines such as the
HPV vaccine are the main focus to help reduce these numbers in
young women.
Descriptive Epidemiology of Cervical
Cancer




The descriptive epidemiology for the place variables include country or
city of residence, urban or rural areas and the neighborhood in which one
resides.
The prevalence of cervical cancer is much higher in developing countries
due to the lack of health education, screening tests, such as Pap tests,
HPV tests, and HPV vaccines to help prevent contracting HPV and then
that becoming cervical cancer.
As far as in the western countries, cervical cancer is less prevalent and
working towards becoming more controlled due to the medical
advances, improving the screening Pap tests, HPV vaccines and health
education and making sure these advances are available and accessible
to all.
Prevalence rates are widespread among western countries, most areas in
developed countries are equally affected by cervical cancer, since all
women can get cervical cancer. Factors that can affect which areas
could be more prone to cervical cancer include Socioeconomic status,
availability of resources such as screening tests and HPV vaccines and
accessibility to these preventative measures. Because some parts of the
western countries have less accessibility to these resources than others, it is
important to remember some parts of the country may be susceptible to
having more risk factors that contribute and lead to cervical cancer.
Prevention Measures





There are two tests that have been proven to help prevent
cervical cancer:
The Pap test (or Pap smear) is designed to look for
precancerous cell changes on the cervix that could
become cervical cancer if not treated appropriately.
The human papillomavirus (HPV) test looks for the virus that
causes these cell changes.
It is most important to start regular screening tests at the age
of 21 and to continue to see your doctor regularly for a Pap
test to have the best chance of preventing cervical cancer.
Even if you do not think any of the risk factors apply to you, it
is still important to continue getting Pap tests to ensure you
do not have cervical cancer. It has been mentioned that all
women can be at risk for cervical cancer and one should
stop getting Pap tests only when directed by a doctor.
Prevention Measures




There are currently two HPV vaccines available to protect females
against the types of HPV that cause most cervical, vulvar and
vaginal cancers. These two vaccines can be given to girls as young
as 9 years of age. It is very important to remember that women who
receive the vaccination against HPV still need to have regular Pap
tests to screen for cervical cancer.
The two HPV vaccine brand names are Gardasil and Cervarix which
are both proven to be highly effective in preventing infection with
the types of HPV they are made to target. Gardasil targets the HPV
types 6, 11, 16, and 18 while Cervarix targets to prevent against
types 16 and 18. Types 16 and 18 are shown to be responsible for
around 70% of all cervical cancers.
It is important that one becomes vaccinated before engaging in
sexual activity, so before they could be exposed to HPV. Even if a
person has HPV (one type or another) it is still beneficial to get the
HPV vaccine because it can still prevent infection from HPV types
that have yet to be acquired.
Vaccination to prevent HPV is not a substitute for Pap tests
screening. Those are still the most effective way to find changes in
the cervix before cancer can develop.
Reducing Your Risk

Brief recap- what can increase a woman’s chance of getting
cervical cancer?







Having HPV
Smoking
Having HIV or any other health condition that can make it hard for
your body to fight off additional health problems
Having given birth to three or more children.
Being overweight or obese
SO…what can you do to reduce your risk?
Along with taking the preventative measures I previously listed, it
is important to take these steps as well to reduce your risk of
getting cervical cancer.




Don’t smoke
Use condoms during sexual activity
Limit your number of sexual partners
Follow up with your doctor if your Pap test results are abnormal.
Here is a great Info graph from the
Centers for Disease Control and
Prevention about key ways to prevent
cervical cancer. A good summary of
all the information I just shared!
http://www.c
dc.gov/canc
er/cervical/b
asic_info/info
graphic.htm
Control Measures







Once one has been diagnosed with cervical cancer, they will be referred
to a gynecologic oncologist, who is trained to control and treat cancers of
a woman’s reproductive system.
The extent of the disease is referred to as the stage, and there are four
main stages, all of which have been previously covered (refer to slides 3-5)
There are several ways that have been developed to treat and control
cervical cancer. The treatment often received depends on what stage the
cervical cancer the patient is in as well as how far it has spread. The CDC
mentions 3 main treatment options
Surgery- to remove the cancer tissue.
Chemotherapy- use of drugs to stop or slow the growth of cancer cells.
There are many known side effects of chemotherapy, but they have been
reported to get better or even go away after the treatment is over.
Radiation therapy- this treatment option uses high energy rays to try to kill
the cancer cells and cease them from spreading.
Complementary and alternative medicines are also used to help control
cervical cancer. Examples such as meditation and yoga are said to be
beneficial when used along with standard treatments (complimentary) and
Supplements such as vitamins and herbs are examples of alternative
medicines some can use.
Centers for Disease Control (2014)
Interventions

The best interventions I found for cervical cancer prevention
and control were on the national level from The Community
Guide. These client based interventions were designed to
increase cervical cancer screenings. The interventions for
clients either provided education to increase cancer
screening or made it easier for clients to get screened. The
following interventions are the ones I am going to summarize
for cervical cancer:

Client reminders
Small media
Group education
One-on-one education



Interventions

Increasing Cancer screening: Client Reminders




The client reminders are written or telephone messages advising people
that they are due for screening. These reminders may be enhanced by
one or more of the following: follow up printed telephone reminders,
additional text with information about benefits or ways to overcome
barriers to screening and assistance in scheduling appointments. These
interventions can be untailored to address the overall target population
or tailored with the intent to reach one specific person.
After the intervention was conducted, the Community Preventative
Services Task Force found this intervention to be highly effective and they
strongly recommend the use of client reminders to increase screening for
cervical cancer.
The results from this test include a median increase with 2.8 percentage
points for women receiving Pap tests. Enhanced telephone reminders
showed an increase of 1.6 to 31.4 percentage points.
It was concluded that the client reminder interventions data to increase
cervical cancer screening should be applicable to a variety of settings
and populations, as long as the messages are adapted to the target
population.
The Community Guide to
Preventative Services (2014,
March 19)
Interventions

Increasing Cancer Screening: Small Media Targeting Clients





This small media targeting for cervical cancer screening intervention
include videos and printed materials such as letters, brochures and
newsletters. These materials were used to inform and motivate women
to get screened for cervical cancer. These messages can provide
information tailored to specific individuals or targeted to general
audiences.
The Community Preventative Services Task Force found strong evidence
of this methods effectiveness and recommends interventions that use
small media.
This intervention definitely showed an increase in cervical cancer
screening by Pap test to be at an increase of 4.5 percentage points.
Tailoring this intervention was found to be no more effective than
untailored interventions
It is important to note that these studies were conducted in both rural
and urban communities and among different ethnic, racial and
socioeconomic groups.
The Community Guide to
Preventative Services (2014,
March 19)
Interventions

Increasing Cancer Screening: Group Education for Clients


Group education is designed to encourage group members to
get screened for cervical cancer by discussing the benefits of
screening and share helpful ways to overcome barriers to
screening. Health professionals are taught to give group
education to a variety of groups in different settings using role
modeling, lectures, teaching aids and other styles that best fit for
the intervention.
The Community Preventative Services Task Force found
insufficient evidence to determine the effectiveness of group
education in increasing screening for cervical cancer because of
the small number of studies with methodological limitations and
inconsistent findings.
The Community Guide to
Preventative Services (2014,
March 19)
Interventions

Increasing Cancer Screening: One-on-One Education for
Clients.



In one-on-one education, a health professional discusses the
benefits of screening and ways to overcome barriers to
screening to one person, by telephone or in person. This one-onone education can take place in a workplace, a medical
office, a community setting or at home. A beneficial aspect of
one-on-one education is that this message can be generic or
tailored to the recipients characteristics, beliefs or barriers to
screening for cervical cancer.
Based on the intervention, the Community Preventative Services
Task Force recommends the use of one-on-one education for
educating clients on screening for cervical cancer because of
the strong evidence of effectiveness.
The results of this intervention showed an increase of 8.1 percent
in completed Pap tests, after this intervention was given.
The Community Guide to
Preventative Services (2014,
March 19)
What are Some Campaigns to Help
Raise Awareness of Cervical Cancer?
 Cervical
Cancer
Awareness Month
 Pearl
of Wisdom
Cervical Cancer Awareness
Month


January is the month dedicated to raising awareness of issues
related to cervical cancer, HPV disease and the importance of
early detection. Popular topics of discussion are recent
advances and research in prevention, detection and treatment
of cervical cancer or HPV. Also popular to cover when discussing
the importance of cervical cancer awareness are highlighting
the success of local or regional cervical cancer early detection
screening and treatment programs as well as the importance of
early detection and education on cervical cancer and HPV.
Contacting the local media is a great way to help publicize your
message on cervical cancer awareness and the National
Cervical Cancer Coalition (NCCC) website lists many ways to
gain the medias interest and share your message to ensure it
reaches the greatest amount of people possible. The NCCC also
lists many ways you can become involved to help support
cervical cancer locally.
Pearl Of Wisdom



The Pearl of Wisdom is a campaign to prevent
cervical cancer and raise awareness of the
opportunities available to prevent this disease. This
program is designed to increase awareness of the
tools accessible to prevent cervical cancer and
they also encourage women to take advantage of
these methods. They strongly advocate for the
accessibility to cervical cancer prevention for girls
and women everywhere.
This campaign’s goal is to promote the Pearl of
Wisdom as the global symbol for cervical cancer
prevention. All profits made from this campaign
directly support cervical cancer prevention
activities.
This campaign’s slogan is “Wearing your pearl”
which means when a women is wearing their pearl,
they are helping to spread the message that
cervical cancer is preventable with the Pap test,
HPV test and HPV vaccine.
Thank you!
References:





Borruto, F., & De Ridder, M. (2012). HPV and Cervical Cancer Achievements
in Prevention and Future Prospects. New York: Springer.
Centers for Disease Control and Prevention. (2012, December 20).
Cervical Cancer Statistics. Retrieved from
http://www.cdc.gov/cancer/cervical/statistics/index.htm
Centers for Disease Control and Prevention. (2012, July). Cervical Cancer,
Inside Knowledge: Get the Facts About Gynecological Cancer.
Retrieved from
http://www.cdc.gov/cancer/cervical/pdf/cervical_facts.pdf
Centers for Disease Control and Prevention. (2012, August 13). Human
Papillomavirus- Associated Cancers. Retrieved from
http://www.cdc.gov/cancer/hpv/statistics/cervical.htm
National Cancer Institute at the National Institutes of Health. (2014, March
14). Stages of Cancer. Retrieved from
http://www.cancer.gov/cancertopics/pdq/treatment/cervical/Pati
ent/page2
References:





National Cervical Cancer Coalition. (2013). January is Cervical Cancer
Awareness Month. Retrieved from http://www.nccconline.org/index.php/january
Pearl of Wisdom Campaign to Prevent Cervical Cancer. (2010). Get the
Facts. Retrieved from http://www.pearlofwisdom.us/get-the-facts
Prevent Cancer Foundation. (2014, February). Cervical Cancer. Retrieved
from
http://preventcancer.org/prevention/preventablecancers/cervical- cancer/
Quality Assurance Project Every Women Counts, Resources for Health
Professionals. (2013, August 25). Cervical Cancer Facts and Stats.
Retrieved from
https://qap.sdsu.edu/screening/cervicalcancer/facts.html
The Community Guide, The Guide to Community Preventative Services
What Works to Promote Health. (2014, January 3). Retrieved from
http://www.thecommunityguide.org/cancer/screening/clientoriented/index.html