Cervical Cancer Toolkit

The cervix is part of the female reproductive system – connecting the uterus to the vagina (or birth canal). Cervical cancer is an abnormal growth of cells on the cervix, or an abnormal growth of cells that began in the cervix. Cervical cancer is almost 100 percent preventable through regular, routine screening, avoidance of controllable risk factors, and vaccination against the human papillomavirus (HPV). The American Cancer Society (ACS) estimates that there were 12,900 cases of invasive cervical cancer were diagnosed in the United States during 2015, and over 4,100 deaths occurred nationally as a result of cervical cancer. During 2013, 255 new cases of cervical cancer and 82 cervical cancer-related deaths occurred among Indiana females.

Who gets Cervical Cancer Most Often?

HPV infection is the single greatest risk factor for cervical cancer. HPV is passed person-to-person through sexual contact. Delaying first sexual activity, limiting sexual partners, using condoms during sex, and being vaccinated can reduce the risk of contracting HPV.

The HPV vaccine is recommended by the Centers for Disease Control and Prevention (CDC) for all boys and girls ages 11-12. In addition, the CDC recommends vaccination for teens that did not get the vaccine when they were younger. Young women can get the HPV vaccine through age 26, and young men can get vaccinated through age 21. The vaccine is also recommended for gay and bisexual men (or any young man who has sex with men), and for men with compromised immune systems (including HIV), through age 26, if they did not get HPV vaccine when they were younger.

Hoosier women are most often diagnosed with cervical cancer during their middle adult years. During 2013, 78 percent of cervical cancer cases occurred among Indiana women less than 65 years-old, including 38 percent of cases occurring among women ages 25 to 44 and 39 percent among women ages 45 to 64.

During 2004-2013, in Indiana, African-American women, compared to white women, had a 21 percent higher cervical cancer incidence rate (9.2 versus 7.6 cases per 100,000 females) and a 48 percent higher mortality rate (3.4 versus 2.3 deaths per 100,000 females). While many factors are probably impacting this disparity, one apparent issue is that African-American women tend to be diagnosed more often at a later stage.

According to the ACS, women who smoke are twice as likely to develop cervical cancer when compared to non-smokers. For help quitting, or to help a loved one quit, contact the Indiana Tobacco Quitline at 1-800-QUIT NOW (1-800-784-8669) or www.quitnowindiana.com.

Women with a suppressed immune system, a high number of live childbirths, and who have a history of long-term use of oral contraceptives (birth control pills) may also be at an increased risk for cervical cancer.

Women who are overweight, or who eat a diet low in fruits and vegetables may be at an increased risk for cervical cancer.

Early Detection

In the United States, the cervical cancer death rate declined by almost 50 percent in the last 30 years, mainly because of the effectiveness of Pap smear screening. Pap screenings allow for early identification and treatment of abnormal cervical cells before they become cancerous. This is important, because typically, the pre-cancerous conditions do not cause pain or other symptoms and are only detected through Pap screenings.

There are two screening tests that can help prevent cervical cancer or find it early. The Pap test (or Pap smear) looks for pre-cancers, which are cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The second test is an HPV test, which looks for the virus that can cause these cell changes.

The United States Preventive Services Task Force recommends screening for cervical cancer in women ages 21 to 65 with a Pap test every three years; or, for women ages 30 to 65 who want to lengthen the screening interval, screening with a combination of a Pap test and an HPV test every five years.

In 2014, 78 percent of Indiana women ages 21-65 reported having had a Pap test during the past three years. This rate was similar for all racial and ethnic groups.

The Indiana Breast and Cervical Cancer Program provides access to breast and cervical cancer screenings, diagnostic testing, and treatment for uninsured and underinsured women who qualify for services. To find out if you qualify for this program, call (317) 233-7448, or visit the website at www.in.gov/isdh/19853.htm.

Survivorship

Due to advances in treatment and earlier screenings, more and more people are living after a cancer diagnosis. The ACS defines a cancer survivor as any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life. According to the Indiana State Cancer Registry, as of December 31, 2012, there were an estimated 286,973 cancer survivors for all cancers combined; the four highest-burden cancers in the state (breast, colorectal, lung and prostate) account for approximately 56 percent of these survivors. Survivorship, like cancer itself, is complex and can be difficult to navigate.

According to the Indiana Cancer Facts and Figures 2015 report, there are three phases of cancer survival – the time from diagnosis to the end of initial treatment, the transition from treatment to extended survival, and long-term survival. More often than not, the terms “survivor” and “survivorship” are associated with the transitional period after treatment ends; however, survivorship includes a wide range of cancer experiences and paths, including:

  • Living cancer-free for the remainder of life;
  • Living cancer-free for many years, but experiencing one or more serious, late complications of treatment;
  • Living cancer-free for many years, but dying after a late recurrence;
  • Living cancer-free after the first cancer is treated, but developing a second cancer;
  • Living with intermittent periods of active disease requiring treatment; and
  • Living with cancer continuously without a disease-free period.

The preferred path for most cancer patients is to receive treatment and be “cured.” This is the primary goal of all cancer treatment, when possible. For many cancer patients, the initial course of treatment is successful and the cancer does not return.

Many cancer survivors must still cope with the mid- and long-term effects of treatment, as well as any psychological effects – such as fear of returning disease. It is important that cancer patients, caregivers, and survivors have the information and support needed to help minimize these effects and improve quality of life and treatment.

The overall cervical cancer death rate has declined by almost 50 percent in the last 30 years. For the most part, this is attributed to improvements in treatment and increased use of Pap testing.

According to the ACS, the five-year relative survival rate varies depending on the cancer stage. When cervical cancer is detected early, the five-year survival rate is 91 percent. If the cancer has spread regionally, that rate decreases to 57 percent. In instances where cervical cancer has spread to distant organs throughout the body, the five-year survival rate decreases to 16 percent.

During 2013, in Indiana, only 41.6 percent of cervical cancer cases were diagnosed at the local stage. During this same time, approximately 55 percent of Indiana’s cervical cancer cases were diagnosed in the regional or distant stages.

Cervical cancer treatment can vary based on cancer staging. Precancerous cervical lesions may be removed with loop electrosurgical excision procedure (also called LEEP). This removes abnormal tissue with a wire loop heated by electric current. Other treatment options include destroying cells by using extreme cold (called cryotherapy), use of lasers to remove tissue (called laser ablation), or removing a cone-shaped piece of tissue containing the abnormal cells (called a conization). Invasive cervical cancer (cervical cancer that has spread into the healthy tissue around it) is generally treated with surgery or radiation combined with chemotherapy. Chemotherapy alone is often used to treat cervical cancer that is diagnosed at a later stage. According to the ACS, for women with metastatic (spread beyond the cervix), recurrent, or persistent cervical cancer, the addition of the targeted drug bevacizumab (Avastin®) to standard chemotherapy has been shown to improve overall survival, and has recently been approved by the Food and Drug Administration for this use.

In 2006, the Institute of Medicine (IOM) issued a report titled From Cancer Patient to Cancer Survivor: Lost in Transition. The report recommends that every cancer patient receives an individualized survivorship care plan that includes guidelines for monitoring and maintaining their health. In response to the IOM recommendation, many groups have now developed various types of “care plans” to help improve the quality of care of survivors as they move beyond their cancer treatment.

A treatment summary is critical for cancer survivors. The summary should describe the cancer diagnosis and medical treatments that were received (or that may be needed moving forward). Not only does the treatment summary provide survivors with a record of cancer treatments, but it helps survivors talk with other health care providers who may not have been part of the cancer care team.

According to the ACS, in addition to a treatment summary, a survivorship care plan should include a description of what follow-up appointments and tests will be needed and when they will be needed, a description of preventive measures that can be taken to help stay well, a description of any possible side effects from cancer treatments and ways to manage those side effects, and a description of ways to manage physical and mental health.

There are several organizations that assist with the development of survivorship care plans, including the American Society of Clinical Oncology, Journey Forward and LIVESTRONG Care Plan. A list of additional organizations can be found on the ACS website.

Resources

Additional and online resources: