The Facts About Cervical Cancer

An estimated 14,100 women will be diagnosed with cervical cancer in the United States in 2022. And while the survival rate for cervical cancer has increased significantly in recent decades thanks to the increased use of the Pap test, an estimated 4,280 women are expected to die of the disease this year, according to the American Cancer Society (ACS).

Cervical cancer and HPV

The cervix is a part of the body located at the bottom of the uterus and connected to the vagina. Cervical cancer occurs when cells in the cervix mutate, grow out of control and cause harm to otherwise healthy cells.

While not all the causes of cervical cancer are known, medical experts have found that various strains of the sexually transmitted virus called the human papillomavirus (HPV) play a significant role in most cervical cancer cases.

HPV is a common virus that is spread through unprotected sex. The Centers for Disease Control and Prevention (CDC) reports that at least half of sexually active people will have HPV at some point in their lifetime. It's worth noting, however, that compared to the number of people with HPV, relatively few women end up developing cervical cancer as a result.

In most cases, the body's immune system naturally prevents HPV from causing harm, but in a small percentage of people, the virus can survive for years. Long-lasting HPV infections can contribute to the process that causes some cells in the cervix to become cancerous.

The ACS states that while cervical cancer was once one of the most common causes of cancer-related deaths in women, the survival rate has dramatically improved due to the wide adoption of screening tests and the use of a vaccination that helps to protect the body from HPV infection.

Cervical cancer risk by demographic

Women of any age, race or ethnicity can develop cervical cancer. That said, some groups are more at risk of the disease than others. According to the CDC's cancer statistics for the United States, Hispanic and Black women are at the highest risk for cervical cancer, at rates of 8.9 and 8.3 per 100,000 women, respectively.

An estimated 14,480 women will be diagnosed with cervical cancer in the United States in 2021.

Statistics show that white women are the next demographic group most at risk of cervical cancer, as 7.3 out of 100,000 will get the disease at some point in their lifetime.

The data goes on to show that 6.6 out of 100,000 women who are American Indians/Alaskan natives will get cervical cancer, whereas 6 out of 100,000 Asian/Pacific Islanders will develop the disease.

As is the case with most cancers, aging is one of the biggest risk factors associated with cervical cancer. The disease is most commonly diagnosed in women ages 35 to 44, and the average age of diagnosis for cervical cancer is 50, according to the American Cancer Society. Women younger than 20 rarely get cervical cancer.

Calculating the risk

Other than being a woman and aging, there are a few other factors that put a woman at a higher risk of developing cervical cancer:

• Multiple sex partners: The more people you have sex with, the more likely it is that you will contract HPV, which can contribute to the development of cervical cancer.
• Early sexual activity: Medical experts have found that individuals who start to have sex at a young age are at a higher risk of cervical cancer.
• A weak immune system: When a woman's immune system is weakened by another health condition, especially if she also has HPV, then she will be at a higher risk of getting cervical cancer.
• Smoking: According to research, certain types of cervical cancer have been linked to smoking.
• Exposure to diethylstilbestrol (DES): According to the Mayo Clinic, children of women who took a miscarriage prevention drug known as DES while pregnant in the 1950s are at an increased risk for a certain type of cervical cancer known as clear cell adenocarcinoma.
• Sexually transmitted diseases (STDs): Women who have STDs such as gonorrhea, syphilis, chlamydia or HIV/AIDS are at an increased risk of HPV, which would also put them at a greater risk for cervical cancer.
• Family history: Women with a family history of cervical cancer are more likely to develop the disease themselves.

If you are concerned about your risk for cervical cancer, be sure to talk to your doctor so you can work together to come up with a detection and prevention strategy that's right for you.

Symptoms and diagnosis

In most cases, early-stage cervical cancer doesn't present any signs or symptoms, which makes it particularly important for you to maintain regular preventive health checkups so any abnormal cell changes in your cervix can be detected and addressed as soon as possible.

According to the CDC's cancer statistics for the United States, Hispanic and Black women are at the highest risk for cervical cancer, at rates of 8.9 and 8.3 per 100,000 women, respectively.

Symptoms typically become more apparent once the cancer has progressed to more advanced stages. One of the most common symptoms of cervical cancer is vaginal bleeding after sex, between periods or after menopause. Other signs of the disease include pelvic pain, pain during sex and watery, bloody vaginal discharge that has a strong or foul smell.

There are also cases in which you may not experience any symptoms of cervical cancer, but your Pap smear results come back abnormal. If this happens, your doctor may recommend a colposcopy to further examine your cervix. But this is nothing to worry about at this point. Abnormal test results don't necessarily mean you have cancer. In fact, most colposcopies don't lead to a cancer diagnosis.

Before we continue, let's take a closer look at Pap smears. The test was invented by two scientists working independently in the 1920s—Georgios Papanikolaou and Aurel Babes—and the test is named after the former. The Pap smear as we know it today was updated by Anna Marion Hilliard in 1957.

A Pap smear is performed by opening the vaginal canal with a speculum and collecting cells at the outer opening of the cervix, where the outer squamous cervical cells meet the inner glandular endocervical cells. The collected cells are examined under a microscope for abnormalities, with the goal of detecting potentially precancerous changes.

In the U.S., guidelines around Pap smear screening have changed recently. The American Cancer Society now recommends cervical screenings begin at age 25 and be followed up every three years until age 65. But with the HPV test proving its merit, it has been figured into the new guidelines. According to the ACS, women ages 25 through 65 have three options:

• Primary HPV test every five years (preferred)
• HPV/Pap co-test every five years
• Pap smear screening every three years

A colposcopy is similar to a Pap smear, but the doctor uses a magnifying lens for closer inspection of abnormal cells in the cervix. Depending on what the exam reveals, your doctor might recommend a cervical biopsy, which can either involve the removal of a sample of the abnormal tissue for testing or the complete removal of the abnormal tissue.

Once the lab results come back, your doctor will schedule a follow-up appointment to discuss the test results. If there has only been a low-grade change in the cells of the cervix, then they are unlikely to become cancerous.

The American Cancer Society now recommends cervical screenings begin at age 25 and be followed up every three years until age 65.

Moderate- to high-grade changes in cervical cells indicate a higher risk of cervical cancer. If this is the case, your doctor will discuss treatment and prevention options with you.

Catching precancerous and cancerous cells at an early stage is essential for successful treatment and outcomes. So while your Pap smear test may not be your favorite medical appointment, it is vital and shouldn't be skipped—it could save your life.

Staging the cancer

After an individual has been diagnosed with cervical cancer, her doctor will then need to determine the stage of the disease in order to plan for how best to treat it. Imaging tests—X-rays, CT scans, PET scans and MRIs—may be used to detect whether the cancer has spread beyond the cervix, and the doctor will likely conduct a visual examination of the bladder and rectum.

According to the American Cancer Society, cervical cancer is classified into four different stages, and each stage is broken up into specific levels:

• Stage I: Cancer has spread from the surface of the cervix to its deeper tissues but hasn't yet spread to nearby lymph nodes or distant sites.
• Stage II: The cancerous cells have spread beyond the cervix and the uterus but have not yet reached the pelvic walls or the lower region of the vagina. The cancer hasn't yet spread to nearby lymph nodes or distant sites.
• Stage III: Cancer has reached the lower region of the vagina or the pelvic walls. At this point, the cancer may block the ureters, the tubes responsible for carrying urine from the kidneys to the bladder. The cancer may also have spread to nearby lymph nodes but hasn't yet metastasized to other, more distant locations.
• Stage IV: Cancer has spread to the bladder or rectum or to faraway organs such as the lungs or to the bones.

Getting treated for cervical cancer

Treatment for cervical cancer in the early stages typically involves surgery, although the procedure will be dependent on how far the cancer has advanced and whether the patient is considering becoming pregnant in the future.

Individuals who have been diagnosed early may be able to have the disease removed entirely with a cone biopsy, a surgical procedure in which a cone-shaped piece of tissue is removed from the cervix while the rest of the organ is left intact. This option doesn't interfere with future fertility.

In other cases, a trachelectomy may be performed. This is a surgical procedure, in which the entire cervix and some surrounding tissue are removed, is typically conducted when the cancer is still in its early stages and it spares the uterus, which allows the patient to consider pregnancy following the procedure.

One of the other most important things you can do to protect yourself is to undergo regular Pap tests.

The third surgical option—radical hysterectomy—includes the removal of the cervix, the uterus and part of the vagina, along with nearby lymph nodes. According to the Mayo Clinic, most early-stage cervical cancers are treated with this procedure as it effectively eliminates the disease and prevents recurrence. However, it should be noted that a hysterectomy makes it impossible for a patient to become pregnant in the future.

Advanced cervical cancer is often treated with a combination of chemotherapy, radiation therapy and immunotherapy.

Outlook for cervical cancer

When detected and treated early, the relative survival rate for cervical cancer is relatively high.

The most recent research indicates that women with localized cervical cancer that has not yet spread to other organs are 92 percent as likely as women without cervical cancer to survive another five years—that's the relative survival rate—according to the American Cancer Society. If cervical cancer has spread in the region but has not yet reached distant organs such as the lungs or the bones, then a woman has a 58 percent relative survival rate.

That figure drops to just 17 percent for women in the advanced stages of cervical cancer.

Rate of recurrence 

Unfortunately, unless the cervix has been completely removed, there's always a chance that cervical cancer might come back, even after successful treatment.

Cancer Treatment Centers of America data says 35 percent of patients with invasive cervical cancer will eventually experience a recurrence after treatment, although that rate is lower for individuals in the earlier stages of the disease. According to experts, most cancer recurrences happen within two years of treatment.

Prevention strategies

While there's no surefire way to prevent cervical cancer, you can take steps to significantly reduce your risk of the disease. And those steps start with talking to your doctor about the HPV vaccine. It cannot be stressed enough: Getting the HPV vaccine can help protect you from the HPV infection itself as well as HPV-related cancers such as cervical cancer.

One of the other most important things you can do to protect yourself is to undergo regular Pap tests. These routine well-woman checkups allow your doctor to detect abnormal cell changes in your cervix as soon as possible, so they can be addressed and treated before they develop into cancer.

And, of course, practicing safe sex and abstaining from smoking also play an important role in reducing your risk for cervical cancer.

Talk to your doctor about assessing your risk and about ways you can better protect yourself. If you think you may be experiencing symptoms of cervical cancer, consult a medical professional immediately.