It is estimated that 1 in 130 American women will develop cervical cancer (American Cancer Society, 2005b). In 2005, approximately 10,370 new cases of cervical cancer were expected in the United States. A Pap smear, taken during routine pelvic exams, can detect early changes in the cervical cells. A few cells are painlessly scraped from the cervix and are examined under a microscope for abnormalities.
Cervical cancer has high cure rates because it starts as an easily identifiable lesion, called a cervical intraepithelial neoplasia (CIN), which usually progresses slowly into cervical cancer. Better early detection of cervical cancer has led to a sharp decrease in the numbers of serious cervical cancer cases. Screening for cervical cancer should begin
no later than age 21 and should be done every year. But for some women in poor countries, routine pelvic examinations and Pap smears are not available. It is for this reason that approximately 80% of the 500,000 new cases of cervical cancer are diagnosed every year in poor countries such as sub-Saharan Africa and Latin America (Nebehay, 2004). In Chapter 15 we will discuss vaccine development for sexually transmitted infections that have been found to contribute to cervical cancer.
Cervical intraepithelial neoplasia (CIN) occurs more frequently in women who have had sexual intercourse early in their lives as well as women with multiple sexual partners (American Cancer Society, 2003). Women who begin to have children at an early age, such as teenage mothers, are also at increased risk. Chronic inflammation of the cervix (cervicitis) has also been found to be frequently associated with cervical cancer (American Cancer Society, 2003). Because a number of viral infections of the genitals can lead to low — grade cervicitis, it is particularly important for those with a diagnosis of genital warts or herpes to have annual Pap smears. Oral contraceptive users have two to four times the risk for developing cervical cancer, particularly if they have used oral contraceptives for more than 5 to 10 years; and so there, too, annual Pap smears are important. Of course, good gynecological health care requires that all women have annual Pap smears.
There are simple and effective treatments for CIN, such as surgery, radiation, or both, which have resulted in cure rates up to 90% in early-stage disease and a dramatic decline in mortality rate for cervical cancer. If the disease has progressed, treatment hysterectomy commonly includes a hysterectomy followed by radiation and chemotherapy.
The surgical removal of the uterus.