Cervical screening


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Cervical screening

  1. 1. Don’t Fear the Pap Smear What You Should Know About Cervical Cancer By: Irina Frenkel, Hannah Holmes, and Jennifer Zuckerman
  2. 2. Cancer of the cervix typically originates from a dysplastic or premalignant lesion that is previously present. Precursor cells (cervical dysplasia, CIN) develop into invasive cancer, slowly within several years. CIN grades I,II, and III correspond to mild, moderate, or severe cervical dysplasia. The more severe the cervical dysplasia, the more unlikely that it will regress on it’s own. And if left untreated will become invasive carcinoma. Squamous cell carcinoma accounts for 80 to 85% of all cervical cancers. Adenocarcinomas account for most of the rest. Cervical Cancer
  3. 3. Cervical cancer results from a genital infection called Human Papillomavirus (HPV), which is a known human carcinogen. Although HPV infections can be transmitted via nonsexual routes, the majority result from sexual contact. To date, more than 115 different genotypes of HPV have been identified and cloned. A large multinational cervical cancer study found that more than 90% of all cervical cancers worldwide are caused by 8 HPV types: 16, 18, 31, 33, 35, 45, 52, and 58. Three types—16, 18, and 45—cause 94% of cervical adenocarcinomas. Cervical Cancer
  4. 4. Cervical cancer is the third most common gynecologic malignancy and the eighth most common malignancy among women in the USA. The mean age for developing cervical cancer is 50yrs. Cervical cancer is the third most common malignancy in women worldwide. Cervical cancer is the second most common cancer in developing countries, but only the tenth most common in developed countries. The American Cancer Society's estimates for cervical cancer in the United States are for 2013:About 12,340 new cases of invasive cervical cancer will be diagnosed. About 4,030 women will die from cervical cancer. Epidemiology
  5. 5. Of all the women diagnosed with cancer of the cervix, about 67 out of every 100 (67%) will live for at least 5 years. About 63 women out of every 100 (63%) will live for more than 10 years after diagnosis. Younger women have a better survival rate than older women. This is at least partly because in younger women the disease tends to be diagnosed at an earlier stage. In the U.S., Hispanic women have the highest rate of cervical cancer, followed by African Americans, Caucasians, American Indian/Alaska Natives, and Asian American/Pacific Islanders. Mortality rates are highest for African American women. When detected at its earliest stage, cervical cancer has a 5-year relative survival rate of approximately 91%. For regional disease, it is nearly 57%. If cancer has spread to distant organs, 5-year survival drops to approximately 16%.4 In general, the prognosis is affected by the extent of disease at the time of diagnosis. Incidence and Mortality
  6. 6. Sexual activity: The main risk factors for HPV infection through sexual activity are early onset of sexual activity, multiple sexual partners, high-risk sexual partners, and failure to use a condom. Smoking: The risk of squamous cell cervical cancer is increased for women who smoke. Smoking not only exposes the body to cancer-causing chemicals but also weakens the immune system Immunosuppression: A weakened immune system, such as that caused by HIV or by drugs used for suppressing immune response, places women at higher risk for HPV infection and also for cervical cancer First full-term pregnancy at a young age: A first full-term pregnancy in women younger than age 17 nearly doubles the risk of developing cervical cancer later in life, as compared with women who had their first full-term pregnancy at age 25 and older Multiple full-term pregnancies: Women with 3 or more full-term pregnancies have an increased risk of developing cervical cancer. Hormonal changes or weaker immune systems during pregnancy are possible reasons Family history: A women with a mother or sister with cervical cancer has 2 to 3 times the risk of women without this family history Poverty: Less access to health care Diet: overweight, may place women at increased risk for developing cervical cancer. Risk Factors
  7. 7. Tobacco prevention and cessation: Smoking cigarettes and breathing in secondhand smoke increase the risk of cervical cancer. Among women infected with HPV, dysplasia and invasive cancer occur 2 to 3 times more often in current and former smokers. Secondhand smoke causes a smaller increase in risk. Physical activity Weight control and obesity prevention Dietary improvements: Diets high in fruits and vegetables may have a protective effect against many cancers. Conversely, excess consumption of red and preserved meat may be associated with an increased risk of cervical cancer. Safer sex: One study found that when condoms are used correctly they can lower the HPV infection rate in women by about 70% if they are used every time they have sex. Screening: Vaccination is not a substitute for screening with Pap tests. Even in women who have been vaccinated, cervical cancer can still occur. Screening is the most effective means for finding changes in the cervix before cancer has a chance to develop. HPV Vaccines: Two FDA-approved vaccines (brand names, Gardasil and Cervarix) are highly effective in preventing infection with the types of HPV they targe Modifiable Risk Factors
  8. 8. American Cancer Society. Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society; 2013. Boardman, Celia (2013, July 1). Cervical Cancer. Medscape. Retrieved on October 6, 2013 from http://emedicine.medscape.com Burda, B.U., Eder, M., Lutz, K., Senger, C.A., Whitlock, E.P., Vesco, K.K. (2011, October 11) Risk Factors and other Epidemiologic Considerations for Cervical Cancer Screening. U.S. Preventive Services Task Force. Retrieve on September 30, 2013 from http://uspreventiveservicetaskforce.org Lacey JV Jr, Swanson CA, Brinton LA, et al. Obesity as a potential risk factor for adenocarcinomas and squamous cell carcinomas of the uterine cervix. Cancer. 2003;98(4):814-821. Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354(25):2645- 2654. WHO guide for effective programs (2007, January1). Cancer Control: Knowledge into Action. Prevention. World Health Organization. Retrieved on October 5, 2013 from http://who.int/cancer