Cervical cancer's slow, noticeable growth makes it "an ideal disease" for screening, but poor choices--like not getting a Pap smear or having unprotected sex as young adults--give the disease a disastrous head start, a University of Wisconsin Medical Center cancer specialist says.
Simply changing these behaviors could go a long way toward preventing the disease altogether or allowing its diagnosis at an early, treatable stage, according to Dr. Daniel Petereit, a UW Hospital radiation oncologist who recently took part in a national roundtable on cervical cancer. Each year 5,000 American women die of cervical cancer and nearly 15,000 others are diagnosed with the disease.
Petereit treats cervical cancer with high-dose-rate brachytherapy, a technique he described at the National Institutes of Health (NIH) Consensus Development Conference on Cervical Cancer on April 1-3.
After extensively studying the disease's prevention and treatment, Petereit came away convinced that increased awareness--especially among rural elderly women and women in their 20s--could go a long way toward keeping women from becoming his patients.
"'This disease is highly preventable and highly curable when caught early, but substantial numbers of women are either not being screened (with Pap smears and pelvic exams) or are not being screened routinely," Petereit said.
Despite the recognized benefits of Pap smear screening, half of the women with newly diagnosed cervical cancer have never had a Pap smear and another 10% have not had one within 5 years, according to the NIH panel's report.
"'Most alarming to me, since I see many women from small communities, is the large number of rural, elderly women who do not get screened," he said.
Nearly one-fourth of cervical cancer cases and 40% of deaths from the disease are in women 65 and older who live outside metropolitan areas, according to the panel's report. Groups of women with low rates of screening and high rates of cervical cancer include women over 65, the uninsured, ethnic minorities, and people with low incomes.
A Key Step Toward Prevention
Another key step toward preventing cervical cancer is conscientious sexual behavior, Petereit said.
"Cervical cancer is the first solid tumor shown to be caused by a virus in virtually every case (up to 93%)," Petereit said. "'Much of the disease can be prevented by avoiding high-risk sexual behaviors like sex at a young age or especially unprotected sex," he said.
Genetic traces of human papillomavirus (HPV), a sexually transmitted disease, are found in virtually every case of cervical cancer and its precursors worldwide, Petereit said. Women are most likely to contract HPV in their early to mid 20s.
Researchers, including several at the University of Wisconsin-Madison, are working toward developing an HPV vaccine. The NIH panel said that this research "should be given the highest priority."
In addition to emphasizing prevention, Petereit said the conference clearly showed that "we have very effective therapies to treat the disease." Cervical cancer in its early stages can be cured with radiation therapy or surgery in up to 85% of cases. For more advanced cancers, treatment with radiation therapy is the best option, providing cure rates of 40% to 60%.
The panel said improved radiation techniques, including increased use of brachytherapy, has led to "improvement in tumor control and long-term survival" for women with advanced tumors.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
