In view of the recent “new” screening recommendations for cervical cancer by the USPSTF (United States Preventive Services Task Force) I would like to provide a historical recount of the progress made through the last 40 years.
As of March 2012 the USPSTF recommends screening for cervical cancer in women ages 21-65 with a pap smear every three years. For women ages 30-65 who want to lengthen the screening interval, the current recommendation is obtaining cytology (pap smear) and HPV every five years.
Cervical cancer used to be one of the most common causes of cancer death in women in the USA. In fact, between 1955-1992 with increased screening by pap smear, the mortality rate decreased greater than 70%. In spite of the major achievement it is estimated that > 12,000 women will be diagnosed with cervical cancer in 2012 and >4,000 will die from the disease.
The majority of cervical cancers are caused by HPV but by taking care of pre-cancerous lesions, we can avoid the development of invasive cancer. We have vaccines available nowadays that are most effective if started prior to beginning sexual activity and is recommended starting the injections at age 11.
The five-year survival rate for stage I cervical cancer is between 80-93% but for stage IV it drops to 15%. If the cancer is localized to the cervical area, surgery is the only modality recommended. If the margins of resection are positive or the lymph nodes are positive radiation is added with chemotherapy used as a radiosensitizer.
Stage IV disease when the cancer is spread in other parts of the body (outside the pelvis) is not curable, but is treatable with chemotherapy and the standard treatments include cisplatin, carboplatin, taxol, gemzar, topotecan and vinorelbine.
With increasing understanding of the molecular genetic changes that occur in cancers new emerging targeted therapies for cervical cancer include drugs like avastin, pazopanib and tykerb that have shown to improve survival and have much lower range of side effects than chemotherapy. We need to continue moving forward for the cure of cervical cancer, not backward.