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Cervical cancer: What you need to know

A family at a doctor's office
(Photo credit: Getty Images)
All for them promotional poster
Promotional poster for the All for Them initiative (Courtesy of UTHealth School of Public Health)

When it comes to preventing cervical cancer, the Human Papilloma Virus (HPV) vaccine is a game-changer that reduces risk.

Elizabeth K. Nugent, MD, a specialist in cervical cancer treatment at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and UT Physicians, says that when cervical cancer is detected early, it can be treated successfully.

“HPV plays a critical role in the development of cervical cancer for most patients,” she says. “For women, cervical cancer is the most common HPV-associated cancer, and for men the most common is head and neck cancer.”

The HPV vaccine, Gardasil 9, produces immunity to about 90 percent of the HPV strains that are implicated in many cervical, vulvar, and vaginal cancers. This vaccine also protects against head and neck cancers and anal cancer in both women and men, as well as penile cancer in men.

According to the Centers for Disease Control and Prevention (CDC), about 42,700 HPV-associated cancers occur in the United States each year: about 24,400 among women, and about 18,300 among men.

Research shows that an estimated 79 million people in the United States are infected with HPV and 14 million people become infected yearly.

“We advise parents to vaccinate their 11-year-old children to prevent cancer that may not show up until later in life,” she says, “and the immune response is stronger around ages 11-12.”

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.

“We recommend women make appointments for routine well-person exams and begin screening for cervical cancer at the age of 21,” Nugent notes. “Women can reduce their risk of developing cervical cancer with Pap testing with HPV testing, and the HPV vaccine that protects against HPV infection.”

Cervical cancer is a slow-growing disease. “Thankfully, this means there are excellent opportunities for prevention, early detection, and successful treatment,” Nugent says. “We may have five to 10 years to identify precancerous changes before these changes result in an invasive cancer.”

Symptoms of cervical cancer are often vague, but can include vaginal bleeding after stopping periods, a change in periods, or pelvic pain.

Diagnosis of precancerous changes can happen and be treated any time. “The average age of a woman diagnosed with cervical cancer is the mid-50s,” she explains. “That is a young age, and in the U.S., cervical cancer is one of the leading causes of years of life lost for women due to cancer.”

Treatment options for a patient with cervical cancer depend on the extent (stage) of the cancer and may include surgery, radiation, chemotherapy, or a combination.

Treatment is also determined by the location of the cancer in the cervix and the surrounding structures of the pelvis, the type of cancer (squamous cell or adenocarcinoma), the patient’s age and overall health, and if the patient wants to have children.

Nugent reports there is promising new research underway for cervical cancer, including multiple clinical trials focused on reducing the chance that a cancer will come back, as well as new vaccine trials for stages 3 and 4 cervical cancer.

All vaccines better than some 

To increase HPV vaccine rates among minority youth in medically underserved areas across Houston, the Cancer Prevention and Research Institute of Texas (CPRIT) awarded $1.5 million to researchers at the UTHealth School of Public Health.

The three-year HPV vaccination initiative, called All for Them, began in March 2017.

“HPV is extremely common, and our public health challenge is to communicate the urgency to parents about the importance of the HPV vaccine. Different types of the HPV virus cause six different kinds of cancer, which affect both men and women,” says Paula M. Cuccaro, PhD, principal investigator and assistant professor in the Department of Health Promotion and Behavioral Sciences at UTHealth School of Public Health.

Cuccaro emphasizes that the vaccine is proven to be safe and effective, and it protects children throughout their life from HPV-related cancers and other illnesses. 

All for Them is showing positive results. During its first year, while not every youth in the 28 schools required vaccinations, of those who attended one of the free school-based vaccination clinics and needed a dose of HPV vaccine, over 95 percent received it.

“We advise parents that making sure their child gets the HPV vaccine before they’re exposed to the virus is as important as vaccinating their child as infants against other illnesses,” she adds.  “Recommended vaccines in adolescence are Tdap (Tetanus, Diphtheria, Pertussis); HPV; meningococcal (MCV4); hepatitis A; and influenza (Flu).  Our message to parents is that all vaccines are better than some.”

The adolescent vaccination initiative is a collaboration among UTHealth School of Public Health, Cizik School of Nursing at UTHealth, and Baylor College of Medicine.

A hallmark of the initiative is free school-based vaccination clinics held annually in public middle schools, where youth are offered all recommended adolescent vaccinations. The HPV vaccine is recommended, although not required for school, as with some other vaccines.

All for Them also features a parent-focused social marketing campaign that includes culturally appropriate messages and continuing education opportunities for nurses regarding HPV vaccine awareness for parents.

“Our campaign is reaching the parents of 25,000 public middle school youth in participating schools,” Cuccaro explains. “Our goal is to help parents understand the importance of these vaccinations, and for their kids to receive them without the parent forced to take time off from work to go to a clinic.”

The goal, she adds, is “to change the language health professionals use when discussing the vaccine with parents.”

The initiative is being implemented through a partnership with the Houston Independent School District (the largest school district in Texas), Texas Children’s Mobile Clinic Program, and Memorial Hermann Health Centers for Schools Program.

Age guidelines for vaccine expanded

The U.S. Food and Drug Administration (FDA), in October 2018, recommended expanding the age guidelines for the HPV vaccination to include adults between the ages of 27 and 45. Current guidelines include girls from age 9 to 26 and boys from age 9 to 21.  The Advisory Committee on Immunization Practices will discuss the recommendation at its meeting in February 2019.

“Approximately half of the adolescents in the U.S. are up-to-date on the HPV vaccine,” says Cuccaro, “but the majority of adult men and women are at risk. The new FDA guideline communicates the vaccine’s importance within a broader age range.”

Cervical cancer is one of the most preventable cancers, and both Nugent and Cuccaro emphasize the importance and effectiveness of the HPV vaccine. “Early is better, but everyone within the age range of 9 to 45 can benefit from the vaccine,” Cuccaro adds.

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