Cervical Cancer: Behavioral Changes Could Save Most Women

Cervical cancer's slow, noticeable growth makes it "an idealdisease" for screening, but poor choices--like not gettinga Pap smear or having unprotected sex as young adults--give thedisease a disastrous head start, a University of Wisconsin MedicalCenter cancer specialist says.

Simply changing these behaviors could go a long way toward preventingthe disease altogether or allowing its diagnosis at an early,treatable stage, according to Dr. Daniel Petereit, a UW Hospitalradiation oncologist who recently took part in a national roundtableon cervical cancer. Each year 5,000 American women die of cervicalcancer 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 April1-3.

After extensively studying the disease's prevention and treatment,Petereit came away convinced that increased awareness--especiallyamong rural elderly women and women in their 20s--could go a longway toward keeping women from becoming his patients.

"'This disease is highly preventable and highly curable whencaught early, but substantial numbers of women are either notbeing screened (with Pap smears and pelvic exams) or are not beingscreened routinely," Petereit said.

Despite the recognized benefits of Pap smear screening, half ofthe women with newly diagnosed cervical cancer have never hada Pap smear and another 10% have not had one within 5 years, accordingto the NIH panel's report.

"'Most alarming to me, since I see many women from smallcommunities, is the large number of rural, elderly women who donot get screened," he said.

Nearly one-fourth of cervical cancer cases and 40% of deaths fromthe disease are in women 65 and older who live outside metropolitanareas, according to the panel's report. Groups of women with lowrates of screening and high rates of cervical cancer include womenover 65, the uninsured, ethnic minorities, and people with lowincomes.

A Key Step Toward Prevention

Another key step toward preventing cervical cancer is conscientioussexual behavior, Petereit said.

"Cervical cancer is the first solid tumor shown to be causedby a virus in virtually every case (up to 93%)," Petereitsaid. "'Much of the disease can be prevented by avoidinghigh-risk sexual behaviors like sex at a young age or especiallyunprotected sex," he said.

Genetic traces of human papillomavirus (HPV), a sexually transmitteddisease, are found in virtually every case of cervical cancerand its precursors worldwide, Petereit said. Women are most likelyto 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 saidthat this research "should be given the highest priority."

In addition to emphasizing prevention, Petereit said the conferenceclearly showed that "we have very effective therapies totreat the disease." Cervical cancer in its early stages canbe cured with radiation therapy or surgery in up to 85% of cases.For more advanced cancers, treatment with radiation therapy isthe best option, providing cure rates of 40% to 60%.

The panel said improved radiation techniques, including increaseduse of brachytherapy, has led to "improvement in tumor controland long-term survival" for women with advanced tumors.