Spotlight on… cervical cancer

Robert Music

Jo’s Cervical Cancer Trust

Our first Spotlight on of the year looks at cervical cancer, to coincide with Cervical Cancer Prevention Week, which runs from the 20th to the 26th January. The European Cervical Cancer Association (ECCA) introduced this week in 2001 when it became clear that low levels of public awareness about cervical cancer prevention would be a major barrier to the uptake of cervical screening and HPV vaccination programmes. Today, over 3000 events take place during this week in over 30 countries. Robert Music provides us with an overview of cervical cancer, including the symptoms, treatments and how it can be prevented.

What is cervical cancer?

Cervical cancer forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may or may not have symptoms but can be prevented through regular screening (a procedure in which cells are taken from the cervix and looked at under a microscope).

figure-1-cervical-cancer-diagram

Figure 1: Diagram showing the transformation zone on the cervix. Copyright: CancerHelp UK

Cervical cancer is the most common cancer amongst women in the UK under 351. Around 3 women die every day from cervical cancer with over 3,000 newly diagnosed each year2,3. On top of that, some 300,000 women a year are told they have a cervical abnormality that may require treatment4.

Cervical cancer, unlike many other cancers, is primarily a younger woman’s disease with the most common age for a woman to be diagnosed is in their 30s5.

What causes cervical cancer?

Cervical cancer is unlike most other cancers as it is caused by environmental factors and in almost all cases it is caused by persistent Human Papilloma Virus (HPV)6. Approximately 99.7% of cervical cancers are caused by HPV, which is a very common infection that 4 out of 5 sexually active adults will come into contact with in their lives, without any symptoms. It is important to remind readers that HPV is transmitted through intimate relations / skin-to-skin contact in the genital area and not just through sexual intercourse.

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“Cervical cancer is unlike most other cancers as it is caused by environmental factors…”

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The most effective method of preventing cervical cancer is through regular cervical screening, which allows detection of any early changes of the cervix7. For younger women, the HPV vaccination can help prevent 70% of cervical cancers8. Cervical cancer is largely preventable and, if caught early, survival rates are high9.

Who is at risk?

Anyone who is sexually active can be infected with HPV and in fact around 80% of us will be infected with HPV at some time in our lives. The body’s immune system will usually clear it up and generally, most people don’t even know they have contracted the virus at all.

Other risk factors include:

• Smoking (which can double your risk)10

• Having intimate contact at a young age

• Having children at a young age

• Having many sexual partners

• A poor immune system – women with HIV

• Long term use of contraceptive pill

Symptoms

There are usually no symptoms with abnormal cells (in their pre-cancerous state) and sometimes also no symptoms with early stage cervical cancer. However, there are some recognised symptoms associated with the disease. These include,

• Abnormal bleeding: during or after sexual intercourse, or between periods

• Post menopausal bleeding, if you are not on HRT or have stopped it for six weeks

• Unusual and / or unpleasant vaginal discharge

• Discomfort or pain during sex

• Lower back pain

Treatments

In most hospitals, a team of specialists will work together to decide which treatment is best. This multidisciplinary team (MDT) will include:

• a surgeon who specialises in gynaecological cancers

• a clinical oncologist (chemotherapy and radiotherapy specialist)

• it may include a number of other healthcare professionals such as:

o a nurse specialist

o dietician

o physiotherapist

o psychologist or counsellor

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“It is estimated that cervical screening saves around 5,000 lives a year…”

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Depending on the stage of the cancer and the specific needs of the individual, the MDT will in most cases consider the following treatment recommendations: surgery, radiotherapy or combined chemotherapy and radiotherapy (chemoradiation). Survival rates are high if the disease is caught early, with stage 1B1 cancers having a 90-95% cure rate.

A preventable disease

The UK is fortunate to have both cervical screening and HPV vaccination programmes. It is estimated that cervical screening saves around 5,000 lives a year and that by 2030 there will be significant reduction in the numbers of women under 30 being diagnosed thanks to HPV vaccination11. However, there is a real concern over the numbers of women and girls not taking up these potentially lifesaving programmes.

figure-2-cervical-screening-women-60-64

Figure 2: Cervical cancer screening coverage in women aged 60-64

 figure-3-cervical-screening-women-25-29

Figure 3: Cervical cancer screening coverage in women aged 25-29

Overall, 20% of women are not taking up their cervical screening invitation. What is of particular worry is that for women invited for their first screening appointment, aged 25-29, more than 1 in 3 do not attend, and for those aged 60-64, who are due their last screening, uptake, is at a 15-year low. Furthermore, for those living in areas of deprivation the incidence is twice the national average.

Looking ahead

The Cervical Screening Programme is constantly evolving and across the UK, HPV testing will be playing a greater key role in indentifying which women are more at risk of cervical cancer. This will result in quicker and more targeted treatment, ensuring that women who are HPV negative can go back into the routine screening programme, reducing the number of potential treatments as well as the anxiety and stress associated with screening.

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“Overall, 20% of women are not taking up their cervical screening invitation.”

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We also need to see more work undertaken on awareness of symptoms. A recent survey, which the charity undertook with women diagnosed with cervical cancer, showed that for around 70% of women who had symptoms were not aware that these symptoms were linked to cervical cancer. Increasing awareness will hopefully result in an earlier conversation with their doctor, faster diagnosis and better outcomes.

The impact of a diagnosis of cervical cancer cannot be underestimated and for those that survive, many will go through invasive and painful treatments, suffering on-going side effects, losing the ability to have children – all of which can have detrimental and far-reaching effects on relationships and their ability to work. “If only I’d gone for my regular screening, perhaps things would have been different now,” said one of our users recently diagnosed with cervical cancer. Sadly this is all too common, with many women the charity supports diagnosed with cervical cancer because of a delay in attending screening. Experts say that around 50% of those diagnosed with invasive cancer had delayed or ignored screening for at least 7 years.

Clearly there is still much to do!

References

1. UK Cervical cancer incidence statistics. Cancer Research UK website- accessed December 2012 http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/

2. UK Cervical cancer mortality statistics. Cancer Research UK website- accessed December 2012 http://info.cancerresearchuk.org/cancerstats/types/cervix/mortality/?a=5441

3. UK Cervical cancer incidence statistics. Cancer Research UK website – accessed December 2012 http://info.cancerresearchuk.org/cancerstats/types/cervix/incidence/

4. NHS Information Centre – Cervical screening programme – accessed December 2012 http://www.ic.nhs.uk/searchcatalogue?productid=8907&amp,q=title%3a%22Cervical+Screening+Programme%22&amp,sort=Relevance&amp,size=10&amp,page=1#top

5. UK Cervical cancer incidence statistics. Cancer Research UK website – accessed December 2012 http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/incidence/uk-cervical-cancer-incidence-statistics

6. About HPV – Jo’s Cervical Cancer Trust – accessed December 2012-12-11 http://www.jostrust.org.uk/about-cervical-cancer/hpv

7. About Cervical Screening – Jo’s Cervical Cancer Trust – accessed December 2012-12-11 http://www.jostrust.org.uk/about-cervical-cancer/cervical-screening-smear-test-and-abnormal-cells

8. Department of Health HPV – Key vaccine information: HPV – accessed December 2012 http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Immunisation/Keyvaccineinformation/DH_104010#_1

9. UK Cervical cancer survival statistics. Cancer Research UK website – accessed December 2012 http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/survival/

10. UK Cervical cancer risks – smoking -. Cancer Research UK website – accessed December 2012 http://www.cancerresearchuk.org/cancer-info/cancerstats/types/cervix/riskfactors/#smoking

11. NHS Cervical Screening Programme- accessed December 2012 http://www.cancerscreening.nhs.uk/cervical/cervical-cancer.html

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About the author:

Jo’s Cervical Cancer Trust is the UK’s only charity providing direct support to women, their families and friends affected by cervical abnormalities and cervical cancer. We do this by offering a range of information and support, both online and face to face.

Robert Music has been Director of the charity since 2008 overseeing a positive period of change and growth. Income has risen by 400%, staffing has increased, more women than ever have contacted the charity for support, new services have been implemented and the charity has undergone a major rebrand.

Web: www.jostrust.org.uk

Free UK helpline: 0808 802 8000

Email: info@jostrust.org.uk

How can we raise further awareness of cervical cancer screenings?