Black Women and Cervical Cancer
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FACT: According to the World Health Organization (WHO), cervical cancer is among one of the most highly treatable gynecological cancers.
Cervical cancer occurs most often in women between the ages of 35 and 55.
Black women experience a higher mortality and morbidity rate from cervical cancer than any other ethnic group.
Black women seem to have more trouble clearing Human Papilloma Virus (HPV)—the virus that causes cervical cancer.
- National Institute on Minority Health and Health Disparities (2012)
Cervical cancer is among one of the most preventable gynecological cancers.
Let's start with the basics. What is the cervix?
The cervix is the lower part of the uterus, which is the female reproductive organ that holds a baby during pregnancy. The cervix connects the uterus and the vagina. Both the uterus and the cervix are located in the pelvis. They are in close contact with other pelvic organs, such as the ovaries, the upper part of the vagina, the bladder, and the rectum.
Cervical cancer starts in the cells on the surface of the cervix, which is comprised of two types of cells: squalors and columnar. Most cervical cancers are from squamous cells. It is a slow-growing cancer that usually starts as a pre-cancerous condition calls dysplasia.
THE FOUR STAGES OF CERVICAL CANCER:
Cervical Cancer is comprised of four stages: carcinoma in situ, which is referred to as Stage 0. Stage I denotes the presence of abnormal cells that may become cancerous. Stage II is reached when the cancer spreads just beyond the cervix. Stage III develops as the cancer spreads to the vagina, pelvic wall and/or kidneys. Stage IV is when the cancer spreads to the bladder, rectum, and other parts of the body (WHO).
WHAT CAUSES CERVICAL CANCER?
Cervical cancer is caused by persistent infection with certain high-risk, oncogenic types of Human Papilloma Viruses (HPVs), of which type 16 is the most prevalent. HPV types 16 and 18 account for 65-70 percent of cervical cancers.
Cervical Cancer Screening & Prevention
The Pap test or Pap smear is a very simple and important test. The doctor uses the Pap test to see if there are any changes in the cervix. The best time for a woman to have a Pap test is 10 to 20 days after her period. A Pap test can be done in a doctor's office or a health clinic. The doctor or nurse practitioner uses a tool called a speculum to hold the vagina open to see the upper part of the vagina and the cervix. Then the doctor uses a wooden scraper or a small brush to get some cells from the cervix and vagina. They put these cells on a glass slide or in a solution and sends it to a laboratory to be looked at under a microscope to check for abnormal cells.
Women should begin to test when they turn 21. The Pap test is recommended every 2-3 years until a woman has 3 or more normal exams. Then, a doctor may recommend doing the test less often. Women should talk to their doctors about how often they need the test.
Cervical Cancer Prevention: FAQ
Human Papillomavirus (HPV) infection: Certain strains of HPV put women at higher risk for cervical cancer. These viruses can be transmitted by sexual contact. HPV infection is a major risk factor for cervical cancer.
Smoking: A woman who smokes has a higher chance of getting cervical cancer.
Weak immune systems: Women living with HIV, the virus that causes AIDS, have a greater risk of getting cervical cancer. This is because HIV makes the immune system weaker so the body will not effectively clear the HPV infection.
Family history of cervical cancer: If other people in your family have or have had cervical cancer your risk is higher than a woman without a family history.
Chlamydia infection: This is a sexually-transmitted bacterial infection that may increase your risk of developing cervical cancer.
Diet: Obesity and a diet low in fruits and vegetables may increase the risk for cervical cancer.
Oral contraceptives: A woman who has taken oral contraceptives for a long time may have a higher risk.
Multiple pregnancies: A woman who has had three or more full-term pregnancies may be at greater risk.
DES: If a woman's mother took the drug diethylstilbestrol (DES) when she was pregnant, she has a greater chance of getting cervical cancer.
Socioeconomic status: Many low income or uninsured women still lack or have limited access to healthcare which may prevent regular screenings and increase their risk of cervical cancer.
- Regular Pap tests are important in detecting cancerous cervical cells when they are more treatable. Talk to a doctor about when to go for checkups. It is generally recommended for women who are sexually active or 18 years and older to have a regular Pap test and a gynecologic exam each year.
- Quit smoking.
- Avoid intercourse at a young age.
- Use condoms during intercourse.
- Limit the number of sexual partners.
- Get vaccinated with the HPV vaccines.
Cervical cancer and cervical pre-cancers usually have no symptoms. That is why it is important to have Pap tests. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs.
Here some are common symptoms in women with fully developed cervical cancer:
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- Vaginal discharge
- Abnormal vaginal bleeding
- Vaginal odor
- Pain
These symptoms may be caused by cancer or by other health problems. It is important for a woman to see her doctor if she is having any of these symptoms.
The HPV vaccines offer the greatest health benefits to individuals who receive their two or three doses before having any type of sexual activity. That’s why HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years. HPV vaccines are recommended for all teen girls and women through age 26, who did not get their two or three doses of the vaccine when they were younger. The HPV vaccine is recommended for all teen boys and men through age 21, who did not get all three doses of the vaccine when they were younger (CDC).
According to the CDC, Gardasil® 9 is the HPV vaccine available for use in the U.S. It is both safe and effective. Since it was developed, 135 million doses have been administered and infections by cancer causing HPV strains have dropped more than 80% in young adult women.
Women who have received the vaccine should continue to have regular Pap smears, as there are some strains of HPV that are not prevented by the vaccination.
- Don't take the test if you're having your menstrual period.
- Don't douche for 2 days before the test.
- Don't have sexual intercourse for 2 days before the test.
- Don't use tampons, birth control foams, jellies, or other vaginal creams or vaginal medicines for 2 days before the test.
The doctor will ask questions about the woman's medical history and family history. The doctor will also do a pelvic exam and Pap test. If the doctor finds something suspicious, other tests can help determine if the woman has cervical cancer.
A doctor may order one or more of these tests to help make a diagnosis:
Cervical Cancer: The Research
Researchers are working on many fronts to better prevent, diagnose, and treat cervical cancer. For example, researchers have developed vaccines to prevent HPV infection. They are also working on vaccines to treat cervical cancer, and they are developing surgical techniques that will remove localized cancers while preserving as much tissue as possible.
What about Clinical Trials?
Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are the ones that work better or have fewer side effects than the current treatments. People who participate in these studies have access to these treatments before the U.S. Food and Drug Administration (FDA) approves them. People who join trials also help researchers learn more about cancer and help future cancer patients.
Cervical Cancer Treatment: FAQ
Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including:
- Not feeling comfortable with the treatment decision
- Being diagnosed with a rare type of cancer
- Having several options for how to treat the cancer
- Not being able to see a cancer expert
These are some of the many ways to get a second opinion.
Ask a primary care doctor. He or she may be able to suggest a specialist. This may be a gynecologic oncologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
Call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
Consult the ABMS Directory of Board Certified Medical Specialists. This book, from the American Board of Medical Specialists, lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries, and you can also view it online at www.abms.org.
Seek other options. Check with a local medical society, a nearby hospital, medical school, or support group to get names of doctors who can give you a second opinion. You can always ask other people who've had cancer for their recommendations.
If you have cervical cancer, you'll likely be treated by one or more of the following specialists: a gynecologic oncologist, a radiation oncologist, and a medical oncologist. An oncologist is a doctor specially trained in diagnosing and treating cancer.
If you have been diagnosed with precancerous changes, it's not essential that you see an oncologist. Depending on the degree of the change seen, your gynecologist or your primary care doctor may monitor your condition and provide treatment.
Treatment for cervical cancer is often surgery, especially for cancers that have not spread. Surgery is used to remove as many cancer cells as possible. This is a local treatment. Local treatments fight cancer cells in one area. Another type of local treatment used for cervical cancer is high-energy X-rays, called radiation therapy. Chemotherapy is the use of drugs to kill cancer. This is called systemic treatment. It travels throughout the body, and it may be combined with radiation, either before or after surgery.
In the first year after treatment, most women are advised to see their doctors every 3 months for Pap tests. Also, women may have computed tomography (CT scans) regularly. Until the fifth year, women may have check-ups regularly, at least every 6 months. After 5 years, a woman will most likely go back to yearly checkups. Women who have been treated for cervical cancer should tell their doctors about any vaginal discharge, bleeding, bone pain, weight loss, and bowel or bladder problems. They should quit smoking and use protection during intercourse to prevent further problems.
- Centers for Disease Control and Prevention: Cervical Cancer
- Centers for Disease Control and Prevention: Inside Knowledge About Gynecologic Cancer
- PAHO
- World Health Organization (WHO)
- Office on Women’s Health
Phone: 800-994-9662 (TDD: 888-220-5446) - American Cancer Society
Phone: 800-ACS-2345 - Gynecologic Cancer Foundation
Phone: 800-444-4441 - National Breast and Cervical Cancer Early Detection Program, CDC, NIH
Phone: 800-232-6348 - National Cancer Institute, NIH, HHS
Phone: 800-422-6237
REFERENCES
- Schiffman M and Castle PE. 2005. The promise of global cervical-cancer prevention. New England Journal of Medicine. Vol. 17;353(20):2101-4.
- Sherris, Jacqueline et al. 2001. Beyond Our Borders: Cervical cancer in the developing world. - Western Journal of Medicine. Volume 175;231-233.