Cervical Cancer - Status In 2013 And Beyond
Online, April 22, 2013 (Newswire.com) - Cervical cancer is unique among common cancers: it has a single known cause, the human papilloma virus (HPV), and highly effective screening and prevention have the potential to virtually eliminate the death from this disease. The wide spread use of PAP smear has helped to reduce US cervical cancer death rate by nearly 70 percent since the 1950. And now the recent introduction of tests to detect HPV and vaccines to prevent HPV infection hold promise to reduce these deaths even further.
Despite this advancement, the cervical cancer burden in developing countries is still high with some 2,50,000 women dying of cervical cancer and 80 % of these deaths occurring in (developing countries) low resource countries where access to preventive vaccines, screening and treatment is limited. Increasing access to these services, remains a top global health priority. While screening and vaccination remain the first line of defense, researchers are also working to improve treatments for women diagnosed with cervical cancer.
In particular, new therapies are urgently needed to prevent recurrence and to eliminate cancer that remains after tumors are surgically removed or treated with radiation. As we study the timeline of cervical cancer, it was the British Surgeon Ernst Wertheim in 1950 who introduced a new surgical technique, the Wertheims Radical
Hystrectomy, that enabled more than 30 % of cervical cancer patients who underwent the surgery to remain free of cancer after five years. This was considered amonumental feat despite the fact that 15 percent of women died during the procedure which involved removal of the uterus, cervix and surrounding lymphnodes through abdominal incision. This remains the standard treatment till date with various modifications.
Detection of cervical cancer by examining and staining vaginal cell smear was a novel discovery by George Papinicolaou in 1928 which remained the gold standard for cancer detection for several decades. It was in 1983- 84 that researchers led by Harald Zurhansen were able to isolate stains of human papilloma (HPV) as the likely cause of cervical cancer and that most cervical pre-cancers and cancers contain D A from HPV-16 or HPV-18 strains of the virus and these two have been established as the most virulent. In 2008 Dr Zurhansen_was awarded the Nobel Prize for Medicine/Physiology for his discovery.
In 1999, the FDA approved a new test to detect the strains of the human papilloma virus (HPV) that are known to cause cervical cancer. The HPV DNA test which identifies the high risk virus types is approved for use in women aged 30 and older in combination with the PAP test, and in women of all ages who have an abnormal PAP test result. Subsequent studies show that HPV testing alone is significantly more sensitive in detecting advanced pre-cancers than PAP test (96 % vs 55 %), but HPV testing accreus results in more false positive results. When combined, the HPV test and PAP tests are found to be 100 % sensitive for identifying women at risk for cervical cancer.
For women younger than age 30, however, the PAP test is sufficient and combined screening is not recommended. It was also in the year 1999 that National Cancer Institute (NCI) issued an alert recommending that physician consider adding chemotherapy to radiation therapy for women being treated for invasive cervical cancer (cancer that has spread within the cervix). The ongoing results from a large clinical trial called the ASCUS-LSIL triage study (ALTS) which was held in 2000-2006, provide important guidance on managing the mild abnormalities that often show up PAP test and help doctors to decide which women need colposcopy and ablative procedures and which one requires more definitive treatment.
Contact Details:
Rajiv Gandhi Cancer Institute and Research Centre
Sector - 5, Rohini
Delhi - 110 085, India
Helpline: +91-11-47022222
Appointment: +91-11-47022070 / 71
bajpai.sachendra@rgcirc.org