New Tool in Fight Against Cervical Cancer

Advanced Medical Technology Offers New Tool in Fight Against Cervical Cancer: Test Identifies Those at Highest Risk, Allowing Treatment before Cancer Develops

In January 2000, Christine Baze was on top of the world. The then 31- year-old had just quit her day job as a marriage and family therapist to focus on music full time. The aspiring rock musician was ready to devote as much time as she could to writing songs and booking her band to play.

But within three months of dropping everything for her music, Baze was diagnosed with advanced cervical cancer. Her situation was extremely serious. To save her life, doctors performed a radical hysterectomy followed by intense treatment with both radiation and chemotherapy.

Her story would likely have a far different outcome today, thanks to recent advances in medical technology. A recently approved diagnostic test can now identify women who carry high-risk types of the human papillomavirus (HPV), a common virus that causes virtually all cases of cervical cancer. The link between HPV and cervical cancer is critical. Almost no cases of cervical cancer are reported in the absence of HPV.

Since her recovery, Baze has combined her passion for music with her dedication to raising awareness of cervical cancer and the advanced new technologies that greatly improve the odds that women at risk can be identified and if necessary, treated, before their situations become life-threatening. Baze's non-profit organization - popsmear.org -has held a series of benefit concerts (dubbed The Yellow Umbrella Tour) to raise awareness of cervical cancer and its link to HPV.

Improving screening, saving lives

Cervical cancer was once one of the most common causes of cancer death for American women. Thanks to the Pap test, however, abnormal cervical cells are now most often identified and treated before they become cancerous. In fact, the Pap test is largely responsible for the 74 percent drop in the number of cervical cancer deaths in the U.S. between 1955 and 1992. Still, Pap tests - which rely on a visual recognition of changes in cells - are not perfect, which is why Baze was not diagnosed with cervical cancer until it was so advanced.

Complicating efforts to diagnosis cervical cancer is the fact that HPV is very common, with an estimated 75 to 80 percent of adults likely to contract the virus at some time in their lives. And while many strains of HPV do not cause cancer, those strains that do present no symptoms unless, and until, cervical cancer occurs.

While only a fraction of women with HPV will actually develop pre-cancerous cervical cells or cervical cancer, adding the HPV test to the menu of screening tools allows doctors to more precisely identify risk among patients. Close surveillance of women are found to carry high-risk types of HPV greatly increases the likelihood that pre-cancerous cells will be identified when they can easily be treated.

Dr. Tom Cox, a Santa Barbara, California gynecologist, points out that most people have a good immune response to HPV. "It is the minority who cannot clear it who are at-risk - usually over a period of many years or decades," he says.

Preventing the onset of cancer

Knowing its cause makes cervical cancer one of the most preventable of all malignancies. In fact, in 2003, the FDA approved the use of the HPV test along with the Pap in all women age 30 and older (the age group most at risk of cervical cancer). If women are tested for high-risk HPV, physicians can monitor those with infections to determine if their bodies are able to fight off the virus. In women with persistent infections, a procedure called a colposcopy can be performed to find any abnormal cells in the cervix and treat them before cancer develops. In contrast, the Pap test alone cannot directly detect HPV, and abnormal cells may be missed.

"If abnormal cells are caught early, treatment almost always eliminates the risk of cervical cancer," says Cox. Combining HPV testing with Pap testing provides the best strategy for early detection and effective treatment of cervical cancer, he says, adding that the sooner the disease is found and dealt with, the sooner the patient can get back to enjoying a normal life.

While Cox points out the high rate of success in identifying, and, if necessary, treating women at high risk of cervical cancer, he adds that health care protocols can also be modified for women who are not likely to develop the disease. Women who test negative for HPV and have a normal Pap test are at exceedingly low risk of cervical disease or cancer, both at the time of the testing and for at least the subsequent three years, Cox says. This means that with the use of the HPV test, screening is needed less frequently. And that could result in cost savings as well as less discomfort for women..

"This is a real difference in practice compared to the standard 'annual Pap,' which is repeated annually because it is less sensitive and because it does not have the longer-term predictive value of an HPV test," Cox says.

Better Patient Outcomes, Lower Health Care Costs

Cox also notes that advanced technologies like the HPV test could result in reduced health risks for women and significant cost savings. A program of annual conventional Pap tests has been shown to cost $2,457 over the lifetime of a woman and reduce cervical cancer by 89 percent.¹ In contrast, combined screening with an HPV test and a Pap has the potential to dramatically reduce health care costs because, as Cox points out, lower-risk patients can generally be screened for cervical cancer less frequently than once a year.

Screening women over age 30 and older every three years, using HPV testing combined with liquid-based cytology (Paps), reduces cancer incidence by 90 to 92 percent and is predicted to be about 30 percent less costly.²

Cox stresses that it is still beneficial for women to have an annual physical exam, allowing for other health checks, such as breast and pelvic exams, contraceptive management, evaluation for depression, and promotion of smoking cessation and good nutrition, as well as cardiovascular and peri- and post menopausal management.

As Baze tours the country, performing with her band and speaking about her experience, she urges women to talk to their doctors about these new technologies. "I tell my story because I don't want other women to have to go through what I did to save their lives. This is a cancer we have the answer to. I really believe this," she says.

¹ Goldie SJ, Kim JJ, Wright TC, Cost-Effectiveness of Human Papillomavirus DNA Testing for Cervical Cancer Screening in Women Aged 30 Years or More. Obstetrics & Gynecology 2004; 103: 619-631

² Goldie, et. al.