STIs 3: Cervical Cancer

Cervical Cancer

Each year, as many as 200,000 women in developing countries die from cancer of the cervix (the narrow portion of the uterus that opens into the vagina). Yet, if cervical cancer precursors are detected and treated, the disease can be prevented.

Over 99% of all cases of cervical cancer stem from infection with the human papillomavirus (HPV), which is transmitted through sexual contact. HPV is transmitted more readily than many other STIs and is hard to prevent.

The types of HPV that lead to cervical cancer are difficult to detect without screening as the only changes they cause in women are lesions or abnormal cells in the cervix. Some HPV lesions are precancerous, but they usually take many years to develop into cervical cancer. This is why cervical cancer develops most often in women ages 35 to 65 who were most likely infected with HPV at a much younger age.

Different types of HPV cause genital warts and cervical cancer.

The primary symptom of cervical cancer is abnormal bleeding that may start and stop between regular menstrual periods or may begin after sexual intercourse, douching, or a pelvic exam. Other symptoms include:

Menstrual bleeding that lasts longer and is heavier than usual
Bleeding after menopause
An increase in vaginal discharge

When a woman is screened, any abnormalities of the cervix are identified, assessed to determine whether they are likely to be precancerous, and, if so, treated. Therefore, regular screening to identify and treat precursor lesions before cancer forms is a woman’s best defense against cervical cancer.

Screening for cervical cancer prevention

The Pap smear is the principal method used worldwide to screen for precursor lesions. However, it is not widely available in low-resource settings. Analyzing the test can be costly and requires equipment, highly trained staff, and systems that often do not exist in these settings.

One alternative to the Pap smear is direct visual inspection of the cervix with acetic acid (VIA). This method may be more appropriate for screening in low-resource settings because it does not require expensive equipment or systems. However, VIA often gives false-positive results, identifying some women as having precancerous lesions when they actually do not. This causes many women to receive unnecessary treatment, which is costly, may be emotionally distressing, and may increase their risk for other diseases. Research to determine appropriateness of VIA is ongoing.