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Boost patient knowledge on Pap test importance
Cervical cancer, once one of the most common cancers affecting U.S. women, now ranks 14th in frequency among American women. Thanks to the introduction of the Papanicolaou (Pap) smear, the incidence of invasive cervical cancer has seen a dramatic drop. Between 1955 and 1992, U.S. cervical cancer incidence declined by 74%.1
Almost all cases of cervical cancer are caused by persistent infection with specific types of human papillomavirus (HPV), which can be transmitted by sexual contact. While there are more than 100 types of HPV, 15 types are considered to be cancer-causing. HPV types 16 and 18 are responsible for about 70% of cervical cancers worldwide.1
With the 2006 approval of the first HPV vaccine, more women are becoming aware of the link between HPV infection and cervical cancer. So why is it important for women to continue having Pap test, now that a HPV vaccine is available? The answer is very simple: The HPV vaccine Gardasil (Merck & Co.; Whitehouse Station, NJ) only protects against four strains of the virus, says Andrea Milbourne, MD, associate professor in the Department of Gynecologic Oncology at the University of Texas M.D. Anderson Cancer Center in Houston. For example, a woman could be infected with HPV types 58 or 45 (both of which have been implicated in causing cervical cancer), but be protected against types 6, 11, 16, and 18 due to vaccination, she explains.
Even with HPV vaccination, there is no definitive answer yet as to long-term efficacy of the immunization, says Milbourne. Published data show efficacy five years out from immunization.2 Long-term follow-up studies are under way to determine duration of protection.3 Vaccine efficacy can diminish over time, Milbourne notes; she points to pertussis (whooping cough). Pertussis incidence has increased as the vaccine's effectiveness wanes over time; however, many clinicians who treat adults have little knowledge that newly available booster vaccines against pertussis are needed.4
Women who receive the HPV vaccine should be counseled about the continued importance of consistent and correct use of condoms. Even with the availability of the vaccine, consistent condom use offers protection against infection with other high-risk types of HPV that put women at risk for cervical cancer.5 Condoms also are an important defense against HIV, since the HPV vaccine does not offer such protection.
More HPV-associated cancers occur in the cervix than any other site: about 10,800 per year, according to a 2008 analysis of the largest, most comprehensive assessment of HPV-associated cancer data to date in the United States.6 Black and Hispanic women had higher rates of cervical cancer (12.6 and 14.2, respectively) than white and non-Hispanic women (both 8.4). When examined by region, the South led in the highest incidence of cervical cancer.6
Disparities by race/ethnicity and region persist in the burden of cervical cancer in the United States, researchers found.6 Comprehensive screening and vaccination programs, as well as improved surveillance, are essential if incidence rates are to be reduced, they state.6
Research indicates that cervical cancer is closely linked to failure to receive regular Pap test screenings, the presence of the HPV infection, intercourse at an early age, multiple male sexual partners, and sex with a male partner who has had multiple sexual partners and immunosuppressive disorders such as HIV/AIDS.7
Findings from a 2005 analysis indicate that half of women who had cervical cancer diagnosed in the United States had not had a Pap test in the three years before diagnosis.8 Efforts to step up screening have come from the National Breast and Cervical Cancer Early Detection Program, sponsored by the Centers for Disease Control and Prevention. The program provides low-income, uninsured, and underserved women access to timely breast and cervical cancer screening and diagnostic services. In program year 2007, the program screened 318,220 women for cervical cancer with the Pap test and found 4,996 cervical cancers and high-grade precancerous lesions.9 (Editor's note: To help women understand their Pap test results, use a patient handout developed by the Association for Reproductive Health Professionals. See resource, below.)
To help women understand their Pap test results, use a patient handout developed by the Association for Reproductive Health Professionals. At the organization's web site, www.arhp.org, click on "Publications & Resources," "Patient Resources," "Health Matters Fact Sheets," then "Understanding Pap Test Results." The fact sheet is available in English and Spanish.