Guidelines assist health professionals with secondary prevention of cervical cancer

By Maria Perno Goldie, RDH, MS

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"Since oral HPV could put one at risk for oropharyngeal cancer, it is within the purview of oral health care professionals to educate and inform our patients about HPV infection, how to prevent it, and recognize its symptoms."

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Prevention of disease helps to reduce morbidity and mortality. Cancer is second only to heart disease as the leading cause of deaths for Americans. Among some groups, cancer has surpassed heart disease into the top slot. The death rate due to cancer is greater than that of heart disease in several states. In 2000, there were only two states where cancer was the leading cause of death; in 2014, there were 22.(1)

This article will discuss prevention in terms of cervical cancer.

Primary, secondary, and tertiary prevention are ways to describe the variety of interventions available to health experts. Primary prevention is an attempt to prevent disease or injury before it ever occurs. The goal of secondary prevention is to reduce the impact of a disease or injury that has already occurred. Tertiary prevention attempts to lessen the impact of an ongoing illness or injury that has lasting effects.(2)

New Guidelines

A document titled, “Secondary Prevention of Cervical Cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline,” was recently released.(3) The intent of the guidelines is to offer expert guidance on secondary prevention of cervical cancer for clinicians, public health authorities, policymakers, and laypersons in all resource settings.

Cervical cancer is a disease in which normal cells on the surface of the cervix change, grow uncontrollably, and form a tumor. It is a deadly cancer, but it remains largely preventable with proper education and screening.

Since the 1950s, deaths from cervical cancer in the United States have been reduced by 70% because of diagnostic testing, most notably the Pap test.(4) Physicians now also use the human papilloma virus (HPV) test to identify infection with high risk HPV—the virus that causes cervical cancer and some oral cancers.(5) Regular cervical cancer screening has greatly decreased the number of new cervical cancers diagnosed each year, as well as deaths from the disease. Screening with Pap and HPV testing has noticeably reduced mortality from cervical cancer.(6)

Regarding primary prevention, the HPV vaccine was found to reduce cervical pre-cancers among young women 15 to 19 years of age. The incidence rate of cervical abnormalities decreased between 2007 and 2014.(7) Young girls and boys who get the human papillomavirus vaccine before the age of 15 need only two doses, rather than three, according to the CDC.(8)

According to the new guidelines, here are some of the protocols that should be observed:(3)

• Cervical cancer screening with HPV DNA testing should be offered every five years from ages 25 to 65 years.
• Women who are 65 years of age or older and who have had consistently negative screening results during past 15 years may stop screening.
• If the results of the HPV DNA test are positive, clinicians should at that point perform triage with reflex genotyping for HPV 16/18.

There are many other guidelines available in the document, including recommendations for special populations, women who are immunosuppressed or pregnant, and others.

Additional Steps

According to the guideline’s authors, secondary prevention of cervical cancer is a cost-effective approach to reduce the incidence and mortality of cervical cancer. Patient education information is available, and urges prevention of cervical cancer by making use of screening tests and limiting risk factors. In addition to obtaining the HPV vaccine, other controllable risk factors are: not smoking; limiting the number of sexual partners, and avoiding sexual intercourse with anyone showing signs of genital warts or other symptoms.(9)

As with any disease, prevention of cervical cancer can save pain, suffering, money, and lives. Since oral HPV could put one at risk for oropharyngeal cancer, it is within the purview of oral health care professionals to educate and inform our patients about HPV infection, how to prevent it, and recognize its symptoms. HPV can be transmitted from person to person even when an infected person has no signs or symptoms. And remember, there is no cure for the HPV virus. Let’s help stop the spread of this deadly virus.

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References

1. Changes in the Leading Cause of Death: Recent Patterns in Heart Disease and Cancer Mortality. NCHS Data Brief No. 254, August 2016. http://www.cdc.gov/nchs/products/databriefs/db254.htm.
2. http://phprimer.afmc.ca/Part1-TheoryThinkingAboutHealth/Chapter4BasicConceptsInPreventionSurveillanceAndHealthPromotion/Thestagesofprevention.
3. www.asco.org/rs-cervical-cancer-secondary-prev-guideline.
4. The Value of Diagnostic Tests in Detecting Cervical Cancer. advameddx.org.
5. American Cancer Society: Cervical Cancer Prevention and Early Detection. http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervicalcancer-prevention-and-early-detection-h-p-v-test.
6. Gustafsson L, Ponten J, Bergstrom R, Adami HO. International incidence rates of invasive cervical cancer before cytological screening. Int J Cancer. 1997; 71:159–165.
7. Vicki B. Benard, Philip E. Castle, Steven A. Jenison, William C. Hunt, Jane J. Kim, Jack Cuzick, Ji-Hyun Lee, Ruofei Du, Michael Robertson, Scott Norville, Cosette M. Wheeler. Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era. JAMA Oncology, 2016; DOI: 10.1001/jamaoncol.2016.3609.
8. http://www.cdc.gov/media/releases/2016/p1020-hpv-shots.html.
9. http://www.cancer.net/cancer-types/cervical-cancer/screening-and-prevention.