COMMENTARY

March/April 2003: A Look at Cervical Cancer

Ursula Snyder, PhD

Disclosures

April 25, 2003

Introduction

The past year has been one of note in the field of cervical cancer, and the past several months have also yielded some controversial and some important results in cervical cancer screening. This seemed, then, an opportune time to highlight some of the research, clinical news, and opinion in the field and related material that can be found on Medscape and in the medical literature.

When routine use of the cervical (Pap) smear test developed by George Papanicolaou and Herbert Traut was just beginning in the 1950s, cervical cancer was the leading cause of cancer death in women in the United States; 50 years later, it is the 13th. On order of 35,000 women died annually before the advent of screening; the projected number of cervical cancer deaths in 2003 is about 4100.[1] Today, precancerous cervical lesions (cervical intraepithelial neoplasia [CIN]) are diagnosed much more frequently than invasive cancer. For the most part, they are easily treated with cryotherapy, electrocoagulation, laser ablation, or local surgery (large loop excision of the transformation zone, cone biopsy, hysterectomy) -- survival approaches 100%. The American Cancer Society estimates there will be about 12,200 cases of invasive cancer in 2003, but treatment of invasive cancer detected at an early stage is also generally successful, with a 5-year survival rate of 92% for localized cancer. Unfortunately, most will be aware that in the United States there is today significant disparity in cervical cancer death rates according to population -- with older, poorer, and minority women having the highest mortality. Worse, current indications suggest that this will be the case tomorrow as well.[2]

Cervical cancer is the second most prevalent cancer globally, with 470,000 new cases occurring annually. In developing countries of Central America, Southwest Asia, and sub-Saharan Africa, cervical cancer remains a leading cause of cancer death in women. Of the 231,000 cervical cancer deaths worldwide, 80% occur in developing countries. The simple reason is that cervical cancer screening and treatment programs have been largely ineffective or unavailable. According to Reproductive Health Outlook, about 5% of women in developing countries have been screened for cervical cancer in the past 5 years, compared with as many as half of all women living in developed countries. However, exciting developments in testing and treatment methods appropriate for rural and low-resource settings are yielding impressive results in real-world demonstration projects.[3]

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