Cervical Cancer May Be Prevented, Starting With Simple Pap Test by Gina Shaw The causes of most cancers remain, in large part, mysterious: What is genetic, what is environmental, what is both? With breast cancer, for example, genetic mutations have been discovered that predispose certain women to the disease, but these genes only account for a fraction of all cases of breast cancers. But for one form of cancer, scientists are virtually certain of a single cause. Cervical cancer, which kills some 230,000 women worldwide each year, at least 80 percent of them in the developing world, can be traced not to a genetic mutation or a toxin in a womanís food, but to an infection: human papillomavirus (HPV). HPV, clinical studies confirm, causes essentially all cases of cervical cancer, but most women are not aware of their risks. According to the National HPV & Cervical Cancer Campaign, 70 percent of women in a recent study could not name the cause of cervical cancer, and 76 percent of them had never heard of HPV. HPV, explained Dr. Sylvia Robles, coordinator of the Pan American Health Organizationís (PAHO) Program on Non-Communicable Diseases, is a common sexually transmitted virus. Certain strains of HPV called ìhighñriskî strains cause 99.7 percent of c ervical cancers, while other ìlowñriskî strains cause genital warts. Many people with HPV never know they are infected because the infection may resolve itself on its own (although it is not technically ìcurableî)óbut when it doesnít, it can develop into cervical cancer. ìRoughly 30,500 women die annually of cervical cancer in Latin America and the Caribbean,î Robles noted. ìYet we know how to prevent it, since it has an infectious origin.î In fact, screening and treatment programs in the developed world have helped reduce cervical cancer cases to fewer than 10 per 100,000 women. The first line of defense: the standard Pap test, which by itself has reduced the rate of cervical cancer in the United States by 75 percent over the past 50 years. But what if a womanís Pap test comes back inconclusive, as some 2 million to 3 million of the 50 million performed in the United States annually do? Most of the time, abnormal Pap results donít mean there is any disease present, but in some cases, they can be an early warning sign that cervical cancer may develop. To get more definitive answers when a womanís Pap results come back with an abnormality, many doctors now recommend a new test designed specifically to detect HPV infection. Itís done by swabbing cells from inside the womanís cervix, just as a Pap test is, and can even be done using the same cells from the initial Pap swab. Itís also relatively inexpensive, between $50 and $90 per test, and a negative result provides strong reassurance that no precancerous or cancerous cells are present. However, this test isnít the only option. Repeat Pap tests and colposcopyóexamination of the cervix with a lighted, magnifying instrumentócan also help to detect the kinds of changes that may indicate a precancerous condition. Because cervical cancer develops very graduallyówomen most often become infected with HPV in their 20s and 30s, but the disease doesnít manifest itself until usually much lateróregular Pap smears and follow-up testing offer an excellent opportunity to prevent HPV from turning into cervical cancer. ìWe have made incredible progress in how we screen women for cervical disease. Five years ago, there was still controversy about whether HPV is the cause of cervical cancer,î said Dr. Angel Houghton of the American Medical Womenís Association. ìNow, we have definitive data that show that HPV is not only the cause of essentially all cervical cancer but that testing for HPV is the most effective screening method for women with inconclusive Pap tests.î When potentially precancerous lesions are detected, they can be removed through surgery or cryotherapy; thereís even the promise of a vaccine on the horizon. But the lifesaving screening tests remain far more available to women in the United States and other developed countries than elsewhere in the world. Through an umbrella group called the Alliance for Cervical Cancer Prevention, PAHO and four other organizations are working to bring new cervical cancer prevention approaches to women in the developing world. With the help of a five-year, $50 million grant from the Bill and Melinda Gates Foundation, Alliance partners are implementing or providing technical assistance to research and demonstration projects in 17 countries in Asia, Africa and Latin America. With local partners, the Alliance has made substantial progress since its founding in 1999. For example, in a South African screening project, staff utilize a local radio call-in program to educate women in the community about cervical cancer and encourage them to come for a screening. In Thailand, village health volunteers educate women about the importance and availability of cervical cancer-related services at local health centers, including a simple test involving visual inspection of the cervix following application of acetic acid. ìThe lack of awareness continues to contribute to unnecessary cervical cancer deaths among women worldwide,î said Phyllis Greenberger, executive director of the Society for Womenís Health Research. ìThrough education, we can improve the quality of life for all women.î Gina Shaw is the medical writer for The Washington Diplomat.