The Power of Two: Strategies for Finding Cervical Cancer
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By: Christine Haran

While scientists are scrambling for effective screening tests for most cancers, women and their doctors have several options when it comes to detecting cervical cancer. Yet this wasn't always the case.
"We forget that, in the 1940s and earlier, cervical cancer was a very common cancer in the United States," says Alan G. Waxman, MD, an associate professor of obstetrics and gynecology at the University of New Mexico School of Medicine in Albuquerque. Around 1940, George Papanicolaou, MD, developed the Pap test, which can detect changes in the cells of the cervix that can lead to cervical cancer. Since the Pap test was introduced, the cervical cancer rate has dropped by roughly 70 percent. Experts say the rate would likely have dropped even further if more low-income women and minority women had been screened.

In the last few years, an improved Pap test and a new cervical cancer screening test that detects the virus responsible for cancerous changes on the cervix have been developed, requiring an update to current guidelines for cervical cancer screening. In observation of Cervical Cancer Awareness Month, Dr. Waxman, who co-wrote the American College of Obstetrics and Gynecology (ACOG) guidelines, discusses the new technologies and recommendations below.

What are the primary risk factors for cervical cancer?
Cervical cancer is sexually transmitted and this has been known for a long time. What has only been appreciated over the last 10 to 15 years is that cervical cancer is caused by the human papilloma virus, or HPV.


The risk factors for cervical cancer are therefore the same as the risk factors for acquiring a sexually transmitted disease, so women who have multiple partners are more likely to come in contact with the virus. And because of the nature of the cervix, the cervix is more susceptible to HPV when women are young. Therefore, women who initiate sexual intercourse in adolescence, which is when most women in the United States do, are at increased risk.

The virus is necessary but not sufficient to cause the cancer. Which is to say, lots of women get HPV and, in most cases, their immune system gets rid of it, or at least clears it to levels that are too low for us to detect with the available technologies.

While the exposure and acquisition of the virus is necessary, the development of cervical cancer requires other factors. For instance, women who are transplant patients, who are on corticosteroid medications long-term or who have HIV are at increased risk because their immunity is suppressed.

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