Cervical Cancer

Disease Background

The cervix is the lower, narrow part of the uterus (womb) that serves as the birth canal. Like all organs of the body, it is made up of different types of cells. The various cancers of the cervix are named for the type of cell in which they originate. About 85 to 90 percent are squamous cell carcinomas. Squamous cells are thin, flat cells that form the surface of the cervix. The remaining 10 to 15 percent are typically adenocarcinomas, which start in the mucous-producing gland cells. If the cancer has features of both types it is called mixed (or adenosquamous) carcinoma.

Each year about 11,150 American women will learn they have invasive cervical cancer, and about 3,670 will die from this disease. Cervical cancer occurs most often in women between age 35 and 55. Non-invasive cervical cancer, where the abnormal cells are limited to the surface of the cervix, is about four times as common as invasive cervical cancer. Cervical cancer is termed invasive when the abnormal cells are found deeper in the cervix or have spread beyond the cervix into other organs or tissues. When found and treated early, cervical cancer often can be cured.

Cervical cancer used to be one of the most common causes of cancer death for American women. But between 1955 and 1992, the number of deaths from cervical cancer declined 74 percent. The main reason for this decline was the introduction and use of the Pap test, which detects abnormal cervical cells, to find cervical cancer early. The rate continues to decrease about 4 percent per year.

Now the five-year survival rate for early invasive cancer of the cervix is 92 percent. The overall five-year survival rate (for all stages combined) is about 72 percent. For non-invasive cervical cancer, the five-year survival rate is nearly 100 percent.

Race plays a role in cervical cancer risk. It is found most often in Hispanic women, who have rates that are twice that found in non-Hispanic women. African American women are 50 percent more likely to develop cervical cancer as non-Hispanic Caucasian women. Other risk factors include smoking, HIV, and Chlamydia infection. Multiple pregnancies, weight and diet also play a role.

An important risk factor for cervical cancer is infection with certain types of human papillomavirus (HPV), the virus family that causes warts. Researchers have found a higher risk of cervical cancer among women who become sexually active at an early age and among those who have had many sexual partners. These behaviors likely increase risk because they contribute to a greater probability of infection by sexually transmitted microorganisms, including HPV. The risk of cervical cancer is also higher among smokers and women with weakened immune systems. Women who do not have regular Pap tests also face increased risk. It is currently believed that, in many cases, cervical cancer develops when two or more risk factors act together.

Our Research

Overview of Hutchinson Center Research

Hutchinson Center researchers were among the first to demonstrate that genetic material from human papillomavirus (HPV) is consistently found in cervical tumors, verifying the link between HPV infection and cancer development.

Additional research highlights include:

• Hutchinson Center research on the human papillomavirus revealed why infection with certain strains of the virus is a major risk factor for cervical cancer and contributed to a development of a vaccine to prevent infection, which could prevent more than 270,000 deaths worldwide each year.

• Hutchinson Center research has found that a strain of human papillomavirus called HPV 18, found in up to 30 percent of women with cervical cancer, appears associated with a mortality rate nearly double that of other HPV-related cervical cancers. Results of the research confirm several previous, smaller studies that suggest HPV 18 may be an excellent molecular tumor marker for predicting the prognosis of women diagnosed with early-stage cervical cancer.

• With collaborators at the University of Washington and Harborview Medical Center, we are developing culturally appropriate informational programs to encourage regular cervical-screening among Vietnamese-American women. Such an intervention could help to reduce incidence of invasive cervical cancer among Vietnamese-Americans, which is five times higher than that of non-Latina whites.

• In 1997, researchers at the Hutchinson Center played a key role in the first major advance for cervical cancer in 40 years. Five studies, including one coordinated by the Center's Southwest Oncology Group (SWOG) Statistical Center, showed that treating women with chemotherapy and radiation compared to radiation alone can reduce cervical cancer recurrence and death by half. The studies prompted the National Cancer Institute to recommend that physicians treat patients with the combination therapy.

Relevant Articles

• Beliefs influence Pap testing among Vietnamese-Americans
  
  
• HPV vaccine linked to work in Galloway lab — Breakthrough research from Denise Galloway and colleagues laid the groundwork for vaccine to prevent human papillomavirus types 16,18
  
  
• Promotoras for cancer prevention — Female cancer survivors turned lay health educators offer personal approach to screening among their own trusted circles of friends
  
  
• Pushing Pap across cultural lines — PHS, Harborview team identifies barriers to cervical-cancer screening among Vietnamese-American women
  
  
• Thwarting virus with immunity — Genetic variants that boost or lower risk may help scientists develop vaccines to treat women with cervical cancer