Cervical cancer is most common in women between the ages of 21-50.
However, it is estimated that 12,900 new cases of cervical cancer were diagnosed in the US last year, and 4,100 deaths occurred as a result of the disease, suggesting that there is still more that can be done to combat the cancer.
In line with Cervical Health Awareness Month, we highlight the signs and symptoms women need to look out for when it comes to cervical cancer, the importance of screening and what more can be done to increase awareness of the disease.
Cervical cancer forms in the tissues of the cervix - the organ that connects the uterus and the vagina.
There are two forms of cervical cancer. The first is squamous cell cervical cancer. This is cancer on the outer surface of the ectocervix - the area of the cervix that projects into the vagina.
The other form of cervical cancer is called adenocarcinoma of the cervix. This is cancer of the endocervix - the inner area of the cervix.
According to the American Cancer Society, cervical cancer is most common in women under the age of 50, and it rarely occurs in women under the age of 20.
The risks for cervical cancer
There are over 100 types of HPV, and around 40 of these can be sexually transmitted. Of these, approximately 15 are thought to be cancer-causing viruses, with two types - HPV-16 and HPV-18 - being responsible for around 70% of cervical cancer cases globally.
Studies have shown that other risk factors for cervical cancer include a family history of the disease, smoking, a weakened immune system and long-term mental stress.
Research has also shown that taking contraceptive pills can increase a woman's risk of cervical cancer.
Ignoring the signs of cervical cancer
In the past, health professionals have referred to cervical cancer as the "silent killer." Spotting cervical cancer in its early stages can prove difficult, as early forms of the disease do not usually present symptoms.
It is not until the cancer becomes invasive that symptoms occur, such as abnormal bleeding after sexual intercourse, during menopause or between periods, heavy or prolonged periods, unusual discharge and/or pain during sex.
Given the absence or subtleness of early symptoms of the disease, it is a concern that some women may not realize they have it, and some may even ignore the signs or confuse them with symptoms of other conditions.
Debbie Saslow, director of breast and cervical cancer at the American Cancer Society, told Medical News Today:
"Bleeding and pain are symptoms that women sometimes do ignore, but women also identified abnormal bleeding as the most likely symptom to be associated with cancer.
There are also a range of reasons that people ignore symptoms - one major explanation is denial. Other reasons can be related to culture. For example, some cultures are very fatalistic and believe that if you have cancer, there is nothing you can do about it so there's no reason to see a doctor."
The importance of cervical cancer screening
The fact that cervical cancer rarely presents any symptoms in its early stages highlights the importance of regular screening for the disease.
There are two main screening methods for cervical cancer. The first is liquid-based cytology (LBC).
This involves the doctor or nurse scraping the cervix with a small brush to collect cells. The head of this brush is then detached and preserved in liquid, before being sent to a laboratory to be analyzed for cell abnormalities.
During a Pap test, cells are collected from a patient's cervix and sent to a lab to be tested for abnormalities, from which cancerous cells (pictured) may be detected.
The second screening method is the Papanicolaou (Pap) test, also referred to as a cervical smear test.
This involves a doctor or nurse scraping the outer opening of the patient's cervix in order to collect a sample of cells. These cells are then analyzed under a microscope for any abnormalities.
In 2014, the Food and Drug Administration (FDA) approved the first HPV test for primary screening of cervical cancer, called the cobas HPV test. This test simultaneously detects 14 HPV types - including HPV-16 and HPV-18 - from DNA.
Women aged between 30-65 years can choose to have the Pap test every 3 years, or the Pap test and an HPV test (carried out the same way as a Pap test) every 5 years.
Due to increased usage of the Pap test, the American Cancer Society state that between 1955-1992, the death rate as a result of cervical cancer reduced by almost 70% - meaning the screening may have saved hundreds of thousands of lives.
Saslow explained that in most areas of the US, cervical cancer screening rates are very high - at over 80%. But she notes that in some places, screening rates are very low, and so there should be focus on increasing awareness in these areas.
She told MNT:
"Awareness efforts should include education about what the Pap test and HPV test is. While many women get screened regularly, a good many of these women do not know what the test is for.
Women often do not know the difference between a pelvic exam and a Pap test, and often think that Pap tests look for sexually transmitted diseases and/or ovarian cancer. Awareness about HPV tests is much lower than for Pap tests, since the latter have been in use for many more decades."
On the next page, we discuss the negative implications of cervical cancer screening and the possibility of new screening tests for the disease.