Women's Health: Focus on Cervical Cancer
Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health
Inside HealthHints....
- Women's Health: Focus on Cervical Cancer
- Cervical Cancer
- Cervical Cancer in Texas
- What is Cervical Cancer?
- What Causes Cervical Cancer?
- Risk Factors
- Early Detection
- Treatment
- Preventing Cervical Cancer
- Women's Health Corner
- Herbal Update
- Extension Resources
- Mobile Mammography
- April Health Observances
- Putting Your Best Shoe Forward
- Walk Across Texas
- Websites with Reliable Information
- References
Women's Health: Focus on Cervical Cancer
From adolescents and puberty through menopause, women cope with unique health issues. Among women aged 25 to 44, cancer, accidents, and heart disease, respectively, are the three most common causes of death. Among older women, heart disease and cancer are the leading causes of death (Kemper, 1997).
This issue of HealthHints takes a look at one of the most common cancers among women, cervical cancer. We will look at its causes, as well as how to detect, treat, and prevent such cancer.
Additionally, this issue of HealthHints will take a brief look at other women's health concerns such as heart disease, and the risk-reducing behavior, exercise, specifically walking.
Cervical Cancer
More than one half million women will die this decade from breast and cervical cancer. This is true despite the fact that essentially all deaths from cervical cancer and about 30% of deaths from breast cancer are preventable (HMA Associates, Inc., 1995).
Approximately 16,000 new cases of cervical cancer are diagnosed annually, and about 4,800 women die from cervical cancer each year (Woolf, 1997) -- that means about 1/3 of the women diagnosed with cervical cancer will die.
In Texas, cervical cancer is the tenth leading cause of cancer deaths among women. Cervical cancer accounts for 2.5% of all cancer-related deaths in Texas females. These deaths are largely preventable if the disease is detected early and appropriate treatment is sought (Texas Cancer Council).
Cervical Cancer in Texas
In 1992, there were 349 deaths from cervical cancer in Texas. Of those deaths, the ethnic breakdown was as follows:
| Ethnicity | Percent | Number | Age-adjusted Rate* |
|---|---|---|---|
| Anglo | 50.4% | 176 | 2.51 |
| Black | 22.9% | 80 | 8.50 |
| Hispanic | 26.6% | 93 | 5.25 |
*Rates per 100,000. Standard population is U.S. 1970 population.
(Texas Cancer Council)
What is Cervical Cancer?
Cervical cancer is cancer of the cervix, the lower part or opening of the uterus (womb).
The upper part or body of the uterus is the hollow, pear-shaped organ where a baby develops. The cervix connects the body of the uterus to the vagina (birth canal). Cancer of the cervix is a cancer beginning in the lining of the cervix. Before cancerous cells are found in the cervix, there is a gradual change where cells that are abnormal begin to appear (i.e., precancerous changes). This change is called dysplasia.
If cervical cancer is detected early, the survival rate is about 90%; but only about half of cervical cancers are found at this localized stage. At later stages of cervical cancer, the survival rate is only about 10% (National Cancer Institute, 1996).
What Causes Cervical Cancer?
According to the National Cancer Institute (NCI), it is now widely accepted that human papilloma virus is the primary cause of cervical cancer (National Cancer Institute, 1996).
Human papilloma viruses (HPV) are a group of over 70 viruses that tend to cause benign (noncancerous) warts, or papillomas. Different types of HPVs cause warts on different parts of the body. Some types cause common warts on the hands and feet, while others tend to form on the lips and tongue. Specific types of HPV infect the male and female genital organs and the anal area. These types of HPV are passed from one person to another through unprotected sexual contact. Warts forming on genital areas are called condyloma acuminatum. Although there are over 70 types of HPV, only 23 infect the uterine cervix.
Low Risk HPV Types
Most genital warts are caused by two HPV types, HPVs, HPV 6 and HPV 11. These types of HPV rarely develop into cancer, and therefore are considered "low risk."
High Risk HPV Types
There are several types of sexually transmitted HPV, however, that have been linked with genital and anal cancers in both women and men, most commonly HPV 16, HPV18, HPV 33, HPV 35, and HPV 45, accounting for more than 80% of invasive cervical cancers. These HPV types are considered "high risk" (American Cancer Society, 1997b; National Institutes of Health, 1996).
Risk Factors
In addition to HPVs, there are other factors that can place a woman at high risk for developing cervical cancer. These risk factors include the following:
- Smoking -- Smoking exposes the body to many cancer-causing chemicals. These chemicals are absorbed by the lungs and carried through the bloodstream throughout the body. Tobacco by-products have been found in cervical mucus among women who smoke. Even women who are regularly exposed to second-hand smoke are at higher risk of cervical cancer than those who are not (American Cancer Society, 1997b; National Cancer Institute, 1996).
- Human immunodeficiency virus (HIV) infection -- HIV is the virus that causes AIDS. Because this virus damages the immune system, it makes a woman more susceptible to HPV infections, which may increase her risk for cervical cancer (American Cancer Society, 1997b).
- Early age at first intercourse and/or multiple sex partners -- Women who protect themselves from HIV/AIDS and other sexually transmitted diseases by using condoms may reduce their risk of cervical cancer. Having multiple sex partners or having one partner who has had multiple sex partners, however, puts a woman at greater cervical cancer risk due to the greater risk of contracting a sexually transmitted disease (American Cancer Society, 1997c; HMA Associates, Inc., 1995; National Cancer Institute, 1996).
- History of sexually transmitted disease -- A history of sexually transmitted diseases such as herpes or HPV places a woman at greater risk of cervical cancer (National Cancer Institute, 1996).
- Previous abnormal Pap smear -- Having an abnormal Pap test may mean that you are at higher risk for cervical cancer. It is essential to have a routine Pelvic exam and Pap test to rule out any abnormal cell growth.
- Diet -- Poor diet may contribute to risk for cervical cancer (American Cancer Society, 1997b). Several studies have found that a diet high in nutrients such as beta-carotene (found in carrots), and possibly vitamins C and E may reduce a woman's risk of developing cervical cancer (National Cancer Institute, 1996).
- Oral contraceptives -- There is no definite evidence that links oral contraceptive (OC) use with cervical cancer; however, some statistical evidence suggests that long-term use of OCs may slightly increase risk for cervical cancer.
- Low socioeconomic status -- Many people with low incomes do not have ready access to adequate health care services, including Pap tests and treatment of precancerous cervical disease. Additionally, these women may be undernourished, which may increase their risk for cervical cancer (American Cancer Society, 1997b).
Eligibility for Medical Coverage
Medicare -- To qualify for Medicare an individual must be a U.S. Citizen and either 65 years or older, disabled for 2 years, or in end stage renal disease. Medicare covers routine Pap smears every 3 years, as well as a routine mammogram annually (some exceptions may exist based on age and risk). For more information call the Medicare hotline at 1-800-638-6833.
Medicaid -- Individuals can fill out an application at their social service office to see if they qualify for Medicaid benefits. Pap smears and mammograms are covered as deemed necessary by an ordering physician.
(HMA Associates, Inc., 1995)
Early Detection
In addition to visible genital warts, in women, HPVs can also cause flat warts on the cervix or vagina that are not visible and cause no symptoms. Flat warts caused by low risk HPV types have little or no effect on cancer risk; however, flat warts caused by high risk HPV types can develop into cervical or vaginal cancers. Most health care providers, however, do not perform tests to determine the HPV type since these warts can usually be treated. Thus it is extremely important to have regular Pap tests to determine whether or not you have HPV, particularly those types that are non-symptomatic and only visible by using a microscope to find abnormal cells in your Pap test specimen (American Cancer Society, 1997b).
Pap Smear
Routine screening for cervical cancer with Papanicolaou testing (i.e., a Pap test or Pap smear) is recommended for all women who are or have been sexually active, and who have a cervix (Woolf, 1997). Pap smears should begin with the onset of sexual activity or at age 18 and should be repeated annually (American Cancer Society, 1997d). A Pap test can detect changes in the cervix that can be treated before they become cancerous (American Cancer Society, 1997a).
A Pap smear is a simple procedure in which your health care provider takes a sample of cells from the cervix during a pelvic exam.
Pelvic Exam
In a pelvic exam, the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum are all examined for abnormalities in size or shape. During the pelvic exam, your health care provider will use a device called a speculum to widen the vagina so that both the vagina and cervix can be examined (National Cancer Institute, 1996).
The best defense against cervical cancer is early detection. The Pap test through pelvic exam is very effective in detecting cervical cancer in its early stages before it has spread to other parts of the body, when it is highly curable (American Cancer Society, 1997a). Women should have a Pap test and pelvic exam annually.
Treatment
There is currently no cure for papilloma virus infection (American Cancer Society, 1997b).
Though there is no cure for HPV, the warts and abnormal cell growth (common to all cancers) caused by these viruses can be effectively treated.
Precancerous Treatment
There are two methods typically used to treat precancerous warts and their abnormal cells:
- cryosurgery -- the use of extreme cold to destroy abnormal cells
- electrocoagulation -- the use of electronically generated heat or laser therapy to destroy abnormal cells.
Cancerous Treatment
Several types of surgery can be used for cervical cancer. Most often, cervical cancers are treated with surgery, radiation, or a combination of the two. Chemotherapy is also sometimes used to treat cervical cancer.
Choosing the Best Treatment
The best type of treatment should be decided by you and your health care provider. Your care provider's recommendations will depend upon the stage of the disease, size of cancerous growth, your age, your overall condition, and your desire to have children (National Cancer Institute, 1996).
Preventing Cervical Cancer
Since most forms of cervical cancer start with preventable and easily detectable precancerous changes, there are two ways to prevent the disease:
- Prevent precancers -- Most precancers can be avoided by avoiding risk factors, for example:
- Delay onset of sexual activity, particularly if you are young.
- Use condoms during sexual activity at any age to avoid infections of HPV and other sexually transmitted diseases.
- Do not smoke, and try to avoid much exposure to second-hand smoke.
- Eat a well-balanced diet.
- Have routine Pap tests -- To detect HPV and precancers, be sure to have your routine Pap test at age 18 or when you become sexually active, whichever comes first. This is the best way to detect and treat cervical cancer and its symptoms early.
Some women believe they do not need a Pap test after they have stopped having children, however, this is not correct. Women should continue to have annual Pap tests even after child bearing. Additionally, these guidelines apply to women who have had a hysterectomy and to women who are past menopause. Older women, and women who do not have access to regular medical care are especially vulnerable if they do not have regular Pap tests and pelvic exams (American Cancer Society, 1997a).
Note: If a woman has 3 negative annual Pap tests in a row, her Pap test may be done less often at the judgment of her health care provider (American Cancer Society, 1997b).
Women's Health Corner
Women and Heart Disease: Are You at Risk?
Although Coronary Artery Disease (CAD), the condition that typically prefaces heart disease, was once thought to be a disease common only among men, this is no longer the case. Researchers have now involved women and looked at numerous female cases. Some of the factors that may put a woman at higher risk for CAD include:
- Arterial blockage that impedes circulation to the legs.
- Diabetes Mellitus -- This condition is more strongly related to heart disease in women than men.
- Estrogen depletion -- If you are postmenopausal and do not take estrogen, your risk for CAD is the same as for a man who is 10 years younger.
- Unfavorable lipid profile -- A total cholesterol level greater than 265, and fasting triglyceride level greater than 400.
- Smoking -- Smoking is also more strongly related to heart disease in women than men.
- High blood pressure -- High blood pressure puts stress on the arteries.
- Obesity -- Being overweight, especially if you carry extra weight in the central portion of the body, puts you at high risk for heart attack.
- Inactivity -- The heart is a muscle and needs to be used just like any other muscle in the body. Try to get at least 30 minutes of activity in each day (Merz, 1997).
Herbal Update
Many premenopausal and menopausal women are looking for "natural" alternatives to estrogen replacement. One of the herbs many have requested information about is dong quai.
Dong Quai
This is a root from a Chinese plant. As with other herbal treatments, no scientific research supports it as being effective for anything. However, producers say that it is an antispasmodic, vasodilator, and energy booster. Some chemical analysis does show that there are small amounts of substances in dong quai roots that could produce some of these results if people took them in sufficient amounts. However, no producer can say how much of any of these substances are actually present in their preparations.
Years ago, dong quai was given to women to help with menstrual cramps. Today, it is being promoted as a natural relief for menopausal symptoms such as hot flashes. If dong quai is a vasodilator, causing blood vessels to dilate, this is not something that women having hot flashes would want to take. Hot flashes are thought to be caused by vasodilation. Additionally, taking large amounts of dong quai can produce skin reactions in some people.
The only really effective relief for menopausal symptoms is taking estrogen prescribed by a health professional. Women should consult with their physician regarding whether they should take estrogen based on their family history and health status.
Women should not take dong quai and believe that it will stimulate their body to produce estrogen. Taking dong quai will not reduce women's risk of heart disease or osteoporosis, and they will not know this until approximately 10 years of having the low estrogen levels that occur because of menopause. (Source: The Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies by Varro E. Tyler, Ph.D. 3rd edition. 1993. NY: Pharmaceutical Products Press. ISBN 1-56024-287-6.)
Some General Comments Regarding Herbal Self-treatment
Herbal remedies have not been studied scientifically. They are only supported with people's personal stories, for the most part. Herbal treatments were used throughout history because people had nothing better. If you consider that the life span was around 44 years at the turn of the century when herbal treatments were at their peak, it is highly unlikely that any of these treatments were wonder drugs. Studies have shown that the increased life spans we have today are due, firstly, to better nutrition and shelter, and secondly, to antibiotics, immunizations, and better medical care. Finally, people should never think that because something comes from a plant, it must be safe -- digitalis comes from a plant and if you take too much of it you will die because it may cause your heart to stop. Some herbal treatments can interact with prescribed medications. Any herbal treatments should be discussed with your health care provider and/or pharmacist.
Extension Resources
The following resources will be provided at the FCS Institute in August. If agents need the resources before that time, call Teresa Smith at 979-845-3850.
Each county will receive a video entitled Woman Talk: A Story Promoting Cervical Health (18 minutes).
Each district will receive a Cervix Display that has six models of the cervix. The 11" x 8.5" display shows the lower end of the uterus with progressive changes in the cervix from its normal condition to that of invasive cancer.
Mobile Mammography
The Texas Tech Health Sciences Center Mobile Mammography Unit services 36 counties. Counties served include: Andrews, Borden, Brewster, Coke, Concho, Crane, Crockett, Culberson, Dawson, Ector, El Paso, Gaines, Glasscock, Howard, Hudspeth, Irion, Jeff Davis, Kimble, Loving, Martin, Mason, McCullouch, Menard, Midland, Pecos, Presidio, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler.
To schedule the unit contact Pam Johnson 800-222-8388 or 806-743-1082. Pam is anxious to hear from the County Extension Agents.
April Health Observances
Cancer Control Month
Contact: American Cancer Society, local affiliate or (800) ACS-2345
Materials: flyers, fundraising brochures, coping information
National Child Abuse Prevention Month
Contact: Public Awareness Department, National Committee to Prevent Child Abuse (312) 663-3520
Materials: Information packet
National STD Awareness Month
Contact: Public Relations Office, American Social Health Association (919) 361-8400
Materials: Brochures on sexually transmitted diseases and sexual health communication
Alcohol-Free Weekend
April 3-5
Contact: National Council on Alcoholism and Drug Dependence (212) 206-6770
Materials: Public information packet
World Health Day
April 7
Contact: Christina Verni, American Association for World Health (202) 466-5883
Materials: Resource booklet, posters
National Infant Immunization Week
April 19-25
Contact: Community Outreach and Planning Branch, Centers for Disease Control and Prevention, National Immunization Program (800) 232-5222
National Minority Cancer Awareness Week
April 19-25
Contact: Outreach Coordinator, Cancer Information Service, NCI Office of Cancer Communications (800) 4-CANCER
Materials: A variety of free materials targeting special populations
1998 WalkAmerica
April 25-26
Contact: Tony C. Chappa, March of Dimes Birth Defects Foundation (914) 997-4573
Materials: Brochures, posters
Putting Your Best Shoe Forward
Exercise is one way to reduce your risk for heart disease and maintain good health. Aerobic exercise, such as walking, helps to strengthen your heart and lungs, maintain or reduce your weight, lower blood pressure, and increase "good" (HDL) cholesterol (Kemper, 1997).
Walking, one of the best physical activities, is simple, generally safe, easy to do, and requires no special equipment except walking shoes. Good walking shoes are needed to help prevent injuries. Walking shoes are designed to provide rigidity, durability, flexibility, proper fit, adequate cushioning, and comfort. The most important consideration should be a good fit when buying walking shoes. They should be comfortable from the moment they are put on.
Consider the following points when choosing walking shoes:
- Support. The construction of the back and the heel of the shoe should provide stability and control of foot movement and protect the Achilles tendon from injury.
- Cushioning. Good cushioning in the heel and midsole is important. Walking shoes should be flexible; however, they should be slightly more rigid than a running shoe to permit rolling off the toes and joints rather than bending through them (Wichmann, 1993).
- Performance. Walking shoes that are lightweight and durable are preferred. Consider traction for the surface you will be walking on. The shoe should be made of material that will breathe, such as nylon mesh. This type of material will allow the sweat to evaporate.
- Fit. Shoes that fit correctly will make walking more fun. Tips to help ensure a good fit when trying shoes are easy to follow.
- Shop late in the day when your feet are the biggest.
- Wear the same type of socks you will normally wear when walking.
- The toe box of the shoe should be large enough for you to wiggle your toes and about a thumbnail longer than your longest toe.
- Feel inside for seams and ridges.
- The shoes should bend easily at their widest part.
- Walk briskly around the store to check for comfort and cushioning.
- Make sure the shoes feel good on your feet!
Walk Across Texas
The residents of the 22 counties in District 5 are putting their best walking foot forward by participating in the Walk Across Texas fun and fitness program developed by the Texas AgriLife Extension Service and Texas A&M School of Rural Public Health’s Health Education and Rural Outreach (HERO) program.
Walk Across Texas is an eight week program promoting walking, jogging, and biking activities. Teams of eight walkers or joggers as well as teams of four bikers have a friendly competition to see who will get from each east Texas town to El Paso first.
Registered team members keep a daily log of how far they walk each week and turn the miles in to a team captain. The team captain then reports the number of miles walked by their team to the Extension agent in each county. Each team's progress is charted on maps at various public locations such as malls and courthouses.
Week three progress reports indicate that the total number of teams participating in Walk Across Texas is 647. This is a total of 5,841 persons Walking Across Texas.
All of the District 5 counties are filled with enthusiasm. Harrison County has the largest number of participants with over 85 teams and approximately 776 people walking. Shelby County started their walk at the Louisiana state line. Walkers walked their first mile by crossing the Logansport bridge which serves as an entrance to Texas.
The Alabama-Coushatta Indian Reservation in Polk County has three adult teams, Family Walkers, A-C (Alabama-Cushatta) Gang, and I.H.S. (Indian Health Service) Pacers. The Family Walkers organized a bike team of five year olds and primary youth called The Little Cruisers who ride along as their parents walk.
Upshur County has a walkers support group that meets every other Monday. Teams come together and walk as one group rain or shine.
Health education classes are also part of Walk Across Texas. At the end of three weeks, 87 classes had been held with approximately 1,152 people attending. Some counties use the "Health Break" handouts as newsletters by mailing them to registered participants. Over 1000 "newsletters" have been sent.
So much is being done by every county. The work the county agents are doing is greatly appreciated. They, along with HERO Specialist Luwana Rider, have made the 1998 Walk Across Texas not just a tremendous success, but a health success as well. For more information on the Walk Across Texas Program contact Carol Rice or Janet Pollard at the State Extension Office (979) 845-3850.
Websites with Reliable Information
- What You Need to Know About Cancer of the Cervix (National Cancer Institute)
[http://www.cancer.gov/cancer_information/doc_wyntk.aspx?viewid=1529727f-
0309-4f59-aa5f-a17a761f10d9] - What is Cervical Cancer? (American Cancer Society)
[http://www.cancer.org/docroot/cri/content/cri_2_4_1x_
what_is_cervical_cancer_8.asp] - Cancer Statistics (American Cancer Society)
[http://www.cancer.org/docroot/stt/stt_0.asp] - Human Papillomavirus (National Cancer Institute)
[http://cis.nci.nih.gov/fact/3_20.htm]
References
- American Cancer Society (1997a). Cancer Facts for Women [brochure] No. 2007.
- American Cancer Society (1997b). Cervical Cancer. Revised 8/21/97.
- American Cancer Society (1997c). Pap Smear -- What is it? [brochure] No. D402.
- American Cancer Society (1997d). Your Life Your Choice [brochure] No. 2079.
- HMA Associates, Inc. (1995). How to Plan Your Communications Strategy for Breast & Cervical Cancer. Washington, DC.
- Kemper, D.W. (1997). Healthwise Handbook. Boise, Idaho:229-230.
- Merz, B., ed. (1997) Harvard Women's Health Watch. 4: 2-3.
- National Cancer Institute (1996). Cancer Facts: Cervical Cancer [fact sheet].
- National Institutes of Health (1996). National Institutes of Health Concensus Development Statement: Cervical Cancer [on-line]. Available: http://text.nim.nih.gov/upload...s/Cervical/cervical.html#Question1
- Texas Cancer Council. Breast and Cervical Cancer in Texas: A Guide to Resources and Data.
- Tyler, V.E. (1993). The Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 3rd edition. NY: Pharmaceutical Products Press.
- Wichmann, M. (1993). Athletic Shoes: Finding the Right Fit The physician and Sports Medicine 21:204-211.
- Woolf, S.H. (1997) Screening for cervical cancer [on-line]. Available: http://text.nlm.nih.gov/cps/www/cps.15.html
