Cervical Cancer

See also: Cancer, Cervical Screening, Human papilloma Virus (HPV)

• Update on Gardasil - WHU Nov 2007
• Cervical Cancer vaccine doesn't rule out the need for screening- WHU May 2007
• NZ Govt Health Strategies - Cancer Control
• Abnormal smear results and anxiety - WHW June 2006
• Cervical Cancer Vaccine on Horizon - WHU May 2006
• Cervical Cancer Audit report findings - WHU Jan 2005
• Will vaccination end cervical screening? - WHU Jan 2003
• The cervical cancer vaccine study results - WHU Jan 2003
• More evidence links smoking to cervical cancer- WHW Sept 1999
• Mild dysplasia likely to regress - WHW April 1999
• Chemo helps women with advanced cervical cancer - WHW April 1999
• Cervical cancer- From 'Feeling Fabulous' S.Coney (1996)

Update on Gardasil

November 2007  Women's Health Update

Gardasil has been approved for use in New Zealand but in May this year former Minister of Health Pete Hodgson announced that Gardasil would not get government funding for inclusion in the childhood vaccination schedule, but the decision would be reviewed in a year or two. Prime Minister Helen Clark, at the Labour Party conference in Auckland at the beginning of November, said she was seeking urgent advice on the vaccine after the British government decided to go ahead with it in October. Lynda Williams looks at what is happening with the vaccine.  Read More (pdf)

Cervical Cancer vaccine doesn't rule out the need for screening

May 2007 Women's Health Update

The new cervical cancer vaccine has taken the world by storm. Jesse Solomon looks at cervical cancer in New Zealand and the implications of the vaccine for New Zealand women. Cervical Screening has had a dramatic impact on the incidence of cervical cancer and cervical cancer mortality in developed countries including New Zealand. The New Zealand screening programme started in 1991 and now achieves around 75% coverage of eligible women. However, this is significantly lower amongst some groups including Maori women at 55%...

Cervical Screening is availible to all women in New Zealand and women can be screened by their GP, Family Planning or sexual health clinic. Cervical Cancer Screening is the single most effective intervention against cervical cancer...

A vaccine for some types of HPV has been approved for use in New Zealand...Concerns have been raised about some safety aspects of the vaccine, including the aluminium content and its long term neurological effects. The FDA in the United States have required Merck (the makers of Guardasil) to undertake further trials for safty amongst younger girls as the studies so far have not included many girls... Read More

Abnormal smear results and anxiety

June 2006 Women's Health Watch

This study examined the psychological effects of low-grade abnormal cervical smear results. Most studies of anxiety of cervical smear results have included women with high grade abnormalities but the UK study of 3500 participants with low grade abnormalities found that these women experienced increased risk of anxiety as well. This was particularly true if they were young, had children, were current smokers or had the highest levels of physical activity. The study points to potential interventions to decrease women's anxiety such as directly addressing their fears about cancer, treatment and fertility.
British Journal of Cancer 2006 94:1253-62.

Cervical Cancer Vaccine on the Horizon

May 2006 Women's Health Update

An HPV vaccine is on the horizon, potentially reducing the risk of cervical cancer. Two vaccines are battling to get to market; both GSK and Merck (marketed by CSL in New Zealand) have HPV vaccines ready for approval from drug regulators throughout the world. An HPV vaccine would be a welcome advance. However WHA remains cautious as clinical trials have been short and we have yet to see the long term impacts of the new vaccines....Read More (pdf)

Cervical Cancer audit report

January 2005 Women's Health Update

Will vaccination end cervical screening?

January 2003 Women's Health Update

Sandra Coney reports on recent advances in the development of a vaccine against cervical cancer and the New Zealand connection in ongoing research.

For over two decades it has been known that five particular strains of human papilloma virus (HPV) are closely associated with cervical cancer. HPV-16 is one of the main culprits - this strain is present in half of all cases of cervical cancer. About 20 percent of adults are infected with HPV-16.
The recent breakthrough was announced by US researchers, led by Dr Laura Koutsky of the University of Washington in Seattle. They reported in the New England Journal of Medicine that vaccination reduced the incidence of both HPV-16 infection and HPV-16 related cervical intraepithelial neoplasia (CIN). They predicted that 'immunising HPV-16 negative women may eventually reduce the incidence of cervical cancer.'... Read More

The cervical cancer vaccine study results

January 2003 Women's Health Update

The double-blind study randomly assigned 2,392 women between 16 and 23 years old to receive three doses of placebo or an HPV-16 virus-like particle vaccine, and followed them for approximately 17 months. The primary end-point was persistent HPV-16 infection, defined as the detection of HPV-16 in samples at two or more visits. In the vaccine group, 99.7% developed anti-bodies to the virus. In the placebo group, the incidence of persistent HPV-16 infection was 3.8 per 100 woman-years compared to 0 in the vaccine group. All nine cases of HPV-16 related CIN occurred among placebo recipients.
Reference: NEJM 2002; 347:1645-51

More evidence links smoking to cervical cancer

September 1999 Women's Health Watch

New research shows smokers with mildly abnormal smear tests may be able to reverse these cervical changes by quitting smoking. The Imperial Cancer Research Fund study followed 82 women with an abnormal looking area on their cervix and who had agreed to quit smoking for six months. After six months more than 80% of the quitters and the women who had substantially reduced their tobacco intake showed a reduction in the size of the abnormal looking area compared with less than 20% of those who continued to smoke. Previous studies have suggested smoking may weaken the immune response in the cervix and Imperial Cancer researchers suggest quitting smoking may allow the immune system to recover.
Ref: http://www.icnet.uk/research/smokcerv.htm

Mild dysplasia likely to regress

April 1999 Women's Health Watch

A cohort study of Canadian women - 7880 with mild cervical dysplasia and 4123 with moderate dysplasia diagnosed from 1962--1980 - showed that most cases of mild dysplasia were likely to regress. Among the women with mild dysplasia, only 1% progressed to severe dysplasia or worse.

The risk of progression for moderate dysplasia was 16% within two years and 25% within five years.

This reinforces recent recommendations that for women with mild dysplasia, 'watchful waiting' might be an option.This study was a retrospective record review and did not involve prospectively following women.
Ref: J Natl Cancer Inst 1999; 91: 252-58

Chemo helps women with advanced cervical cancer

April 1999 Women's Health Watch

Results from five new trials have concluded that greater use of chemotherapy in treating women with advanced cervical cancer will improve survival rates by up to 50%.

The patient populations in the studies included women with FIGO stages IB2-IVA cervical cancer treated with primary radiotherapy and women with FIGO 1-llA Disease found to have poor prognostic factors (metastatic disease in pelvic lymph nodes, parametrial disease, or positive surgical margins) at time of primary surgery.

The studies are due to be published in the New England Journal of Medicine but have been released early because the National Cancer Institute in America wants to bring the results to doctors' attention. The trials were conducted by the NCI sponsored Clinical Trials Co-operative Groups.

The Institute says although the trials vary in terms of stage of disease, dose of radiation and schedule of cisplatin and radiation, they all demonstrate significant survival benefit for this combined approach. The risk of death from cervical cancer was decreased by 30-50% by concurrent chemoradiation.

'Based on these results, strong consideration should be given to the incorporation of concurrent cisplatin-based chemotherapy with radiation therapy in women who require radiation therapy for treatment of cervical cancer.'

Women with locally advanced cervical cancer (FIGO stage llB-IVA) are generally treated with radiation therapy.
Ref: Clinical announcement National Cancer Institute. Full report is from www.nejm.org

Cervical cancer

from Feeling Fabulous at 40, 50 and Beyond; S.Coney (1996)

Read a brief overview of cervical cancer here