Cervical Cancer 2015
The Israel Cancer Association (ICA) joined the Cervical Cancer Action - a global coalition to stop cervical cancer. As part of this initiative, the ICA was invited to participate in an international webinar that took place on 20 January 2015, along with a large number of representatives from all over the world. WHO's global guidance on cervical cancer control was provided at this event.
Compared to the OECD Average:
The incidence rate (new cases diagnosed each year) for invasive cervical cancer in Israel is one of the lowest in the world: The average incidence rate in Israel is 5.0 per 100,000, lower than that of the U.S. and most European countries. The average incidence rate in Europe is 13.4 per 100,000.
In Israel, the five-year relative survival rate among women diagnosed with invasive cervical cancer spanning the years 2006-11 is high: 71.5% as compared to the OECD average of 66%.
In Israel, the age-standardized mortality rate of cervical cancer in 2011 was about 38% lower than the OECD average: 1.43 per 100,000 Jewish women, as opposed to the OECD average of 4.9 per 100,000, 2.4 per 100,000 in Britain, and 2.3 per 100,000 in the U.S.
Invasive and In Situ Cervical Cancer Incidence
Cervical cancer is not a prevalent cancer in Israel, and the disease incidence rates are among the lowest in Western countries.
Dr. Lital Keinan-Boker, Deputy Director of the Israel Center for Disease Control (ICDC), of the Ministry of Health, reports that in 2011:
244 women in Israel were diagnosed with invasive cervical cancer: 195 Jewish women (80%), 21 Arab women (9%), 28 "others" (11%).
The age-standardized incidence rates for the disease in Israel are 5.42 per 100,000 Jewish women, and 3.25 per 100,000 Arab women.
These incidence rates did not change significantly compared with the rates observed in 1990 among Jewish women (5.66) and Arab women (2.99).
The average incidence rate in Israel, 5.0 per 100,000 women, is lower than the average incidence in the U.S. and that of most European countries. The average morbidity rate in Europe is 13.4 per 100,000.
In Germany, the incidence rate is 9.8, in Australia 9.0, in the U.S. 7.9, in Greece 6.2, in Cyprus 5.2 and in Finland 4.9.
Invasive cervical cancer is prevalent mainly among Jewish women between the ages of 40-44 and 60-64, and among Arab women between the ages of 35-39 and 50-54.
826 women were diagnosed with in situ cervical cancer: 682 Jewish women (83%), 32 Arab women (4%), and 112 "others" (13%).
In situ cervical cancer is prevalent mainly among Jewish women aged 30-39 years, and among Arab women aged 30-49 years.
Early Detection of Cervical Cancer (in situ)
Over 70% of Jewish women with cervical adenocarcinoma in situ are diagnosed at ages 30-39; among Arab women, an in situ tumor is for the most part diagnosed at ages 30-49.
The Ministry of Health Committee for National Guidelines on Cervical Cancer established that in Israel there is no justification for an initiated National Population-Based Screening Program for the detection of cervical cancer. This subject has been discussed in recent years within the framework of 2 National Councils and various expert committees, which arrived at the same conclusion.
Recommendation: Women will undertake a preventive screening (pap smear) once every three years between the ages of 25-65. The health basket currently covers a pap smear once every three years between the ages of 35-54 (although the new WHO guidelines recommend undergoing the screening from the age of 30).
In Israel, about 45% of women aged 21 and over report having undergone a pap smear over the past three years. The OECD statistics among women between the ages of 20-69 indicate an average compliance of 60%.
Among women aged 45-54 years in Israel, the percentage of women who report having undergone a pap smear was the highest, 60.3%, and the lowest percentage was among women aged 65 and over, 21.3%.
Cervical Cancer Survival
The relative five-year survival rate in women diagnosed with invasive cervical cancer spanning the years 2006-11 was 71% among Israeli women, compared to the OECD average of 66%. Israel ranks high among OECD countries (3rd highest, after Korea and Norway).
Cervical Cancer Mortality
In 2011, 79 women in Israel succumbed to cervical cancer: 64 Jewish women (81%), 6 Arab women (8%), and 9 "others" (11%).
The age-standardized mortality rates per 100,000: Jewish women - 1.43, Arab women - 1.00. The mortality rates in Israel are lower than global cervical cancer mortality rates.
In Europe, the average mortality rate is 4.9 per 100,000.
Global rates: In Mexico 12.0, in Chile 10.5, in Russia 7.8, in the UK 2.4, in the U.S. 2.3, in Spain 2.7, in Holland 2.1, in France 2.1 and in Australia 2.0.
International Comparison of Mortality
In Israel, the age-standardized mortality rate of cervical cancer in 2011 was about 38% lower than the OECD average:
Please click here for additional statistics in the attached report.
The ICA has recently published a new booklet called 'Prevention and Early Detection of Cervical Cancer'.
Please click here to read the booklet 'Prevention and Early Detection of Cervical Cancer'.
This booklet is available free of charge through ICA's Telemeida teleinformation service.
Contact Telemeida toll free at: 1-800-599-995.
The ICA joined the Cervical Cancer Action Coalition which operates under the auspices of the UICC, Cancer Research UK and other global organizations. As part of this initiative, the ICA was invited to participate in an international webinar held on 20 January 2015. WHO's global guidance on cervical cancer control was provided at this event. The following updates were issued:
Prevention
Cervical cancer is a preventable disease; however, worldwide, mainly in developing countries, it is one of the leading causes of death among women.
Health education messages about cervical cancer should reflect the national health policy, and should be age- and culturally appropriate vis-à-vis the specific population.
The aim of any comprehensive cervical cancer prevention and control program is to reduce the burden of cervical cancer by (1) Reducing infections caused by the Human Papilloma Virus (HPV), (2) Detecting and treating pre-cancerous changes in the cervix, (3) Providing immediate and supportive treatment for women diagnosed with cervical cancer.
Vaccinating young girls against HPV before they are sexually active constitutes a significant primary preventive measure.
The WHO recommends HPV vaccination programs for young girls aged 9-13, as in most countries, girls of this age are not yet sexually active.
The vaccination is not effective in treating an infection (HPV) derived from the papillomavirus. It is effective in preventing infection with the virus; consequently, the vaccination is recommended prior to engaging in sexual activity.
Various global studies have been conducted with the aim of investigating the effectiveness of the vaccinations and the duration of the protective effect of the vaccines.
The results of these studies indicate that the quantity of antibodies produced after HPV vaccination is greater among girls below the age of 15, than among girls and women aged 15 years and older.
Followup studies are conducted with the aim of establishing the exact duration of full immunization, and they are still underway. Nevertheless, the encouraging statistic is that no decrease in the protective effect was observed 10 years after the date of the vaccine - which is the current surveillance period for women who received the vaccine. Based on these results, there are no recommendations to provide an additional vaccine dose (booster).
Early Detection
As the vaccine does not protect against all types of HPV, which may cause cervical cancer, a vaccine against the virus alone is not sufficient, but rather, conducting a pap smear test is necessary to detect cervical cancer at an early stage.
An early detection test for cervical cancer once every three-five years is recommended between the ages of 30-49, ages at which the test may potentially reduce mortality, with the exception of women below the age of 30, who have an abnormal result indicating 2 CIN+ - a pre-malignant lesion.
Cervical cancer usually develops slowly, over a period of 10-20 years, from the initial stage of the pre-cancerous lesion to invasive cancer. Respectively, cervical cancer prior to the age of 30 is rare. Screening tests for young women lead to the detection of many lesions which will never develop into cancer, and to overtreatment; consequently, these tests are ineffective for young women.
Indeed, in Israel, the percentages of pre-cancer lesions are similar to those of the Western world; conversely, most of them do not become invasive cancer. Subsequently, the percentages of new cases per year (incidence) in Israel are among the lowest in global comparisons, and mortality rates are also low compared to countries which have been conducting screening tests for decades, and still have incidence and mortality rates which exceed those of Israel.
The ICA Information Center presents new studies on cervical cancer
Oral contraceptive use as a protective factor against the development of pre-cancer lesions of the cervix
Despite widespread oral contraceptive use among the general population and its protective effect against certain types of cancer, such as endometrial cancer, and ovarian cancer, there is no consensus regarding their impact against the risk of developing cervical cancer. At the same time, there is a common perception that condom use for contraception protects against infection with the Human Papillomavirus (HPV), which is one of the main risk factors for the development of cervical cancer.
Researchers from the School of Public Health of Curtin University, Perth, Australia, examined the relationship between condom and oral contraceptive use and the risk of developing pre-cancerous lesions of the cervix, initiated by HPV infection.
348 women who underwent a personal interview and answered questionnaires participated in the research study. Demographic data were collected with their assistance, as well as information about their lifestyle characteristics.
The women were asked about their contraceptive use and particularly whether they took oral contraceptives, the duration of usage and whether they used condoms as contraception. The women underwent pap smears to detect pre-cancerous lesions at an early stage.
The prevalence of the pre-cancerous lesions among women who participated in the research study, as it emerged in the pap smear, was 15.8%. It emerged that among those with an abnormal pap smear status, the women who consumed oral contraceptives for a 10 year period or longer, had a 12% lower risk of developing pre-cancerous lesions, compared with women who consumed oral contraceptives for a shorter period - three years or less.
The researchers conclude that the protective effect of prolonged contraceptive use apparently derives from their hormonal effect on the DNA of the HPV, and is also a result of their effect on the viscosity of the cervical mucus. In this research study, the use of condom for contraception did not appear to reduce the risk of developing pre-cancerous lesions.
This article was published in the International Journal of Gynecologic Oncology, July 2014 issue
Lifestyle Modification in Cervical Cancer Survivors: An Ongoing Need
Survival from cervical cancer has significantly improved in the last two decades, and as the percentage of women with cervical cancer who transition into the survivorship phase of the cancer continuum has grown as a result, more and more survivors require comprehensive and long-term surveillance. Researchers from Anderson MD and the University of Texas in the U.S., sought to evaluate patterns of obesity and smoking among cohorts of cervical cancer survivors, and the way these factors impact the development of related morbidity during the surveillance period.
The researchers surveyed the medical records of 298 women aged 18-87, who developed invasive cervical cancer, were treated at the medical center between 2000-2003, and had no sign of active disease for at least 3 years, following completion of treatments. Data on smoking habits and body mass indices (BMI) calculated were included in the information collected. (A patient with a BMI between 25 and 30 is classified as overweight, and with a BMI of over 30, is classified as obese).
The researchers compared the BMI of women at diagnosis and 3 years beyond the date of treatment conclusion, and revealed that the weight of 17% of the women changed; 64.7% gained weight and 35.3% lost weight.
The researchers also investigated the percentage of smoking women in the study: 23.5% of the women who were studied smoked actively at diagnosis, and 46% of them continued to smoke during the followup period. The researchers discovered that women who smoked during surveillance care as well, were 9-fold more likely to receive referrals to the pain management service, 4-fold more likely to receive physiotherapy treatments, and 2-fold more likely to receive psychiatric treatment, compared with the women in the cohort who had never smoked.
Past studies have shown that obesity increases the mortality risk of cervical cancer survivors, and smoking is a significant risk factor for the development of cervical cancer. The researchers indicate that in view of the fact that a considerable number of survivors had weight gain during the 3 years immediately following the research, and the fact that smokers required increased treatment of staff in different medical subspecialties, active intervention is recommended to modify smoking habits and encourage weight loss among survivors, both during treatment and thereafter, in order to reduce these risk factors.
This research study was published in the International Journal of Gynecological Cancer March 2014 issue
Lesbians' attitudes and practices of cervical cancer screening: A qualitative study
Cervical cancer is one of the most prevalent cancers in women worldwide. Since the introduction of the Papanicolaou test (Pap smear) for the early detection of cervical cancer, cervical cancer incidence and mortality rates worldwide have decreased substantially. However significant disparities have been identified between the cervical screening rates among various socio-demographic groups, with a particularly low compliance observed among women who defined themselves as lesbian.
Researchers from the University of Western Sydney in Australia investigated the attitudes and behavior that lesbians have towards cervical screening (pap smears), using hour long-face-to-face in-depth interviews and telephone interviews with 9 lesbian women between the ages of 18-69. The women were asked to explain their point of view and their personal encounters with the pap test and their narrative data were recorded and transcribed verbatim. The data collected attested to similar patterns of behavior and thought vis-a-vis this test, and several points emerged:
Knowledge about the disease - most of the respondents recounted that they knew someone who was diagnosed with a certain type of cervical cancer, but this did not always motivate them to undergo tests that enable early detection.
Misconceptions - the social environment of the respondents and health care staff lacked awareness concerning the risk of acquiring sexually transmitted diseases among lesbians, and their need to be tested.
IVF treatments - pap tests are a pre-requisite for undergoing In Vitro Fertilization (IVF) in Australia. Some of the respondents, who were requested to undergo a pap smear, argued that if not for this requirement, they and friends of theirs would not have taken this test.
Promoting cervical screening awareness - due to their participation in the research, the women expressed their willingness to promote awareness and to make information available to women, and to the lesbian population, regarding the importance of undertaking pap tests.
The research findings reinforce the data that emerged in the scientific literature, according to which, most lesbian women do not undertake pap tests at the recommended rate to detect cervical cancer early.
The researchers emphasize the difficulty in raising awareness of the importance of pap tests among lesbians, mainly due to misconceptions regarding the degree of risk of contracting the human papillomavirus (HPV). According to the researchers, it is necessary to formulate specific targeted educational strategies, both for lesbians and health care professionals, in order to enhance compliance with these screening tests among heterosexual and lesbian women.
This research study was published in the BMC Women's Health Journal in the December 2014 issue
Alcohol consumption and persistent infection of high-risk human papillomavirus
A viral infection caused by various strains of the human papillomavirus (HPV) constitutes a significant risk factor in the formation of pre-cancerous and cancerous lesions. The more the immune system encounters difficulty in eradicating it and this viral infection persists, the higher the risk of developing these lesions.
Researchers from Korea sought to investigate this association between synergistic effect (integrated) of various levels of the papillomavirus infection and alcohol consumption on the one hand, and persistent (prolonged) infection which the body encounters difficulty in eradicating. The intensity of the infection is measured using the 'viral load' level, which is the concentration viral particles in units per volume (pg/ml).
406 women, with an average age of 46, participated in the study, 284 of whom were diagnosed with the papillomavirus infection and 122 of whom were diagnosed with precancerous cervical lesions.
The participants completed a questionnaire regarding their lifestyle, including information about their education, and marital status, health status, smoking habits, and alcohol consumption. The researchers monitored the participants for two years using tests for detecting HPV in their bodies, and also measured the 'viral load' level and classified it as 'high' or 'low'.
The research findings indicate that following a one-year surveillance period, the risk of persistent infection was 4-fold greater, and the risk of 2-year persistent infection was 6-fold greater, among women with a high viral load who consumed alcohol, compared with women with a high viral load who did not consume alcohol at all.
In the analysis of alcohol consumption habits, the researchers found that women with a high viral load who consumed alcohol over a prolonged period (5 years and more) were at a 3-fold risk of a one-year infection persistence, and at a 6-fold risk for a 2-year infection persistence, compared with women who consumed alcohol for a shorter period of time. Women with a high viral load who consumed large amounts of alcohol, 15 gm of alcohol per day (=a standard serving and a half of alcohol) or more, were at a 2-fold higher risk of year-long infection persistence, and a 4-fold higher risk of a 2-year infection persistence, compared with women who consumed less alcohol per day.
In short, the researchers indicate that reducing alcohol consumption may potentially constitute a significant component in reducing the risk of developing cervical cancer, among women who were diagnosed with a high concentration ('high viral load') of human papillomavirus strains.
This research study was published in the Plos One Journal August 2014