Early Detection
Cervical Cancer

Cervical Cancer

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Early Detection of Cervical Cancer

The Israel Cancer Association announced the Cervical Cancer Awareness Week on January 19, 2020. Ahead of this week, the ICA along with the Ministry of Health published the most updated statistics as on cervical cancer in Israel as of January 2020. Due to the complexity of data collection, the most updated obtainable information at the National Cancer Registry refers to 2016 data. According to statistics, 232 Israeli women were diagnosed with invasive cervical cancer in 2016, of which 187 are Jewish women comprising 81% of the total patients; 22 Arab women comprising 9% of the patients and 23 "other" women comprising 10% of the total patients for that year. 



  • ICA Vice Chair and former Director General Miri Ziv: "The most effective means against cervical cancer today are early detection and prevention. The HPV (Human Papilloma Virus) vaccine included in the healthcare basket can also reduce morbidity.  Avoiding smoking can also reduce the risk and a routine PAP smear test of the cervix can diagnose changes and enable early detection and timely treatment of that may prevent the development of a cancerous growth. I call upon women - take responsibility for your health, get checked according to the directives, vaccinate your children and insist on inquiring about any change and checking any symptom you may be having."

  • Prof. Lital Keinan-Boker, Director of the Israel Center for Disease Control (ICDC) of the Ministry of Health, explained: "Cervical cancer is the fourth most common cancer in women in the world, after breast, colorectal cancer and lung cancer, with over half a million new cases worldwide each year. In Israel, cervical cancer is not prevalent, and the incidence rate (number of new cases) are among the lowest in the Western world. The main risk factors are certain types of HPV, smoking and contracting the AIDS virus. The natural course of the disease includes damage to the cervical tissue and a progression from a precancerous cervical lesion to cervical adenocarcinoma in situ or invasive cervical cancer. A considerable amount of lesions disappear on their own and do not develop into invasive cancer."

 

The Most Updated Statistics as of January 2020

 

  • In 2016, 232 women in Israel were diagnosed with invasive cervical cancer: 187 Jewish women (81%), 22 Arab women (9%), and 23 "other" women (10%). In 2016, the average diagnosis age for invasive cervical cancer was 54 in Jewish women, and 50 in Arab and "other" women.

 

  • In 2016, 82 women in Israel died of invasive cervical cancer: 60 Jewish women (73%), 12 Arab women (15%), and 10 "other" women (12%). The average age during death from cervical cancer in 2016 was 66 in Jewish women, 56 in Arab women and 53 in "other" women. 

 

  • According to the recently published World Health Organization (WHO) data (Globocan 2018), the incidence rate of invasive cervical cancer in 2018 in Israel was one of the lowest among the OECD countries: Israel is ranked 33 out of 36 countries in a descending order of incidence rates (number of new case). 

 

  • According to the World Health Organization (WHO), the invasive cervical cancer mortality rate in Israel in 2018 was lower than half of the OECD countries, and higher than the rate in the other remaining half: Israel is ranked 19 out of 36 countries in a descending order of mortality rates.

 

  • The relative survival rate is stable among Jewish women. The relative five-year survival rate is higher in Israel compared to the average in the OECD countries.

  • The cervical cancer mortality rate in 2016 is similar among Jewish and Arab women. Both population groups display low rates.
      
  • In both Arab and Jewish women, invasive cervical cancer mortality rates have been stable and low in the past 25 years.


Early Detection and Prevention Methods

 

PAP Smear Test

  • The 2019 updated national Healthcare basket includes a PAP Smear a free screening test for all women between the ages of 30 to 54 once every 3 years, based on a recommendation to expand the early detection screening from the age of 30. The test is performed at any age if a woman has a medical indication. 

  • The healthcare basket expansions as well as supplementary insurance enable a woman of any age to take the screening test for a small deductible amount.


  • The compliance rate of screening tests for early detection of cervical cancer in the past three years among women ages 35-54 in Israel has stood on 51.5% in 2018, according to the National Program for Quality Indicators in Community Healthcare (QICH) published recently. In 2018, the compliance rate among women of high socioeconomic background (63.0%) was twice as high as the reported compliance rate among women of low socioeconomic background (32.8%). 



Human Papilloma Virus (HPV) Vaccine to Reduce the Risk of Cervical Cancer


  • Cervical cancer is a preventable disease. The World Health Organization (WHO) regards the Human Papilloma Virus (HPV) vaccine as the most important primary prevention method and recommends vaccinating young girls between the ages of 9 and 13 against the HPV virus before they become sexually active. 

  • The Human Papilloma Virus (HPV) has over 150 different strains. Two of those strains (6, 11) cause genital warts in 90% of the cases. Other strains of HPV may cause cancer. The most common ones are strains 16 and 18. HPV is highly common in the population: About 80% of all men and women will contract at least one strain of the virus during their life, mostly during sexual intercourse, including oral sex. A condom does not completely prevent contagion, and multiple sexual partners may increase the chances of contagion, though it may occur with an exclusive partner as well.

  • In most cases, the virus goes away, but in other cases, it remains and may ultimately develop into a pre-cancerous or cancerous growth among men and women alike. Among women, the virus may cause genital warts, cervical cancer, vaginal cancer, rectal cancer and oral cancer. Among men, the virus may cause genital warts, penile cancer, rectal cancer and oral cancer.

  • To reduce the risk of cervical cancer, the relevant populations must get vaccinated against HPV. There are two registered vaccines marketed in Israel. 

  • Girls and boys in 8th grade are given the vaccines as part of the vaccination routine administered at schools free of charge.

  • Teenage boys and girls ages 14-18, who have not been vaccinated for whatever reason, may complete the vaccine at school free of charge (in 9th grade) or through the Ministry of Health's branches (from 10th grade and on) as part of the healthcare basket.

  • The vaccine is also available free of charge for men until the age of 26, who are at high risk of contracting the virus, such as men who are sexually active with other men.

  • The healthcare basket expansions as well as supplementary insurance enable anyone to purchase the vaccine regardless of age, according to the Limitations of Use and Effectiveness of each manufacturer, with a deductible based on the healthcare fund's agreement. 

  • The World Health Organization (WHO) determined that the HPV vaccine is safe and effective. However, as with any vaccine, there are a few side effects that may accompany the vaccination. The main ones are: Swelling and redness around the needling area and local pain.

 

Please click here to view the Ministry of Health Director General Circular (in Hebrew).

  • The ICA 'Prevention and Early Detection of Cervical Cancer' booklet has been updated and is available to the public free of charge. To order a copy of the booklet, please contact the ICA Telemeida information hotline service at: 1-800-599-995
  • Email: telemeyda@cancer.org.il.

 

Please click here to read the Prevention and Early Detection of Cervical Cancer booklet on the ICA website (in Hebrew).

The ICA Information Center Presents New Studies on Cervical Cancer

 

An Increased Chance of Eradicating Cervical Cancer in Australia


A study held in Australia aimed to identify the earliest years in which the annual age-standardized incidence of cervical cancer in Australia could decrease significantly by incorporating the Australian National HPV Vaccination Program screening initiative down to a minimal threshhold where cervical cancer could be considered to be eliminated. Australia was the first country in the world to initiate a national publicly-funded HPV vaccination program back in 2007 and a high level of compliance to taking the vaccine was recorded among both sexes. In 2017, organized cervical screening in Australia transitioned from cytology-based screening every 2 years for women aged from 20 to 69 years, to primary HPV testing every 5 years for women aged 25–69 years (and exit testing for women aged 70–74 years.) The researchers used a model that incorporated different data on the Australian population as well as the vaccine program for boys and girls and the cervical cancer screening program to estimate the age-standardized incidence of cervical cancer in Australia through 2100. This, considering that the vaccines were upgraded in 2018 to include nonavalent (nine strands) of HPV (instead of four). According to the model results, the estimate is that the cervical cancer incidence threshold of six new cases per 100 000 women each year will be achieved in 2020, and by 2028, cervical cancer incidence rate will reach a threshold of four
 new cases per 100 000 women in Australia. Further estimates indicate that by 2066, the annual incidence of cervical cancer will decrease and remain at fewer than one case per 100 000 women if screening for HPV every 5 years continues parallel to the nonavalent vaccine. Alternately, incidence rates may be fewer than three cases per 100 000 women if the nonavalent vaccine alone is administered, without adhering to the 5-year HPV screening program. In addition, mortality from cervical cancer is predicted to decrease to one new case per 100 000 women annually by 2034 in Australia.

To sum up, the researchers claim that combining the HPV vaccine with the national screening program allows for a probable chance of eradicating the disease in in Australia in the future.


Passive Smoking Increases the Risk of Cervical Cancer by 70%


An extensive study conducted in China examined the connection between cervical cancer and passive smoking. There are known factors that increase the risk of developing cervical cancer. The most significant factor is the Human Papilloma Virus (HPV), which may cause (in some cases) pre-cancerous changes in the cervix as well as cervical cancer. The virus is transmitted through sexual intercourse, hence, multiple partners increase the risk of contagion. 

Other factors that may increase the risk are use of birth control pills and smoking. This study focused on women who are expose to smoke from passive smoking. The researchers conducted a meta-analysis of 14 eligible studies from different databases of different countries (Korea, Thailand, Japan, India, Spain and the U.S.). which focused on the relation of passive smoking to cervical cancer in all stages of the disease in different databases; the meta-analysis included 384,995 participants in total from all the studies. 

For the sake of statistical processing, the other variables were disabled that increase the risk of developing cervical cancer, such as birth control pills, early-age first pregnancy, contraction of HPV and active smoking. According to findings, there is a positive relation between passive smoking and the risk of developing cervical cancer. 

From the data shown in all the studies, the risk of cervical cancer among women exposed to passive smoking was 70% higher versus women who were not. Researchers add that implementation of the anti-smoking policy may protect people who have never smoked, and may also help increase the number of smokers who quit. 

The article was published in the Medicine Journal, July 2018 issue and presented by ICA in marking Cervical Cancer Awareness Day 2019 



Processed meat and French fries increase the risk of Cervical Cancer

A study in Italy investigated dietary patterns which may be associated with hrHPV status and the risk of high-grade cervical pre-cancerous cells (CIN2+) and developing cervical cancer. Overall, 539 women participated in the study with abnormal PAP test results that required further examination. Among these, 127 women were diagnosed with CIN2+, and of the rest, who were the control group, 252 had normal cervical tissue. All women were tested for high-risk HPV strains (hrHPV). 302 women tested positive and 237 tested negative for the virus. The women filled out a questionnaire in which they reported their socio-demographic characteristics and habits (including dietary habits), as well as their adherence to the Mediterranean diet (MDS), consisting of high consumption of vegetable, legumes, fruits and nuts, cereals, fish and olive oil and low consumption of dairy and meat. The adherence to the MD was defined as low, adherence, medium adherence and high adherence. According to the data, 33% of the women showed low adherence to MD, 60% showed medium adherence to MD and 7% showed high adherence to MD. Women with medium adherence to the MD showed a 40% less risk of hrHPV infection. The researchers believe that there was no significant relation shown between high adherence to the MD and the risk of hrHPV infection, due to the few women who belonged in that group. The researchers identified two additional dietary sub-patterns - "Western" and "prudent". The Western pattern was positively characterized by a high intake of chips, snacks, dipping sauces, plant oils, processed and red meats, with low intake of olive oil. The prudent pattern was positively characterized by a high intake of legumes, vegetable soups, potatoes, cooked, raw vegetables and olive oil. Women with high adherence to the prudent dietary pattern were at 50% less risk of hrHPV infection, versus women who did not adhere to this dietary pattern. Hence, the risk of developing +CIN2 was lower mainly among women who showed medium adherence to the prudent, MD diet, versus low adherence to it.

To sum up, the researchers conclude that the study data emphasizes the preventative role of healthy dietary patterns such as the MD against the risk of developing +CIN2 and cervical cancer, and warn against the damage that may be caused by unhealthy eating habits. 

The article was published in the Nutrients Journal, April 2018 issue and presented by ICA in marking Cervical Cancer Awareness Day 2019 



Does the loss of someone close increase the risk of HPV and cervical cancer?

 

It is known that the loss of someone close may lead to the development of an array of physiological and emotional diseases. Investigators from various medical centers and universities in Sweden sought to explore the link between loss and bereavement, on the one hand, and the risk of contracting the Human Papilloma Virus (HPV) and cervical cancer morbidity, on the other hand. The exposure to HPV is extensive and normally not dangerous; however a small number of HPV genotypes increase the risk of developing cervical cancer.

 

The research study was based for the most part on cervical cancer statistics of the Swedish Cancer Register, spanning the years 1969-20111, which included statistics on an estimated 14 million pap smears (cervical cancer screening), taken from an estimated 2.5 million women.

The investigators divided the research data into three types of findings:

  • 'Abnormal' cell finding – 390,301 pap tests revealed 'improperly functioning' or 'abnormal' cells which are likely to develop into cancerous cells; five pap tests with normal results, of women who share similar characteristics such as age, lifestyle, screening compliance, and other personal attributes, were compared with each screening with an irregular pap smear status. These screenings served as a control group.

  • Cervical adenocarcinoma in situ or invasive cervical cancer – 69,674 tests of women who developed cervical adenocarcinoma in situ were identified, as were 5,454 tests of women who contracted invasive cervical cancer. Five tests with a normal status from screenings of women with similar characteristics such as age, lifestyle and screening compliance, and other personal attributes, were compared to each one of the tests with abnormal results. These screenings served as a control group.

  • Contracting the HPV16 Human Papilloma Virus – out of an additional collection of pap smear samples, which encompassed 4,033 screenings, 203 were detected with HPV16, which is one of the frequent strains, with a high risk of triggering a malignant process in the cervix, whereas the results of 3,830 screenings did not show this virus and were used as a control group. 


After the test findings were mapped, the investigators examined the subjects' data regarding their loss of a family member, and defined bereavement as the natural or unnatural death of a parent, child, spouse, or sibling; after weighting the various lifestyle variables, which may stimulate the emergence of findings such as: smoking, sexual behavior, use of oral contraceptives, and multiple abortions, the investigators arrived at the following conclusions:

  • Loss increases a woman's risk of an irregular finding on a pap test by 4%-9%, as well as her risk of contracting cervical cancer in situ or invasive cervical cancer, while this risk is particularly high among women who have experienced several losses, the loss of a child, spouse or sibling.

  • No link was found between the time interval which passed since the loss, and the interval during which the cervical cancer developed. The investigators explain that this is not surprising, since the mourning processes, akin to the development of cervical cancer, are not immediate events, but rather, continue over time, sometimes, for years.
     
  • The loss of a parent increases the risk of cervical cancer, only among women aged 40 and under.

  • Women who experienced some kind of loss had a 62% higher risk of contracting the HPV16 genotype. The association was stronger among women with a history of contacting HPV16.


The investigators conclude that bereavement may have an impact on the various stages of the development of cervical cancer. This is mainly due to the fact that the emotional stress involved in loss may increase the risk of contracting HPV among women who did not contract HPV in the past, as well as accelerate the progression of the disease from a pre-cancerous state to in situ, and from cervical cancer in situ to invasive cervical cancer.

The article was published in the Cancer Research Journal, December 2015



Is there a link between cervical cancer and exposure to a spouse's smoking?

 

Rising cervical cancer mortality in young Chinese women has been observed; cervical cancer is one of the most common types of cancer in China and developing countries. According to the annual report of China's National Cancer Registry, each year, over 100,000 women are diagnosed with the disease, constituting approximately a third of global cervical cancer cases.

 

One of the factors known and proven to increase the risk of contracting cervical cancer is active smoking (of the woman herself), however, there is no evidence regarding the association between passive smoking, due to exposure to a spouse's smoking, and the risk of contracting the disease.

 

In a first-ever research study, investigators in China sought to explore the link between active smoking, passive smoking, and their combination on the one hand, and the risk of cervical cancer mortality on the other hand.

 

The investigators compared the exposure to smoking of 1,865 Chinese urban women, aged 35 and up, who succumbed to cervical cancer, with that of women who succumbed to cervical cancer for reasons not related to smoking. The data was taken in part from an international survey conducted in China spanning the years 1989-1991, and in part from interviews that the investigators conducted with spouses of women who had died.

 

Based on the findings, it emerges that generally speaking, women who are exposed to smoking have a 51% higher risk of cervical cancer mortality than women who are not exposed to smoking, while the exposure to passive smoking increases the risk by 28%, the exposure to active smoking increase the risk by 49% and the exposure to both active and passive smoking increases the risk of cervical cancer mortality by 69%.

Furthermore, the investigators found that the risk of cervical cancer mortality of active and passive smokers alike increases according to the time interval during which they were exposed to cigarette smoke, and the number of cigarettes per day:

 

  • Women who were exposed to passive and active smoking of a moderate level, had a 67% higher risk of cervical cancer mortality. An 88% increase in the risk of cervical cancer mortality was observed among women who were exposed to heavy smoking compared to women who were not exposed to smoking.
     
  • Active and passive exposure over a span of 15 years or less spurred a 73% increase in risk. And exposure over a span of 15 years or more, spurred a 95% increase in cervical cancer mortality risk, as opposed to women who were not exposed to smoking.

Due to the research findings, the investigators call for the investment of efforts and resources in the prevention of smoking among men and women, to reduce the numerous hazards, one of which is cervical cancer among women.

The article was published in the Cancer Causes & Control Journal, July 2015 issue

The Link between Inflammatory Diseases and Cervical Cancer

 

The Human Papilloma Virus (HPV) is very common and may produce lesions of the cervix, some of which may develop into cancer. Most of the lesions of the cervix have a low risk of developing into cervical cancer, and are transient, however, other lesions, with a high risk of becoming cancer – the CIN2 and CIN3 strains - for the most part are not transient, and increase the woman's risk of developing cervical cancer.

 

In a study conducted in the United States, the investigators sought to estimate the risk of contracting a pre-cancerous lesion – of the CIN2, CIN3 strain – or contracting cervical cancer, among women who had contracted inflammatory diseases such as inflammatory bowel disease, psoriasis, arthritis and lupus. One of the hypotheses was that their weakened cellular response, mainly if they take medications that suppress the immune system due to their disease, may spur repeated contracting of HPV, and in turn, may increase the risk of the emergence of pre-cancerous lesions of the cervix and cervical cancer.

 

The research study was based on a database consisting of an estimated 650,000 women, spanning the years 2001-2012, of whom an estimated 133,000 are patients suffering from one of the aforementioned diseases, and the remaining women served as a control group.

 

The investigators revealed that women who have arthritis and lupus have a 50% higher risk of contracting a pre-cancerous finding with a risk of developing into cervical cancer, as well as a higher risk of developing cervical cancer, compared to women who do not have inflammatory diseases.

 

Since cancer patients are usually treated with medications that partially suppress the immune system, as well with as steroids, the investigators don't know if the increase in risk is caused as a result of the suppression of the immune system caused by the medications, or caused by the disease itself, or by a combination of the both factors. They suggest continued study to investigate this important point. Similarly, the investigators recommend taking action to ensure early diagnosis, thereby preventing cancer from developing, or improving the chances of a cure, if indeed the patient has been diagnosed with cervical cancer.

This article was published in the Annals of the Rheumatic Diseases Journal, July 2015 issue