Joshua Kesterson, M.D.
Associate Professor, Department of Obstetrics and Gynecology, Penn State Cancer Institute
Cervical cancer is the third most common cancer in women worldwide and the second most common cause of cancer death, killing more than 250,000 women each year. That equates to one woman dying of cervical cancer every two minutes.
All too often, it’s women in women in the primes of their lives dying from this disease, which results in immeasurable devastation to families and communities. A majority of cases are in developing nations, where access to screening and prevention is not readily available, and deaths from cervical cancer are expected to increase by 25 percent over the next decade.
These stories, of thousands of women dying every year from a preventable disease, are as grim as they are sobering.
Prevention is key
Is there hope? How and where does one begin to positively impact such seemingly overwhelming odds?
While research has made great strides in treating cervical cancer, with innovations in surgery, radiation, chemotherapy, targeted therapies, and combinations thereof, most women with cervical cancer will not benefit from these advances. The truly awe-inspiring future of cervical cancer is not in its treatment, but in its prevention.
Cervical cancer is caused by human papillomavirus (HPV), a sexually transmitted infection. While most HPV infections are self-limiting with no long-term sequelae, persistent infection with high-risk, or oncogenic, subtypes of HPV, if not detected and treated, can progress to cancer.
By preventing HPV infection, we can prevent cervical cancer. Cervical cancer is therefore, at its core, a communicable infection. For this reason, we should forego a historically oncology-centric perspective for an infectious disease epidemic paradigm, and in doing so be guided and buoyed by past successes.
A history of cures
Poliomyelitis, a highly contagious disease that causes paralysis of the leg and respiratory muscles, was diagnosed in more than 50,000 people in the United States in one year, to the Salk polio vaccine becoming available in 1955. Five years later, there were fewer than 200 cases reported. Worldwide, there were fewer than 20 cases last year.
Smallpox, a highly lethal viral infection with no cure, existed for thousands of years with a death toll of hundreds of millions. As a result of global vaccination strategies, smallpox has been eradicated; the last naturally occurring case was more than 40 years ago.
With a similar approach, cervical cancer can be eradicated. Widespread, universal HPV vaccination programs have proven effective in prevention.
Reaching the masses
With proof of concept assured, the next issues become scope and scale.
The scope is one of inequality, with women obviously solely at risk, but in particular women of lower socioeconomic status and/or those who live in low- and middle-income countries.
The scale is global. The challenge is undoubtedly daunting but achievable, as evidenced by prior vaccination successes.
The hopeful future of cervical cancer treatment is its prevention. Just as leg braces, iron lungs, and upper-extremity circumferential scars of prior generations have thankfully been relegated to medical artifact status, so too should the tragic void left by the untimely deaths of our mothers, sisters, and wives.
Joshua Kesterson, M.D., Associate Professor, Department of Obstetrics and Gynecology, Penn State Cancer Institute, [email protected]