Cervical Cancer Awareness Month: What Experts Want You to Know

January is Cervical Cancer Awareness Month. The American Cancer Society, American College of Obstetricians and Gynecologists, and reproductive health advocates want people to know that cervical cancer is often preventable and more easily treated and cured when it is detected early.

The American Cancer Society estimates that in 2021, over 14,000 people with a cervix will be diagnosed with invasive cervical cancer, and 4,290 people will die from it. Early diagnosis is key to improved odds of survival.

Can You Get Tested for Cervical Cancer?

Cervical cancer is one of the most easily treatable cancers if diagnosed in its early stages. However, it does not usually exhibit any signs or symptoms until it is in the later stages, making screenings vital for early detection.

Currently, the American College of Obstetricians and Gynecologists (ACOG) recommends the following screening recommendations for cervical cancer:

• A Pap test every three years if you are 21-29-years old
• A Pap test with human papillomavirus (HPV) testing every five years if you are 30 to 65

Talking to Your Provider

Everyone should be able to have an honest conversation with their reproductive healthcare provider about their complete health history, family history, and any health concerns they might have.

“As an OB/GYN, I take a personalized approach to testing with my patients and have an open dialogue about it,” Jacqueline Walters, MD, an obstetrician/gynecologist, and two-time breast cancer survivor, tells Verywell. “I may recommend Pap testing in different intervals or at a younger age depending on my patient’s history and other factors. It is important that women ask about getting screened with the most comprehensive method for their age.”

Get Screened

Walters warns that delaying or skipping routine screening appointments can have dire consequences. Some experts anticipate higher death rates from cervical cancer in the coming years because people are putting off screenings and treatment during the COVID-19 pandemic.

“Every hour, one woman is diagnosed with cervical cancer in the U.S., and, globally, one woman dies of cervical cancer every two minutes,” Walters says. “There are worries this statistic could increase due to delays in screenings because of COVID-19, as cervical cancer is a very serious disease.”

Earlier detection means better prognosis and cure rates. “By putting off your appointment due to COVID-19, you could be delaying an important step in cervical cancer prevention and treatment: diagnosis,” Waters says. “It can sometimes progress quickly—but through regular testing, cervical cancer is not only treatable but preventable as well.”

What to Ask After a Diagnosis

Jessika Contreras, MD, a radiation oncologist at Miami Cancer Institute, tells Verywell there are a few key questions that any newly-diagnosed cervical cancer patient should discuss with their cancer treatment team:

• What specific type of cancer do I have?
• What is the extent of my disease? Has it spread anywhere else?
• What are my treatment options? Do I need to have surgery, or are there other options?
• What are the short-term and long-term side effects of my treatment plan?
• What is my prognosis?
• What is the end goal of my treatment? Is my plan of care curative or palliative?
• What are additional support services available to me during and after my treatment?

Experts Say Brachytherapy Should Be a Mainstay of Treatment

Treatments for cervical cancer include surgery, external radiation, chemotherapy and brachytherapy. Experts are adamant patients with cervical cancer should be given the option of brachytherapy. “The standard of care should be that most patients receive brachytherapy with external beam radiation,” Contreras says. “It’s the only way to give the high doses of radiation that we need to provide patients with a cure for their disease.”

Brachytherapy is an internal radiation treatment that is delivered to a patient by placing a radioactive source in a device placed inside the body.

Brachytherapy is performed by radiation oncologists (specialists who use radiation to treat cancer). First, the provider inserts an applicator inside the patient. From there, the provider is guided by MRI imaging while they deliver the proper dosage of radiation for the patient.

“To place the device, we use ultrasound. After the applicator is in place, we use MRI to image the patient,” Contreras says. “MRI has allowed us to shape the dose of brachytherapy because it allows us to get a better view of the area that needs treatment. We can adjust where the radiation is going to go after the device has been inserted. We can specify the amount of time that the radioactive source spends in the device, where the radiation goes, and the amount of radiation that is delivered.”

Unfortunately, Contreras says, many patients are not offered brachytherapy as a treatment option for their cervical cancer because it is a specialized treatment that not all cancer centers can perform.

“There has been a trend in the U.S. to reduce the use of brachytherapy, and that is not appropriate,” Contreras says. “Brachytherapy allows us to give almost twice the amount of radiation that we give with an external beam. We know that women who receive high doses of radiation with external beam radiation only have a lot more toxicities. We also have evidence that when women do not receive brachytherapy, they are more likely to die from their disease.”

Types of Brachytherapy

There are two forms of brachytherapy that can be used to treat cervical cancer: high-dose-rate and low-dose-rate.

High-dose-rate (HDR) Brachytherapy

This method delivers high doses of radiation for a few minutes at a time. After the patient receives the radiation, the radiation oncologist removes the delivery device, and the patient can go home. The patient does not remain radioactive and will not expose contacts to radiation.

Low-dose rate (LDR) Brachytherapy

This option is less commonly used to treat gynecological cancers. In LDR brachytherapy, the radiation is given over several days. The patient must remain in the hospital during treatment, and all caregivers have to take precautions to avoid radiation exposure.

There is no long-term difference between people who receive HDR and LDR brachytherapy, but HDR is more common. Brachytherapy can also be used to treat vaginal, breast, prostate, esophageal, and other cancers.

“The outcomes are the same, but HDR brachytherapy is a much more convenient procedure. Patients do not have to stay in the hospital for several days,” Contreras says.

Side Effects of Brachytherapy

Brachytherapy has both short-term and long-term side effects. Short-term effects of brachytherapy for cervical cancer include urinary frequency, urinary burning, urinary urgency, diarrhea, and vaginal discharge.

However, Contreras says that patients can manage them with support from their cancer treatment team. “All of these side effects are usually something that we can manage with medication alone.”

The long-term side effects of the treatment, such as residual urinary urgency and incontinence, and rectal irritation, are generally caused by inflammation and scar tissue surrounding the treatment area.

Additional long-term effects of brachytherapy include scar tissue in the vagina, and vaginal shortening, which can affect a patient’s sex life. Contreras says that patients should not be afraid to discuss these symptoms with their provider because there are treatments available.

“I will bring this up with my patients and their partners. We talk about lubrication or ways to approach sex in a manner that is not painful to them,” Contreras says.

One option is a device known as a vaginal dilator, a firm plastic tube that can be inserted into the vagina to help stretch and relax shortened, tight vaginal muscles.

“I ask patients to use dilators for the rest of their life after they have completed their treatment,” Contreras says. For patients who continue to have vaginal pain, she says that doctors “can send them to see a sex therapist or physical therapist for pelvic floor rehabilitation in some cases.”

Can You Prevent Cervical Cancer?

Human papillomavirus (HPV) causes an estimated 91% of cervical cancers. The Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for children starting at age 11 or 12.

Walters advises that the HPV vaccine is less effective at preventing cervical cancer in someone who has already contracted HPV; therefore, vaccinating both males and females before their first sexual encounter is vital.

Regular Pap tests are also critical to detect the 9% of cervical cancers that test negative for HPV. “I have seen instances of women with HPV-negative cervical cancer, so getting screened with the Pap and HPV tests provide the best protection against cervical cancer,” Walters says.