Cervical Cancer

Cervical Cancer

Cervical cancer is unique among common cancers: it has a single, known cause – the human papillomavirus (HPV) – and highly effective screening and prevention tools have the potential to virtually eliminate deaths from the disease. Research into HPV and cervical cancer detection has helped to reduce U.S. cervical cancer death rates by nearly 70 percent since the 1950s.

Despite these advances, nearly 12,000 American women are still diagnosed with cervical cancer annually, primarily because they do not receive routine screening and follow-up care. Moreover, with limited access to vaccines, screening, and treatment in low resource countries, annual mortality is 250,000 worldwide.

While screening and vaccination remain the first lines of defense, researchers are also working to improve treatments for women diagnosed with cervical cancer. 

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2014

New HPV vaccine protects against more cancer-causing virus types

New HPV vaccine protects against more cancer-causing virus types

The FDA approves a new human papillomavirus (HPV) vaccine, Gardasil 9 following a large clinical trial. The vaccine is approved for use in girls and young women for the prevention of cervical, vulvar, vaginal, and anal cancers caused by HPV, and in boys and young men for the prevention of HPV-related anal cancer and genital warts. Gardasil 9 vaccine protects against five more high-risk strains of HPV than previous vaccines, and researchers estimate it could prevent up to 90% of cervical cancers worldwide.

2013

First-ever regimen to extend survival for aggressive cervical cancer

First-ever regimen to extend survival for aggressive cervical cancer

A major clinical trial shows that adding the targeted drug bevacizumab (Avastin) to standard chemotherapy improves survival for patients with relapsed and advanced cervical cancers. These findings mark the first time any targeted agent has improved survival for cervical cancer – or any gynecologic cancer.  They offer a potential new treatment option for women with a disease for which chemotherapy alone is often ineffective.

2009

HPV vaccine benefits women over age 26

HPV vaccine benefits women over age 26

A large, randomized trial shows that the HPV vaccine Gardasil is more than 90 percent effective in preventing cervical cancer in women aged 24 to 45 who received all three vaccine doses, and who were not infected by the virus. While the vaccine is currently approved only for younger women, it is being considered by the FDA for use in women over age 26.

2008

Minimally invasive surgery shown to be effective for cervical cancer

Minimally invasive surgery shown to be effective for cervical cancer

In a small study, researchers find that two minimally invasive techniques – laparoscopic and robotic radical hysterectomy (removal of the uterus) with radical pelvic lymphadenectomy (removal of surrounding pelvic lymph nodes) – are as effective as traditional radical hysterectomy and lymphadenectomy in women with cervical cancer. The procedures, which are performed through small incisions, are associated with less blood loss and shorter hospital stays than traditional, open surgery. While both of the new techniques had already been put into limited practice, this study provided evidence to support their widespread use.

2006

Preventive cancer vaccine approved for cervical cancer

Preventive cancer vaccine approved for cervical cancer

The FDA approves Gardasil, a vaccine that prevents infection with the two high-risk strains of human papillomavirus (HPV) known to cause about 70 percent of cervical cancers. The vaccine is approved for girls and young women aged 9 to 26. The approval is based on data showing the vaccine is 100 percent effective in preventing HPV16- and HPV18-related cervical pre-cancers, as well as genital warts, for at least 4.5 years following vaccination. Later the same year, the CDC's Advisory Committee on Immunization Practices (ACIP) recommends routine HPV vaccination for girls aged 11 and 12; however, state requirements for HPV vaccinations vary. A second vaccine, Cervarix, was approved in 2009 to prevent infection against HPV16 and HPV18 in women aged 10 to 25. The cost of the three-dose regimen remains a persistent challenge to widespread HPV vaccination, with either version of the vaccine. Also in 2009, the Gardasil vaccine is approved for use in boys for the prevention of genital warts.

Gardasil is later approved to prevent additional HPV-related diseases in children and young adults aged 9 to 26, including vaginal, vulvar and anal cancers in females, and anal cancer and genital warts in males.

2000

Trial improves management of abnormal Pap test results

Trial improves management of abnormal Pap test results

Ongoing results from a large clinical trial – called the ASCUS-LSIL Triage Study (ALTS) – provide important guidance on managing the mild abnormalities that often show up on Pap tests. These findings help doctors more accurately determine which women need further procedures, such as colposcopy (office procedure using a device that enables a physician to closely examine the cervix for abnormalities) and biopsy to detect pre-cancer or cancer, and which women can be spared from these procedures.

1999

DNA test approved to detect HPV virus, the virus that causes cervical cancer

DNA test approved to detect HPV virus, the virus that causes cervical cancer

The FDA approves a new test to detect the strains of the human papillomavirus (HPV) that are known to cause cervical cancer. The test, which identifies DNA from these high-risk virus types, is approved for use in women age 30 and older in combination with the Pap test, and for women of all ages who have an abnormal Pap test result. Subsequent studies show that HPV testing alone is significantly more sensitive at detecting advanced pre-cancers than the Pap test (96 percent vs. 55 percent), but HPV testing results in more false positive results. When combined, the HPV test and Pap tests are found to be 100 percent sensitive for identifying women at risk for cervical cancer. For women younger than age 30, however, the Pap test alone is sufficient and combined screening is not recommended.

Widespread screening reduces cases of advanced cervical cancer in older women

Widespread screening reduces cases of advanced cervical cancer in older women

A study shows that Medicare coverage for cervical cancer screening in women over age 65 led to a 19 percent reduction in cervical cancer diagnoses in this group since 1990, enabling detection of more lesions in their precancerous stages, before they progressed to cancer. Current screening guidelines state that screening can be safely stopped in women over age 65 or 70 who have had three or more consecutive normal Pap test results and who have not had an abnormal screening result within the past 10 years.

1998

NCI recommends chemotherapy-radiation combination for invasive cervical cancer

NCI recommends chemotherapy-radiation combination for invasive cervical cancer

The National Cancer Institute issues an alert recommending that physicians consider adding chemotherapy to radiation therapy for women being treated for invasive cervical cancer (cancer that has spread within the cervix or pelvis). This updated approach is based on several randomized trials showing that women lived longer when treated with both radiation and chemotherapy, compared to those treated with the prior standard of radiation or surgery alone.

New liquid-based Pap tests introduced

New liquid-based Pap tests introduced

FDA approves two new liquid-based Pap tests. Whereas conventional tests involve smearing a swab of cervical cells on a slide, in the new tests, the swab is placed into a special preservative solution. These liquid tests provide a clearer, easier-to-read sample for pathologists to review under a microscope, compared to the traditional method.

1990

U.S. government funds cervical cancer screenings for underserved women

U.S. government funds cervical cancer screenings for underserved women

The Breast and Cervical Cancer Mortality Prevention Act of 1990 provides access to free or low-cost breast and cervical cancer screenings to underserved women across the country. Since its inception, this program run by the U.S. Centers for Disease Control and Prevention has provided more than 9.2 million breast and cervical cancer screening examinations, and helped diagnose more than 2,554 cases of cervical cancer and 123,563 cervical "pre-cancers."

1988

Standard system established for evaluating Pap test results

1983

HPV virus is discovered to cause cervical cancer

HPV virus is discovered to cause cervical cancer

Researchers led by Harald zur Hausen isolate specific strains of the human papillomavirus (HPV) as the likely cause of cervical cancer, a link that is soon confirmed with additional research. They find that most cervical pre-cancers and cancers contain DNA from the HPV-16 or HPV-18 strains of the virus. Researchers later link additional strains of HPV to cervical cancer, but HPV-16 and HPV-18 have been established as the most virulent. In 2008, Dr. zur Hausen is awarded the Nobel Prize for Medicine or Physiology for his discovery.

1943

Doctors begin routine Pap testing

Doctors begin routine Pap testing

The Pap test is first introduced into physician's offices, enabling doctors to detect and begin treating cervical cancer before it has a chance to spread. Over the following decades, the Pap test is credited with driving down cervical cancer death rates in the U.S. and other wealthy countries. Yet cervical cancer remains a major cause of death in low-resource settings around the world, where access to screening and treatment is limited.

1928

Discovery lays groundwork for development of the Pap test, the first-ever cancer screening test

Discovery lays groundwork for development of the Pap test, the first-ever cancer screening test

George Papanicolaou discovers that vaginal cell smears can reveal the presence of cervical cancer. This finding paves the way for the development of the first effective cancer screening test over the next 15 years. With refinements over the following decades, the Papanicolaou test (or Pap test, or Pap smear) remains the gold standard for cervical cancer screening and has been credited with reducing cervical cancer deaths by 70 percent in the U.S.

1905

Radical hysterectomy used to treat early cervical cancers

Radical hysterectomy used to treat early cervical cancers

British surgeon Ernst Wertheim introduces a new surgical technique, the 'Wertheim radical hysterectomy,' reporting that more than 30 percent of cervical cancer patients who underwent the surgery remained free of cancer after five years. This result is considered a monumental feat for the time, despite the fact that about 15 percent of women died during the procedure. The surgery, which involves the removal of the uterus, cervix and surrounding lymph nodes through an abdominal incision, soon becomes the standard treatment for uterine and cervical cancers. Over the following decades, however, it is refined to dramatically reduce the risk of complications, improve outcomes and leave more healthy tissue intact. The highly refined approach is still used today for patients with early-stage cervical cancer.