The United States Congress designated January as Cervical Health Awareness Month. According to the International Agency for Research on Cancer, an estimated 660,000 women were diagnosed with cervical cancer worldwide, and about 350 000 women died from the disease in 2022. According to the National Cervical Cancer Coalition, more than 13,000 women in the United States are diagnosed with invasive cervical cancer each year.
Cervical cancer is a type of cancer that starts in the cervix. The cervix is a hollow cylinder that connects the lower part of the uterus to the vagina, and most cervical cancers begin in cells on the surface of the cervix. The most common type of cervical cancer is squamous cell carcinoma. Most cases of cervical cancer are caused by human papillomavirus (HPV). When found early during regular screening through a papanicolaou test (pap smear), treatment is generally effective.
Many women with cervical cancer don’t realize they have cervical cancer early on, because it usually doesn’t cause symptoms until the late stages. When the symptoms do appear, they’re usually mistaken for symptoms of a period or a urinary tract infection (UTI). Typical cervical cancer symptoms are:
- Unusual bleeding, such as between periods, after sex, or after menopause
- Vaginal discharge that looks or smells different than usual
- Pain in the pelvis
- Needing to urinate more often
- Pain during urination
Although cervical cancer affects women of all races, Black women are at a greater risk of contracting HPV-related cervical cancer. Sadly, this means that Black women are more likely to present with advanced cervical cancer than non-Hispanic white women.
Dr Bola-Ogunyemi Teniola, Department of Obstetrics and Gynaecology, Victory Specialist Hospital, listed some of the factors that contribute to the increased rate of cervical cancer among Black women.
“Most common medical factors leading to prevalence of cervical cancer among Black women include the following: Increased prevalence of persistent HPV infection; limited access to proper healthcare, which includes lower rates/awareness of screening such as Pap smear/HPV DNA, delayed diagnosis → advanced disease at presentation, limited access to timely treatment; lower rates of HPV vaccination, increasing circulation of oncogenic strains; Increased prevalence of co-existing sexually transmitted infections that facilitate HPV persistence including higher rates of chronic cervicitis and cervical inflammation; high parity, causing repeated cervical trauma and hormonal stimulation of HPV activity.”
Black women are also at a higher risk of dying of cervical cancer. A 2017 Johns Hopkins Bloomberg School of Public Health-led research found that Black women in the U.S had been dying from cervical cancer at a rate of 77% higher than previously thought. “It isn’t clear why older and Black women are dying of cervical cancer at higher rates,” said Dr. Anne F. Rositch, an assistant professor in the Department of Epidemiology at the Bloomberg School. Another 2017 study published in the American Cancer Society Journals found that Black women tend to present with cervical cancer at a more advanced stage of the disease, and disparities exist not only in treatment but also in screening.
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What Black Women Need to Know about Pap Smears and HPV Tests
Recently, several colleagues and I were invited to undergo routine cervical cancer screenings. Some did not go for the test. For some, their hesitation was rooted in hearsay that it was a painful process; for some others, it was the fear of what the result would be. While their fears are undeniably valid, the reality is that Black women face a higher risk of cervical cancer, and early detection matters.
Pap Smear (Cervical Cytology), which is short for papanicolaou test, is a screening test used to detect abnormal cells in the cervix.
“It detects precancerous and cancerous changes in cervical cells. However, it doesn’t detect HPV, nor does it diagnose cancer. Cells are gently scraped from the transformation zone of the cervix, the sample is then spread on a slide (conventional Pap smear), or placed in liquid medium (liquid-based cytology), and eventually examined under a microscope,” said Dr Bola-Ogunyemi.
Who Should Have a Pap Smear
- Sexually active women
- Screening begins at 21 years, regardless of sexual activity history
Shedding more light on HPV tests, he noted that they are screening tests used to detect high-risk types of Human Papillomavirus (HPV), especially HPV 16, HPV 18, and other oncogenic HPV types that cause cervical cancer. It does not detect cervical cancer itself, but the virus that causes it
How is the HPV test done? Cervical cells are collected in the same way as a pap smear, and the sample is tested in the laboratory for HPV DNA. The test could be done alone or together with a pap smear, which is called co-testing.
Compared to the pap smear, the HPV test is more sensitive for detecting women at risk. It is important to note that both are screening tests and not diagnostic for cervical cancer. Diagnosis is made by cervical biopsy and histology, where indicated or needed.
Many high-risk HPV strains are preventable through vaccines. Recent findings showed that a single dose of the HPV vaccine could effectively prevent HPV and the cancers it causes, most notably cervical cancer. Though the vaccines have proven to be effective, it’s still important to attend cervical screening appointments if you’ve been vaccinated against HPV, as there’s still a small chance you could get cervical cancer.
“Yes, a woman can still be at risk of cervical cancer even after vaccination because HPV vaccines do not protect against all HPV types. Also, a woman could have been infected before vaccination (when the virus is in the latent or dormant phase) and become undetectable by HPV tests or Pap smear. Cervical cancer can sometimes, but rarely, occur from non-HPV-related pathways, for example is the Gastric-type Adenocarcinoma of the cervix,” Dr Bola-Ogunyemi Teniola added.
Photo credit: drbright_
Asked what symptoms Black women should never ignore, he stated: “The commonest and most important early symptom is post-coital bleeding (bleeding after sex). Other symptoms to look out for include Intermenstrual bleeding (bleeding between periods), post menopausal bleeding, persistent foul-smelling or watery vaginal discharge, unexplained pelvic pain or lower abdominal pain, pain during sexual intercourse (dyspareunia), unexplained weight loss, and persistent low back or leg pain. Cervical cancer is commonest amongst women in their 5 th and 6 th decade of life. The symptoms listed above are red flags in women of that age-range and must be taken very seriously.”
Cervical cancer treatment includes surgery, radiation therapy, chemotherapy, and targeted therapy such as brachytherapy. A 2019 study published in Gynecologic Oncology suggested that brachytherapy may help survival outcomes for Black women with cervical cancer, but sadly, access to brachytherapy for Black women is limited. Increased access to not only this treatment but also increased awareness of causes, signs, and symptoms of cervical cancer is important in ensuring that Black women survive cervical cancer and possibly prevent getting this treatable disease.
Source
National Cervical Cancer Coalition
International Agency for Research on Cancer
Boitumelo Masihleho is a South African digital content creator. She graduated with a Bachelor of Arts from Rhodes University in Journalism and Media Studies and Politics and International Studies.
She’s an experienced multimedia journalist who is committed to writing balanced, informative and interesting stories on a number of topics. Boitumelo has her own YouTube channel where she shares her love for affordable beauty and lifestyle content.
