In the struggle against cancers of all kinds, some of the best news comes from the success the medical community has had in diagnosing and treating cancer of the cervix, or cervical cancer.
The cervix is the opening to the uterus and connects the uterus to the vagina. The tissue of the cervix is particularly susceptible to abnormal cell growth which can and often does develop into cancer.
Once a leading cause of death for women in this country, cervical cancer began to decline in the mid-1950s with the introduction of the Papanicolaou or “Pap smear” screening test that alerts physicians to the presence of cancer. When caught early, the disease is fairly easy to stop in its tracks.
Indeed, the National Institutes of Health (NIH) says, “Between 1955 and 1992 the U.S. cervical cancer death rate declined by more than 60 percent.”
It has gone down even further since 1992.
Perhaps that explains, at least in part, the enthusiasm Dr. Lindsey Bruce shows when talking about her specialty. Board-certified in obstetrics and gynecology, Bruce served her residency at Yale University’s New Haven Health center and recently relocated to the Treasure Coast. She now practices gynecology with Dr. Taryn Gallo in Vero Beach.
The move is something of a reunion for the two physicians.
“Dr. Gallo was my chief resident, so she and I have known each other for several years,” Dr. Bruce says. “She said I should come down for a visit, so I did. Then I just didn’t want to leave. Dr. Gallo is one of my best friends. I have a lot of respect for her and I think the community does too. I’m just really excited to be joining her team.”
Despite progress in the fight against cervical cancer, the disease is still a formidable threat. NIH reports it ranks as the 14th most frequently diagnosed cancer in this country; the American Cancer Society estimates that in 2015 approximately 12,900 new cases of invasive cervical cancer will be diagnosed in the U.S. and more than 4,100 women will still succumb to the disease this year.
Cervical cancer rarely develops in women younger than 20 and tends to be found most often in women younger than 50. However the risk continues beyond age 50 and more than 15 percent of cervical cancers are found in women over 65.
Virtually all cervical cancers are caused by specific types of human papilloma viruses or HPVs. There are more than 100 types of HPV and about 15 of those are considered to be cancer-causing. Narrowing the field even further, just two types, HPV-16 and HPV-18, are responsible for approximately 70 percent of all cervical cancers.
Back in 2006 and 2009 the FDA approved vaccines that are highly effective against those two strains but like all inoculations, they are only effective when given before an infection occurs.
Since then, Bruce explains, “HPV vaccines have come a long way. Now we have a vaccine that covers even more HPV subtypes.”
That said, Bruce is quick to add that, “Just because you have HPV doesn’t mean you have cervical cancer.”
The pap smear remains the gold standard for making an accurate cervical cancer diagnosis. “A pap smear,” Bruce continues, “is where we use a brush and it just quickly goes across the cervix picking up cells. Then the pathologists look at [those cells] under a microscope. They’re looking at the cervical cells, describing what they see; normal or abnormal.”
If abnormal cells are found, the next step is further testing to determine the extent of those abnormalities. If cancer is detected, the additional tests might be followed by surgery, radiation treatments, chemotherapy or a combination of the three.
According to the Susan F. Smith Center for Women’s Cancer at Brigham and Women’s hospital, that is precisely why pap smears are so important: “Symptoms of cervical cancer may not appear until the disease is more advanced. Regular screenings are important to ensure that cervical changes are caught early and pre-cancerous cells are treated before they cause symptoms or develop into cancer.”
Symptoms can include vaginal bleeding, unusual vaginal discharges, pelvic pain or back pain and bleeding after sexual intercourse.
Exactly how often women should get a pap smear has been a hot topic of debate for most of the past decade. This past April, the American College of Physicians joined the American College of Obstetricians and Gynecologists in saying that yearly screenings may not actually be needed.
Still, many women are comforted by those annual pap smears and Bruce has an inkling as to why that might be. “It’s just nice to be reassured that everything is normal.”
Dr. Lindsey Bruce is with Coastal Gynecology and Vero Family Medicine at 1255 37th Street, Suite C in Vero Beach and is affiliated with the Sebastian River Medical Center. The phone number is 772-567-6412.