Cervical Cancer is a preventable disease IF detected on time

The natural course of cervical cancer ultimately ends with fatal outcome unless this trend is interrupted with medical interventions. There are four types of such interventions that have changed the natural course of this disease: Cancer prevention (risk factors), cancer control (surveillance for hidden disease among "healthy" population), cancer diagnosis (use of modern medical tools for detection, diagnosis, staging and control of therapy), and therapy (surgery -- to eliminate local tumor, radiotherapy and chemotherapy for distant progression).

Consequently, the current strategy against cervical cancer emphasizes the optimistic prognosis with the popular clause that the cervical cancer is a preventable disease if:

1. The risk factors are reduced -- HPV vaccination is part of this strategy
2. The disease is detected and treated on time -- Pap test is the best cancer screening test ever
3. The disease is correctly diagnosed (colposcopy, biopsy, histology) and therapy (LEEP, surgery, radiotherapy, chemotherapy) is instituted on time. But, applying any diagnostic procedure and any therapy does not guarantee success. The progress of hidden and overt disease must be addressed properly according to the newest strategy
4. If all these measures are in place and active, in 21st Century, the appearance of invasive cervical cancer should be considered not as a natural trend of this disease, but as a failure of all preventive and curative measures listed above

The contemporary women population in the world differs significantly with regard to women's access to the modern health services. This difference is so large that there are countries with more than two women dying from cervical cancer each hour, to countries where one women dies every 3-5 hours. In a total population of 1.7 billion women at risk for cervical cancer, still 500,000 new cases of invasive cancer appear yearly and 250,000 women die of this preventable disease. Three out of four mortality reports come from developing countries, while women in the developed countries are considering measures for elimination of cervical cancer treat in their localities. The inequality has become even more visible with the introduction of HPV vaccines, one of the most prospective cancer preventive measures, which because of the cost of immunization could be restricted only to the wealthy areas of the world. Because technology to help all women is present, and because of TV, Internet, e-mail and other modern telecommunication marvels the whole world is becoming a "single village," maintaining this inequality of protection against cervical cancer is not acceptable any more.

The Global Academy for Women's Health, Inc. has recently published a new book "What Every Woman Should Know About Cervical Cancer". The book summarizes the current views of cervical cancer prevention, control, diagnosis and treatment presenting them is a language understandable for general public. It is aimed to bring readers the rationale for optimism and provide guidance as how to gain knowledge and skills for critical thinking and making an educational decision when it will be necessary in their lives. The book "What Every Woman should Know about Cervical Cancer" is published by Springer and will be available in July 2008.

Springer is offering visitors to this site a 20% discount on the book when ordered at www.springer.com. To order at the discounted rate, you will need to enter the SpringerToken: S2RAFs6e8w9G2Hy. For detailed instructions on how to use the SpringerToken, please click here.

The book is intended to educate the general population of women about true and false information on cervical cancer, HPV infection and vaccines, responsible sexual behavior, other sexually transmitted diseases, cervical cancer detection methods and their advantages and disadvantages, about diagnostic and therapeutic methods as well as holistic medicine available to women worldwide. The purpose of this book is to improve education and reduce risk factors, to improve awareness of cancer control measures and improve the outreach of women participating in screening. Least, but not the last purpose is to reduce fear of unavoidable death in women who face failure or preventive measures, get cancer and are facing fight against the progress of this disease. More details about this book can be found on the Global Academy for Women's Health Web-Site: www.markpap.com.

The modern strategy for prevention of cervical cancer assigns equal weight to cancer prevention and cancer control measures. Because of these new hopes against cervical cancer, the huge infrastructure that has been built up to maintain millions of Pap tests for cervical cancer control, is currently undergoing a pressure to “improve” the value of Pap test and to transform this “most successful screening test” into a diagnostic test that could provide more information as for guiding clinical actions. Such a pressure has added new methods to be performed on the same sample, and has increased the cost per test. The health insurance companies responded to the increased cost by extending the time for insurance-covered tests from annual to periods of 2-3 years, and are justifying this extension with statistical data based on different end-points (very few based on the survival). Because this trend could continue, and fewer women could be subject to regular annual cervical cancer control, we have recommended that a new risk factor for cervical cancer be introduced. This risk factor is the absenteeism from regular screening. For details, please see the book "What Every Women Should Know About Cervical Cancer" (37,40).

In 2006 and 2007 the major breakthrough in the prevention of cervical cancer was achieved with the FDA approval of the fist HPV vaccine which, in short, is saying that the vaccine could prevent infection with oncogenic HPV strains, which could cause a persistent HPV disease that could lead to the appearance of genital warts (condyloma acuminata) or cervical cancer. Although very conditional, this definition has raised our hopes that cervical cancer could be prevented by eliminating HPV infection as one of the main risk factors that intertwine with other risk factors, such as irresponsible sexual behavior or other sexually transmitted diseases. This perception has influenced health policy and has focused medical device industry towards development of new vaccines (to cover more HPV strains), new HPV tests (to detect minimal disease), and to education of public (to accept mandatory vaccination) and women (to accept change of sexual behavior).

The recently advertised HPV vaccination protocols are creating dilemmas about who and when should be vaccinated, how long the vaccines are protecting, and whether to replace the Pap test with vaccination alone. Currently available scientific data support optimism but not the enthusiasm about the potential protective value of the two vaccines now available (Merck and GlaxoSmithKline). More work is necessary and the Pap test will remain the "gold" standard for the success of cervical cancer prevention efforts. In the beginning of 2006, Federal agencies regulating the cervical cancer screening (FDA, CDC, CMS) and the manufacturers of HPV vaccines and HPV diagnostic tests, have issued information emphasizing the role (current and future) of cytological screening for cervical cancer giving the Pap test credit not only for what this test has done (reduction of mortality from cervical cancer for more than 85% between years 1955 and 2005) but for its future role in an environment with HPV vaccination available. In this situation, the value of our biomarker-based MarkPap test is even more significant. The book "What Every Woman Should Know about Cervical Cancer" should be one of these educational tools that can help women make their own decision on this and similar dilemmas they may have about cervical cancer prevention, control diagnosis and treatment.

Nevertheless to all good intentions and efforts given to improve the safety of women against cervical cancer danger, there are still barriers for worldwide mass Pap testing, e.g., cost of the test, lack of infrastructure to perform Pap test, access for testing, fear of testing, uncomfortable pelvic exam, concerns from false-negative results of Pap test, or cultural/religious restrains to visit gynecologist. Even the most developed countries are not free of such barriers. For instance, in the US, there are still 20% women at risk who do not have regular Pap test because of some of aforementioned reasons. Apparently, further improvements of the Pap test are necessary to make it available and affordable for mass cervical cancer screening (37). The biomarker-based MarkPap® technology is being developed in this spirit by providing a low cost, highly reliable and controlled Pap test which can be easily applied to large populations (1-19). MarkPap LLC has been incorporated to commercialize products coming form this technology R&D. The exquisite characteristics of the biomarker have opened new avenues for translational research: In addition to detection of abnormal cervical cells, the HPV diseased cells could also be detected; providing a basis to use this test as a screening for performing additional and expensive HPV testing. The biological and optical characteristics of the biomarker indicated to its application in telecytopathology (future Tele Pap) and a prospective in self sampling (future Home Pap test), that will further dramatically increase the outreach for Pap test and make possible performing Pap test everywhere in the world and save more women lives (20-40).