Cancer of the Cervix and the Midwife

by Marion Toepke McLean

[Editor’s note: This is an excerpt of an article which appears in Midwifery Today, Spring 2017, Issue 121. View other great articles and columns in the table of contents. To read the rest of this article, order your copy of Midwifery Today, Issue 121.]


Birth attendants need to learn about cervical cancer, to understand and teach about it. Why? Although potentially fatal, cervical cancer is slow growing. Death is almost always preventable, with early detection and treatment. For many women, a midwife is the main or even the only contact with women’s health care.

Recent research suggests that the rate of and death rate from cervical cancer have increased in recent years, particularly when low socioeconomic status prevents the access to screening. (Viens 2016)

Cervical cancer is caused by the human papilloma virus (HPV), of which there are more than 100 strains. Forty to fifty HPV types infect the genitals. Only a handful, referred to as high-risk HPV, can cause cervical cancer, as well as penile cancer, which is rare; anal cancer; and some forms of throat cancer. Much research has been done since the 1990s on cause, natural history, prevention and treatment of HPV-associated cancer. Screening and treatment changes have been made as new information comes in. Currently used screening tests include Pap smears, high-risk HPV DNA testing, and visual inspection with acetic acid (VIA).

The current research-based recommendation for screening in the US is a Pap smear every three years, starting at age 21, then Pap and high-risk HPV DNA screening every five years, starting at age 30.

Men and women may contract the virus through sexual contact, usually in the early years of sexual activity. The typical age of death from cervical cancer is 40 or older. In the US, such deaths are largely among women with HIV, which damages the immune system, allowing cervical cancer to grow rapidly, or among women who don’t receive cancer screening. HPV infections have a long life cycle. High-risk HPV DNA can be present on the genitals for years. Ninety percent of the time the immune system clears it. (Chew et al. 2005)

The virus can be spread to others by mucous membrane contact. While Pap smears or visual examination of the cervix are initially normal, high-risk HPV DNA testing can detect it. In the US, the majority of sexually active people harbor one or more strains of HPV. Because most of these will clear without treatment, HPV DNA testing is not routinely recommended in women until age 30, except to aid in diagnosis when lesions are detected. By age 30, when most will have cleared the virus, HPV DNA screening is useful.

References:

  • Chew, GK, et al. 2005. British Journal of Cancer. “Human Papillomavirus 16 Infection in Adenocarcinoma of the Cervix.” 93:1301–04.
  • Viens, LJ, et al. 2016. MMWR. “CDC: Number of HPV-associated cancers on the rise.” 55:661–66.

Marion Toepke McLean is a certified nurse-midwife and family nurse practitioner. She has written for Midwifery Today since its first issue. She attended her first birth as primary midwife in 1971.


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