Cervical cancer used to be the leading cause of cancer death for women in the United States, according to the Centers for Disease Control and Prevention (CDC). This is no longer the case: rates of the disease have declined dramatically in the past forty years, largely due to increased screening in the form of regular Pap smears, which can detect precancerous cells in the cervix before they turn to cancer. At this early stage, cervical cancer is highly treatable, and survival rates are extremely high.
Now, “the main risk factor for cervical cancer is not having regular and timely screening,” says Sangini Sheth, MD, MPH, assistant professor of obstetrics, gynecology, and reproductive services. According to Dr. Sheth, approximately 50 percent of women who develop cervical cancer did not get adequately screened for the disease in the five years before their cervical cancer diagnosis.
The CDC reports that 90 percent of cervical and anal cancers are likely caused by a sexually transmitted disease, Human Papilloma Virus, or HPV, which is so common that most people get it at some point in their lives. Most people are able to clear the disease without treatment or symptoms. However some forms of HPV cause abnormal, precancerous cells, called high-grade cervical dysplasia, also known as CIN2 or CIN3.
Dr. Sheth emphasizes that the currently available HPV vaccine, Gardasil or Gardasil 9, is, combined with regular screening, a vital and extremely effective tool in preventing cervical cancer. “Unfortunately, national rates show, and what I see in my practice reflects the national trends, is that we are not doing as good a job as we should be in getting the vaccine to adolescents and young women,” she says. Because the vaccine is most effective when given to girls before they are sexually active, at around age 11 or 12, many parents avoid the vaccine, fearing it may cause earlier sexual activity or promiscuity. Several studies have shown this is not the case, Dr. Sheth says.
The main risk factor for cervical cancer is not having regular and timely screening.
Sangini Sheth, MD, MPH, assistant professor of obstetrics, gynecology, and reproductive services
In addition to its role as an essential preventive measure against cervical cancer, Dr. Sheth and her colleague, professor of obstetrics, gynecology, and reproductive services Alessandro Santin, MD, are set to begin a clinical trial at Yale that tests the HPV vaccine’s effectiveness as a treatment for high-grade cervical dysplasia. The current standard treatment is cervical excision, which entails surgically removing the section of the cervix that contains the precancerous cells. Because surgery has inherent risks, Drs. Sheth and Santin are examining a medical, non-surgical alternative treatment.
The study, which is set to begin enrollment in the next few months, is open to women who have been diagnosed with CIN2 or CIN3 cervical dysplasia. Patients would be enrolled for a six-month period, during which they will be randomly assigned to one of three treatment groups: an observational group, a group that is given a medication to clear the HPV infection and its related dysplasia, and one group that is given both the medication and the HPV vaccine. Participants will be observed through regular exams, and at the end of six months, if the medications have not adequately cleared the infections, patients will be treated through standard cervical excision. Dr. Sheth emphasizes that during the six-month trial, dysplasia is unlikely to worsen, so there should be no negative effect of delaying cervical excision if it is necessary.
If you would like more information about participating in this clinical trial, please contact Dr. Santin’s office at (203) 737-4450.