Challenging cervical cancer
Dana-Farber studies and treats cervical cancer while advocating Pap smears
By Saul Wisnia
Cervical cancer survivor Patti Saganey (center) discusses her radiation treatment with Susana Campos, MD, MPH (left), and Akila Viswanathan, MD.
For the past half-century, the primary way of preventing cervical cancer in the United States has been the same: encouraging more women to have yearly Pap smears. This simple screening test, in which cells are swabbed from the cervix and examined under a microscope for precancerous or cancerous abnormalities, was developed during the 1940s — and rates for the disease have plummeted in the U.S. as the procedure has grown more widely available.
Much of the world, however, has not seen such advances. The technology and expertise needed to perform and evaluate Pap smears are beyond the capabilities (and sometimes against the social mores) of many developing countries, so millions of women seldom or never receive the test. As a result, cervical cancer remains the most common gynecological cancer worldwide, accounting for more than 450,000 new diagnoses and nearly 250,000 deaths each year. Even though a multitude of international cases are likely never recorded, it is still the top cancer killer of women in many countries.
Although the numbers at home continue to improve, many of the 12,200 U.S. women that the American Cancer Society estimates will develop cervical cancer in 2003 — as well as the 4,100 projected to die from it — are natives of foreign lands and/or from socioeconomic groups that lack adequate health-care access and education. At the Gillette Center for Women's Cancers of Dana-Farber/Brigham and Women's Cancer Center, a dedicated team of physicians, scientists, and support staff from Dana-Farber and Brigham and Women's Hospital (BWH) hopes to lower these figures.
"Cervical cancer is the second-leading cause of cancer death in women worldwide, and our team is making important contributions to the understanding and treatment of this disease."
— Ross Berkowitz, MD
Buoyed by the announcement last fall of a vaccine that was 100 percent effective against one strain of human papillomavirus (HPV) — the sexually transmitted agent linked to most cases of cervical cancer — Gillette Center researchers are working to identify both therapeutic vaccines for patients already living with cancer and biomarkers that may help investigators recognize the disease. Refinements to radiation and chemotherapy treatments have boosted their effectiveness while lessening the need for hospitalization, and outreach efforts at Massachusetts health-care facilities are enabling physicians to spread the word about the importance of Pap smears.
"Cervical cancer is the second-leading cause of cancer death in women worldwide, and our team is making important contributions to the understanding and treatment of this disease," says Ross Berkowitz, MD, chief of gynecologic oncology at Dana-Farber and the Gillette Center. "There is tremendous collaboration among the different disciplines, with surgeons, radiation therapists, medical oncologists, and researchers doing their part. As excitement builds around a greater understanding of the role HPV plays in cervical cancer, we are continuing to search for new ways, through immunization, to treat precancerous changes and help prevent patients from developing those changes in the first place."
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