Vaccination and Testing Turning the Tide in the Effort to End Cervical Cancer

Dr Ritu Salani  OSUCCC James

About 13,000 women in this country will be diagnosed with cervical cancer in 2018, and a little more than 4000 will die from this disease, according to the American Cancer Society.

While each of these numbers is down dramatically compared to statistics from 50 years ago, they are “still too high,” according to Ritu Salani, MD, an associate professor in the Division of Gynecologic Oncology of The Ohio State University Comprehensive Cancer Center and James Cancer Hospital and Solove Research Institute (OSUCCC – James).

Salani is determined to reduce the number of cervical cancer diagnoses and deaths even further through education, vaccination and research. She recently completed the first phase of a clinical trial that shows great promise in treating women whose cervical cancer has returned and would otherwise have very poor prognoses.

“Cervical cancer is preventable,” Salani said.

January is Cervical Health Awareness Month—an opportunity to share information and education that will help reduce the rate of this form of cancer, which was once one of the most common causes of cancer deaths for American women. That rate declined by almost 70 percent between 1955 and 1992, due in large part to the combination of the human papillomavirus (HPV) vaccination and Pap test.

Cervical cancer (the cervix is located in the lower, narrow end of the uterus) is almost always caused by the HPV.

“Not everyone gets the HPV vaccination, and it’s vital that everyone does,” Salani said. When children—boys and girls—reach the age of 11 or 12, they should all receive two shots of the HPV vaccine six to 12 months apart.

HPV can cause cancers of the cervix, vagina and vulva in women; cancers of the penis in men; and cancers of the anus and the back of the throat, including the base of the tongue and tonsils (oropharynx), in both women and men, according to the Centers for Disease Control and Prevention. This is why the vaccination is so important. About 80 million Americans are currently infected with HPV, and another 14 million people, including teens, become infected every year.

The Pap test detects pre-cancerous lesions in the cervix that can easily be removed, or cervical cancer in the early stages when it is most curable.

“The problem is access to care, a lot of women don’t receive the Pap test,” Salani said, adding that another problem is the frequency of false-negative results, “or a misinterpretation of the test results or inappropriate management and treatment of the test results.”

Prevention and early diagnosis are important because approximately 35 percent of the women diagnosed and treated for cervical cancer will develop “a recurrent or persistent disease,” Salani said. “The prognosis is they’ll only have 18 months to 24 months.”

Research is another key to beating cervical cancer, and Salani and the OSUCCC – James are part of a recently completed phase 1 clinical trial that utilized a more targeted treatment for patients who experience a recurrence. “Chemotherapy has been the recommended treatment, but there’s limited success as the cancer often finds a way to grow,” Salani said.

To help the chemotherapy do its job more effectively, this new clinical trial also treated patients with a PARP inhibitor. PARP is an enzyme found in cells that has many functions, including the repair of DNA damage. By inhibiting—or blocking—the PARP in the cervical cancer cells from doing their job, “the cancer cells can’t repair themselves and they will die,” Salani said.

This clinical trial was a national effort organized by the Gynecologic Oncology Group (GOG) Foundation, an independent and international non-profit organization, of which Salani is a member.

“We had 29 patients with evaluable disease on study and we had a 75-percent clinical benefit rate, which exceeds the current standards,” Salani said.

The next step is to find funding for a larger, phase 2 clinical trial.

Salani is optimistic that the incidence and death rate from cervical cancer will continue to decline. Reaching this goal motivates her.

“What drives me is my patients and their families—that’s why I do this” she said. “We’re making an impact on this disease and we’re on the cusp of some big breakthroughs.”