As the world marks Cervical Cancer Awareness Month, an expert from Cleveland Clinic discusses means of prevention and the potential benefits of immunotherapy treatments
 
 
 
Wednesday, 25 January, 2023, CLEVELAND: The research and development of immunotherapy drugs to treat patients who have cervical cancer, especially in its advanced stages, is offering hope to hundreds of thousands of women worldwide, says an expert from global health system Cleveland Clinic. However, speaking during the Cervical Cancer Awareness Month of January, he points out that regular screenings remain a vital tool to prevent cervical cancer.
Cervical Cancer is the fourth-most common cancer among women worldwide and is caused mainly by persistent infection with high-risk types of human papillomavirus (HPV), according to the World Health Organization (WHO). In its latest figures, the WHO estimates there were 604 000 new cases and 342 000 deaths from cervical cancer in 2020. 

“The positive news is that cervical cancer is preventable, and also very treatable, especially if caught early. New immunotherapy drugs that could offer better outcomes with fewer side effects are also being researched and developed,” says Robert DeBernardo, MD, an obstetrician and gynecologist who heads the Department of Gynecologic Oncology at Cleveland Clinic.

Commenting on the development of immunotherapy drugs, Dr. DeBernardo says, “Immune checkpoint inhibitors have been successful in treating lung cancers and melanoma, so they represent a potentially very new important class of drugs to treat cervical cancer, although we are still learning more about them.”
Dr. DeBernardo explains that whereas traditional treatment approaches use surgery, chemotherapy and radiation to remove or kill cancerous cells, immunotherapy harnesses the body's own immune system to attack the cancer. 

“In simple terms, the body's immune system can initially identify a cancer, in the same way it identifies a bacterial infection, and then attack it. As the cancer grows and spreads, however, it develops mechanisms to hide from the immune system, for example, by using the ‘checkpoint' proteins that the immune system uses to identify healthy cells. Newer drugs target these checkpoints so that the immune system will be able to recognize and destroy the cancerous cells.”
According to Dr. DeBernardo, because the new drugs leverage the body's own immune system, they are generally well tolerated, with fewer side effects than is the case in chemotherapy or radiation. In addition, immunotherapy could potentially improve long-term survival rates, especially in advanced cases of cervical cancer. 
He adds that the results could be even better in future. “Over the coming years, we expect to learn more about how to personalize treatments using these drugs, for example, by combining them with other drugs suitable for specific types of tumors, to improve outcomes,” Dr. DeBernardo explains.

Vaccinations and Screenings
While new treatments offer hope in the fight against cervical cancer, it is still a case of ‘an ounce of prevention is better than a pound of cure,' Dr. DeBernardo says. 
“Recent research in the UK and Australia has highlighted the effectiveness of HPV vaccine programs in reducing the incidence of cervical cancers and pre-cancers. However, more research is needed and regular screenings for cervical cancer remain vital. This is true even in countries that have immunization programs in place,” Dr. DeBernardo says. “People may elect not to have the vaccine, for example, or rare forms of cervical cancer may not be HPV-related so the vaccine would not be effective.”
Dr. DeBernardo says it is important that screenings are regular as cervical cancer can develop slowly over many years, with pre-cancerous cells becoming cancerous. He says that women who are at normal risk should start regular screenings from the age of 21 and continue until the age of 65, in line with the US Preventative Task Force recommendations. 

The most common screening tests are pap smears, which involve swabbing the cervix to collect cells that are then analyzed for the presence of high-risk HPV types in cells and pre-cancer changes in the cervical cells, Dr. DeBernardo says. While the screening guidelines vary from country to country, he recommends visiting a gynecologist every year and following his or her guidelines on the regularity of screening needed based on an individual's risk profile.
 “According to the recommendations, women above the age 65 do not need routine pap smears because the risk is lower if they have never had an abnormal result. However, women at any age can develop cervical cancer, so it is important to see a gynecologist if there are any gynecological symptoms,” Dr. DeBernardo concludes.