Introduction

Cells in the cervix – an opening that connects the uterus (womb) to the vagina – reproduce only when new cells are needed. Sometimes cells that line the cervix grow and divide out of control, creating a mass of abnormal cells called neoplasia (sometimes called dysplasia). If the abnormal cells are contained within the three layers of the cervix (the outer, middle, and inner lining), the neoplasia is considered benign (not cancerous).  If, however, the abnormal cells spread to surrounding tissues and organs, the neoplasia is considered malignant (cancerous).

The two types of cervical cancer are squamous cell carcinoma (SCC) and adenocarcinoma.  SCC accounts for up to 90% of all cases of cervical cancer in the United States.  It develops from squamous cells – the cells that line the inner part of the cervix.  Adenocarcinoma involves cells that line the mucous-producing glands of the cervix.

Only some women with neoplasia of the cervix – usually called cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL) – will develop cancer. It usually takes several years for these pre-cancerous lesions to develop into cancer, although it can happen in less than a year.  However, in many women, these pre-cancerous lesions go away without any treatment.

According to the American Cancer Society, there are a number of risk factors for cervical cancer.  Here are a few important risk factors to know about:

• Human papillomavirus (HPV) infection. Experts believe that HPV is the primary cause of cervical cancer, meaning that infection with this virus is necessary for precancerous lesions to form and develop into cancer.  While HPV is typically spread through heterosexual intercourse – many lesbians do have a history of heterosexual relationships – the virus can also be spread by lesbian sexual activity.
  
  
• Irregular healthcare visits.  Many women, including lesbians, do not access healthcare or the tests used to detect cervical problems on a regular basis.  This greatly increases the chances of precancerous lesions of the cervix going undetected and developing into cancer.
  
  
• Smoking. Women who smoke are twice as likely as non-smokers to develop cervical cancer.
  
  
• Human immunodeficiency virus (HIV) infection. Women infected with HIV are more likely to be infected with HPV and to develop pre-cancerous lesions.  It is also possible that HIV-positive women are at a higher risk for cervical cancer.
  
  
• Diet. Women with diets low in fruits and vegetables may be at increased risk for cervical cancer. Overweight women are also more likely to develop cervical cancer.

The Bad

Worldwide, cervical cancer is the second most common form of cancer in all women (after breast cancer), and the most common in younger women.

The American Cancer Society estimates that in 2007, about 11,150 cases of malignant cervical cancer will be diagnosed in the United States. Approximately 3,670 women will die from cervical cancer in the United States during 2007.

Cervical cancer occurs most often in Hispanic women; the rate is over twice that in non-Hispanic white women. African-American women develop this cancer about 50% more often than white women.

The Good

Cervical cancer is preventable!

Cervical cancer was once one of the most common causes of cancer death for American women. Between 1955 and 1992, the number of cervical cancer deaths in the United States dropped by 74%. The main reason for this change is the increased use of a very important test: the Papanicolaou (Pap) test.

Pap tests can find changes in the cervix before cancer develops.  It can also find early cancer in its most curable stage.  Because of Pap smears, the number of cervical cancer deaths in the United States has dropped by 74% since 1955.  What’s more, the death rate from cervical cancer continues to decline by nearly 4% a year.

There is no reason for any woman to die of cervical cancer. And with regular Pap tests, virtually no woman would.  Read more about Pap tests in the What to Do and Tools sections below.

A vaccine was approved in 2006 to prevent four types of HPV infection, two of which are known to cause 70% of cervical cancers.  The vaccine is recommended for girls and women ages nine to 26.  It is expected to work best in girls and women, before they become sexually active.  The vaccine will not be effective in women who have already been infected with the two HPV types known to cause cervical cancer.  

Why is it LGBT?

Lesbians and bisexual women may be at less risk of acquiring HPV, if they have less sexual intercourse with men. However, many lesbians and bisexual women do or have had sexual intercourse with men. Furthermore, HPV is transmitted between women during sex.

According to information published by the King County (Washington State) Department of Public Health, there is evidence that lesbians and bisexual women are less likely seek routine healthcare because of the discomfort of coming out to health care providers and less access to health insurance. Additionally, because lesbian and bisexual women are less likely to need birth control, they are less likely to have regular gynecological check-ups and Pap tests. For these reasons, lesbians and bisexual women may be at greater risk for cervical cancer, as precancerous lesions would be less likely to be detected at earlier, more treatable, stages.

What to Do

• Work with your healthcare provider to identify problems before they happen.
• Have a Pap test at age 18 (or when you become sexually active, whichever comes first) and every year for three years. If you have had three negative annual Pap tests in a row, your health care provider may recommend that you have it somewhat less often (every 2-3 years) depending upon your risk. HIV-positive women should have more frequent Pap tests. 
• Try to limit your risk of contracting HPV, a virus that can cause cervical cancer, by limiting the number of your sexual partners and by delaying the age at which you become sexually active.
• Don't smoke cigarettes.
• Eat a diet high in fruits and vegetables and low in fat.

Tools

• See a doctor. Be sure to see a healthcare provider on a regular basis, preferably once a year.
  
  
• Learn about Pap tests.  To check for neoplasia or cancer, a healthcare provider can perform a Pap smear, in which cells are scraped from the cervix or anus and examined under a microscope. If the cells are found to be abnormal, a second Pap smear should be conducted to confirm these results.
  
  An abnormal Pap-smear result calls for closer examination. At this point, a colposcope – a magnifying device – is used to look for cancerous or pre-cancerous patches, or lesions of the cervix. If lesions are found, a biopsy can be performed to learn more about the abnormal cells.