While deaths from cervical cancer have declined dramatically over the past several decades, it continues to be one of the most critical health threats facing women today.  The American Cancer Society estimates that, in 2004, 10,520 women in the United States will get this disease, and 3,900 will die from it. In this episode of Second Opinion, you will learn about the causes of cervical cancer, how to reduce your risk of getting it and, if you are diagnosed, how to survive it.

Thanks in large part to widespread screening with a test called the Pap smear , cervical cancer deaths among U.S. women have dropped by 74% since the mid 1950s. Although this form of cancer remains a serious health problem, it is nearly 100% preventable and, in most cases, curable. What is more, cancer vaccines may one day have as dramatic an impact as the Pap smear in reducing deaths from this disease.

Cervical cancer , most prevalent in women between the ages of 35 and 55, starts in the lining of the cervix  when normal cells change to cancerous cells. Like all cancer cells, the ones in the cervix divide rapidly and produce excess tissue, which form tumors. The process usually takes years, but it also can happen much more quickly. This, combined with the fact that there usually are no obvious physical symptoms to warn you that your cells are changing, underscores the need to have regular pelvic exams and Pap tests, which can help your doctor detect and treat these precancerous cells before they turn into cancer.

Among women who receive regular screening, the first sign of the disease is usually an abnormal Pap test result. Symptoms of more advanced disease may include:

• Abnormal vaginal bleeding (e.g., spotting after sexual intercourse, bleeding between menstrual periods, increased menstrual bleeding)
• Abnormal vaginal discharge
• Low back pain
• Painful sexual intercourse
• Painful urination

The Pap smear, a cervical cancer screening test pioneered in the 1940s, has saved the lives of countless women over the years through early detection of precancerous and cancerous cells on the cervix. It is still the best method doctors have for cervical cancer screening. In recent years, laboratory technology, and the way in which healthcare providers interpret and report results have been updated to incorporate the latest knowledge about the biology of Pap abnormalities and to improve test accuracy.  Still, the Pap test is only a screening tool. Women with abnormal test results require additional tests to determine whether or not a precancerous change or cancer are present.

Another fundamental element in today's fight against cervical cancer is a prevention strategy that encourages women to avoid risk factors known to cause precancers. Most of these risks involve exposure to certain strains of human papillomavirus (HPV) . Considered the leading cause of cervical cancer, HPV is a wart virus that is transmitted from one person to another during sexual contact.

Other risk factors for cervical cancer are:

• Smoking: Women who smoke are about twice as likely as nonsmokers to get cervical cancer.
• Human immunodeficiency virus (HIV) infection: HIV bypasses the body's immune system and puts women at greater risk for HPV infections and cervical cancer.
• Chlamydia infection: Women with past or current chlamydia infection are at greater risk for cervical cancer than are women with no history of the disease.
• Diet: Women with diets low in fruits and vegetables and women who are overweight may be at increased risk for cervical cancer.
• Oral contraceptive use: Long-term use of oral contraceptives increases the risk of cancer of the cervix.
• Multiple pregnancies: Women who have had many full-term pregnancies are at increased risk.
• Low socioeconomic status: Women with low incomes who do not have ready access to health care services, including Pap tests, are at greater risk.
• Exposure to Diethylstilbestrol (DES): DES is a hormonal drug that was prescribed between 1940 and 1971 for some women thought to be at increased risk for miscarriages. If your mother took DES, there is a slightly higher risk that you could develop cervical cancer
• Family history of cervical cancer: Women whose mother or sisters have had cervical cancer are more likely to develop the disease themselves.

Women who get cervical cancer have a number of treatment options, depending on the stage of the disease and other factors. The main treatments, which may be used alone or in combination with each other, are surgery (several different types are used), radiation therapy, and chemotherapy. According to the American Cancer Society, five-year survival rates for cervical cancer patients are close to 100% for cancer caught in its earliest stages; 92% when the cancer is slightly more advanced but has not spread beyond the cervix; and 71% for all stages combined.