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Uncovering an Estrogen Enigma

Uncovering an Estrogen Enigma
Scientists’ findings fuel the fight against cervical cancer

January 2006

by Jacquelyn Spruce

It takes every bit of Janie Herrera’s strength to help her four children with their homework and tuck them into bed each evening. The once on-the-go wife and mother used to spend her days substitute teaching and tending to the needs of her family. But those days began to dwindle in September when results from Herrera’s routine well-woman exam transformed her life into something she never thought possible.

Herrera, 38, was diagnosed with an aggressive variant of cervical cancer called glassy cell carcinoma that accounts for less than 1 percent of all cervical cancers.

"If her cancer was diagnosed as being confined to the cervix, then surgery would have been a very reasonable option," said Kevin Hall, M.D., associate professor of obstetrics and gynecology at the Health Science Center.

But at the time of diagnosis, Herrera’s cancer had already spread to other parts of her body. So her only treatment options were radiation and chemotherapy.

"The treatments really take a lot out of you," Herrera said. "After experiencing all of this, I realized I want to do anything I can so that other people don’t have to go through what I do."

As a result, she enrolled in a clinical study at the Health Science Center conducted by Dr. Hall, who is co-principal investigator of the Estrogen and Cervical Cancer study.

The clinical study resulted from landmark evidence discovered last summer by Health Science Center Professor Rajeshwar Rao Tekmal, Ph.D., co-principal investigator who holds the Carl J. Pauerstein Professorship in Reproductive Research, and his research team. Knowing from previous studies that hormones might play a role in the progression of cancer, the researchers screened two groups of women: a group who had normal Pap tests, and another group whose abnormal Pap tests indicated signs of cancer and an infection called the human papillomavirus (HPV), which can lead to cancer.

The results of the study suggest that estrogen can fuel the progression of cervical cancer, raising the possibility that estrogen inhibitors could be used as a line of therapy to treat cervical cancer.

"Through our observations we found evidence that 35 percent of the cervical tumors tested are capable of making estrogen," Dr. Tekmal said. "We now know that, like breast tumors, cervical tumors are capable of making estrogen, too."

Approximately 99 percent of cervical cancer cases are caused by the HPV infection. HPV, most commonly known as the virus that can cause genital warts, is the name of a group of viruses that includes more than 100 different strains. This sexually transmitted infection is so common that by age 50, four of every five women will have acquired it, according to the U.S. Centers for Disease Control and Prevention. Approximately 20 million people are currently infected with HPV, and although it often goes unnoticed in men, it can cause tragic results in women.

"But not all women infected with the virus will develop cervical cancer, indicating that other factors are involved along with HPV to induce the cancer," Dr. Tekmal said. "That is what our original study examined and we expect the clinical trial to provide us with more precise evidence."

A regular Pap test is the best method of detecting and treating HPV right now,
Dr. Tekmal said, because it can detect precancerous and cancerous cells on the cervix. Regular testing and careful medical follow-up can help ensure that precancerous changes in the cervix caused by the HPV infection do not develop into life-threatening cervical cancer.

Herrera had not had a Pap test in six years.

"As a mother, I was always concerned about my children’s health first and about being financially stable for them," she said. "I just put off my health for too long."

Her cancer was diagnosed at stage II. Stage IV is the most severe. Fortunately, Herrera’s treatments have significantly reduced the size of her cervical tumor.

Although Dr. Tekmal’s research is only in its beginning stages, the results have formed a strong foundation for future studies.

"We plan to advance our research by studying more patients in this trial and by further observing the links between estrogen and cervical cancer," Dr. Tekmal said. "Our ultimate goal is to determine the prognostic importance of the local estrogen production in cervical tumors, and design and test therapeutic approaches to stop local estrogen production."

In the meantime, Herrera continues to participate in the clinical study, trusting that her role in it will help save women’s lives.

"I have three boys and one girl," she said. "Just like every mother, I want to see each of my children get married and I want to live until I’m old and gray. My family is my rock, my support."

Drs. Tekmal and Hall are pleased with the preliminary evidence that could lead to advanced treatments for cervical cancer. By continuing to thoroughly study the causes and potential treatments of cervical cancer, they hope to find a cure for women like Herrera.

"Ultimately, we want to limit the number of deaths from cervical cancer, and with this novel finding, we may be one step closer," Dr. Tekmal said.

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Updated 7/30/14