Cervical cancer was once one of the most common causes of cancer death for women in the United States. Two important developments have dramatically reduced the rate of cervical cancer – the Pap screening test and the HPV vaccine, says Dr. Rocio Gonzalez, an obstetrician/gynecologist at Montefiore Nyack Hospital.
What is Cervical Cancer?
Cervical cancer starts in the cells lining the cervix—the lower part of the uterus, or womb. The cervix is covered with a layer of healthy cells that are constantly changing. They can become cancerous and divide and spread to other tissue. Up to 14,000 women in the United States are diagnosed with cervical cancer every year, and about 4,000 die from the disease. It occurs most commonly in women over age 40.
Cervical cancer forms slowly, over many years. Most cases of cervical cancer occur in women who’ve never had a gynecological screening exam. If the precancerous cells are identified and treated, almost all these cancers can be prevented.
Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer. HPV is a common virus that is passed from one person to another during sex. At least half of sexually active people will have HPV at some point in their lives, but few will get cervical cancer.
The HPV Vaccine
There are many types of HPV. Some types can cause changes on the cervix that can lead to cervical cancer, while other types can cause genital or skin warts. The HPV vaccine protects against the types of HPV that most often cause cervical cancer. It also protects against the HPV strains that cause most genital warts.
The HPV vaccine is recommended for preteens—girls and boys—aged 11 to 12 years, but can be given starting at age 9. The vaccine is recommended for everyone through age 26 years if they are not vaccinated already, Dr. Gonzalez said. HPV vaccination prevents new HPV infections but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before someone becomes sexually active.
The vaccine is highly effective – up to 99%, Dr. Gonzalez said. Two doses are required if given before age 14. If given starting at age 15 or older, three doses are required.
Dr. Gonzalez tells her sexually active patients that even if they have had an HPV vaccine, they still need to use condoms to avoid other HPV infections with different strains that are not covered by the HPV vaccine. That is because the vaccine does not protect against every strain of HPV that causes cervical cancer. Condoms also protect against other sexually transmitted diseases.
In addition to being vaccinated against HPV, women should have regular screening tests to help prevent cervical cancer or find it early. These tests are the Pap test (or Pap smear) and the HPV test. The Pap test looks for cell changes on the cervix that might become cervical cancer if they are not treated. The HPV test looks for the HPV virus, which can cause these cell changes.
When to Get Screened
You should start getting Pap tests at age 21. Between the ages of 21 and 29, if your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test. Between the ages of 30 to 65, your doctor will recommend which type of testing is best for you. The options are:
• An HPV test only. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
• An HPV test along with the Pap test. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.
• A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test. If you are over 65 and you have had normal screening in the past, your doctor may tell you that you don’t need more Pap tests, Dr. Gonzalez said.
Importance of Annual Exams
Regardless of how often you have cervical screening tests, you should have an annual gynecological exam, Dr. Gonzalez said. On visits when you don’t have a screening test, the doctor will perform a pelvic exam to look for lesions in the cervix and vagina. The doctor will talk with you about issues relevant to your stage of life. These can include birth control, sexually transmitted infection screening and prevention, menstrual problems, or osteoporosis.
“An annual gynecologic exam is a time to talk about how to maintain a healthy lifestyle and minimize health risks,” Dr. Gonzalez said.