Cervical Cancer: What Women Need to Know
By Eric Schnakenberg, MD
We live busy lives. It’s not surprising that cervical cancer is not first on our list of things to think about…but it should be. Cervical cancer is one of the most common malignancies in women worldwide. There are things you can do today to minimize your risk of this disease.
What is cervical cancer?
Unlike some other cancers, cervical cancer is not considered to be hereditary. Virtually all cervical cancers are associated with human Papilloma (HPV) infection.
Cervical cancer is cancer of the cervix, the lowest part of the uterus that projects into the vagina. This is the area that is sampled during a Pap test, also called a Pap smear.
In the United States, cervical cancer is the second leading cause of cancer-related deaths in women between the ages of 20 and 39. There is a second spike of incidence in the 50 to 69 age groups, presumably from ongoing HPV infection.
What is Human Papilloma Virus (HPV)?
Human Papilloma virus (HPV) causes a common infection that is sexually transmitted. There are many types of HPV. Some types cause external genital warts (typically visible, fleshy) that do not cause cervical cancer. Other types of HPV are oncogenic ‘cancer causing’, so-called high risk HPV, that cause precancerous changes in the cervix and are the causative agents for cervical cancer. If you are sexually active, you may be exposed to HPV and never know it. Most exposures are silent. A healthy immune system will usually clear the HPV. However, sometimes the HPV does not go way on its own.
How do I know if I have HPV?
You may not know your cervix is infected with HPV until a Pap test shows abnormal cells. Your family doctor or gynecologist can test you for HPV-DNA to determine if you carry the high risk HPV virus.
How can I protect myself from HPV and cervical cancer?
We now know HPV causes cervical cancer.
The only way to completely protect yourself from HPV is to avoid sexual activity that involves genital contact.
There are a few things you can do to further reduce your risks of cervical cancer:
- Limit your sexual partners
- Stay in a long term, exclusive relationship with someone who doesn’t have HPV
- Have regular Pap tests to detect early HPV-related precancerous changes
- Treat precancerous lesions to prevent later development of cervical cancer
- Have a HPV-DNA test to see if you carry a high risk HPV infection
- Consider the HPV vaccination to prevent HPV
What is the HPV vaccine?
There are now two HPV vaccines, Cervarix and Gardasil. These vaccines are recommended for women ages 10 to 26. Gardasil is also recommended for boys 11 to 18 years of age.
These vaccines are most effective if given before sexual exposure to HPV.
Am I too old to get the HPV vaccine?
The HPV vaccines are currently approved for women up to age 26. However, if you are high risk HPV-DNA negative and you think you are in a relationship that may expose you to HPV, you should speak with your family doctor. Vaccine use would be considered ‘off label’ for you and getting vaccinated would be a decision between you and your doctor.
How often should I get Pap testing?
Regular Pap testing is an important part of well woman care. How often you get Pap testing depends on your age and health history:
- Consider Pap testing starting at age 21
- Women younger than 30 years of age should have a Pap test every 2 years
- Women over 30 years of age should have a Pap test every 2 years. After 3 normal Pap tests in a row, a woman in this age group may have a Pap test every 3 years if:
- She does not have a history of moderate or severe cervical dysplasia (precancerous changes)
- She is not infected with human immunodeficiency virus (HIV)
- Her immune system is not weakened (for example, by an organ transplant or immunosuppressant medication)
- She is not exposed to diethylstilbestrol (DES) before birth
Should I have HPV testing?
If you are 30 years or older, you can have a high risk HPV-DNA test along with your regular Pap test. If both are negative, the chance of developing a moderate to severe cervical dysplasia (precancerous changes) in the next 3 to 5 years is very low. You do not need to have these tests again for another 3 years.
When can I stop having Pap testing?
No one is really sure about this advice, but most experts agree that women aged 65 to 70 can stop having Pap tests after 3 normal results in a row within the past 10 years. Remember, if you have certain risk factors you should have routine Pap testing. These risks include being sexually active with multiple partners or having a personal history of abnormal Pap test results.
A final thought on cervical cancer
With our new understanding that HPV causes cervical cancer and the availability of two safe and effective HPV vaccines, we are standing on the forefront of preventing cervical cancer.
For the baby-boomer generation, your counseling of younger people on the importance of healthy sexual practices and of the importance of getting the HPV vaccine will go a long way to making cervical cancer a very rare cancer indeed.
Eric Schnakenberg MD is certified by the American Board of Family Practice. He practices at Community Care Family Medicine, located at 5 Southside Drive, Route 146, Suite 204, Clifton Park. Call 518-371-9355 to schedule an appointment. Community Care Family Medicine is a member of Community Care Physicians, PC. For more information, visit www.communitycare.com.
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