Cervical cancer is one of the most common cancers among women worldwide. Last year, The American Cancer Society’s estimated for cervical cancer in the United States that about 14,100 new cases of invasive cervical cancer would be diagnosed and about 4,280 women would die from cervical cancer.
What Is Cervical Cancer?
It is a malignancy in which cells grow out of control in the cervix (the structure which connects the vagina and the uterus/womb). Most cases occur in medically underserved areas where resources are limited. The decreased incidence and mortality in areas with good medical care is due to the availability of screening and human papillomavirus (HPV) vaccination programs.
Precursors to cervical cancer can be detected through screening with the Papanicolaou (Pap-smear) test also known as cytology, HPV testing, and co-testing with both tests. Infection with high-risk HPV is the most important determinant of development of cervical cancer.
Screening is associated with a decreased incidence of cervical cancer. Treatment initiation during precursor/early stage can help reduce progression to cervical cancer. Please note: cervical screenings can be completed by either the patients Primary Care Physician (PCP) or their Obstetrician-Gynecologist (OB-GYN).
What Is a Pap Smear?
A Pap smear collects cells from the cervix, then sent to the lab to look for abnormal cells. A lab test to detect HPV may also be done.
Risk Factors of Cervical Cancer
Any individual with a cervix runs the risk of having cervical center. However, there are several factors that can increase the risk for having cervical cancer, such as:
- Family history of cervical cancer
- Multiple sexual partners
- Having sex at younger than 18 years of age
- Infection with human papillomavirus (HPV)
- Sexually transmitted infections
- Being immunocompromised, history of HIV
- Previous history of abnormal cellular changes of the cervix or vaginal area
- Having a mother who took diethylstilbestrol (DES) while pregnant. (This is a rare occurrence.)
Symptoms of Cervical Cancer
Cervical cancer often has no symptoms at all, which is why screening is so important. Below are some of the common symptoms:
- Abnormal vaginal bleeding, spotting, or discharge
- Trouble with urination
- Pelvic pain
- Swelling in the legs
Screening in Average Risk Patients
Depending on a woman’s stage of life and their risk factors regarding cervical cancer, different precautions are taken when screening for cervical health. According to The Centers for Disease Control and Prevention, depending on the age of an average risk patient, there are certain screenings that should take place during an Obstetrician-Gynecologist (Ob-Gyn) appointment. Please review the guide below.
- Age <21: No screening needed
- Age 21-29: In asymptomatic patients with normal immunity; Pap smear test every 3 years
- Age 30-65: In asymptomatic patients between 30-65; Pap smear test every 3 years, or HPV testing every 5 years; or both tests every 5 years
- Age over 65: No screening needed
Cervical Screening Exceptions
There are several exceptions when it comes to cervical health screening. For example, if you are immunocompromised, have HIV, a history of cervical cancer, or a rare DES exposure, you may need more frequent screening. Continued screening for over 20 years is recommended if you have had a hysterectomy (uterus/womb removed) with the cervix removed along with a history of cervical cancer or cervical changes.
If you had a subtotal hysterectomy (uterus/womb removed but keeping the cervix): you should be treated the same as those that have not had a hysterectomy. Also, if you have had no history of cervical cancer or cervical changes, screening is not needed.
Understanding Cervical Cancer Screening Results
Following up on an abnormal cervical cancer screening test is extremely important. Invasive cervical cancer can occur within 2 years if an abnormal Pap smear is ignored.
A Human Papillomavirus (HPV) test can be positive or negative for the high-risk types of the virus. If the HPV is positive, chances are it may clear up by itself within 2 years, but it should be followed with regular testing for the next 25 years. Quitting smoking and a healthy diet rich in anti-oxidants (vitamins found in fruits and vegetables) can help your immune system clear up HPV.
Depending on your age, risk factors if any, and your results, your doctor may order additional procedures, such as:
- Colposcopy—the doctor can closely examine your cervix in the office with a microscope
- Biopsy—the doctor can take a small sample of tissue which can be further tested at the lab to see the number of cellular changes, graded as mild (CIN 1), moderate (CIN 2), severe (CIN 3)
- Endocervical sampling—the doctor can take a tissue sample from inside the cervix with a small brush to be tested further at the lab to check for cellular changes
- Follow up testing, such as more frequent Pap smear tests or treatment to remove abnormal cells
What is Human Papillomavirus (HPV)?
Human Papillomavirus is a virus that is spread through sex—either vaginal, anal, or oral. There are usually no symptoms. But over time it can cause changes in the cells of the body. Over time, this can turn into cancer of the cervix, anus, penis, mouth or head and neck. Some types of HPV have a stronger tendency to cause cancer than others. Lower-risk types of HPV may cause genital warts.
Vaccines can protect against HPV. The ideal age to be vaccinated is 9-12 years old. It works best if the vaccine series is completed before sexual activity begins. But the vaccine can be given after the person becomes sexually active up to 45 years of age.
Important things to remember
- Regular screening with Pap smear can detect early changes and lead to early intervention against cervical cancer
- Cervical cancer screening with Pap smear can be done by your primary care doctor or your Ob-Gyn