By Laura Holland, MD
Lead Physician, OB/GYN
In the US, 12,710 cases of invasive cervical cancer are expected to be diagnosed this year. Among those cases, 4,290 deaths will be attributable to the disease. According the National Cancer Institute, 48 is the typical age for diagnosis of cancer of the cervix. Black and Hispanic women are the hardest hit by this disease.
Cervical cancer is caused by certain oncogenic (cancer-causing) strains of the human papilloma virus (HPV), a common sexually transmitted infection. Most women with healthy immune systems effectively eliminate HPV infections. Only a small fraction of women with persistent HPV infection will develop cervical abnormalities that lead to cancer. There are more than 30 types of the HPVs; however, most cases of cervical cancer are caused by types 16 and 18.
Fortunately, a vaccine can be given to girls and women from ages 11 to 26 to protect them from these viruses. The vaccine has the potential to prevent more than 4,000 women from dying of cervical cancer each year. It is most effective if given long before a woman becomes sexually active, and that is why it is recommended for 11-year-olds to receive it. These vaccines are nearly 100% effective in protecting females who have not already been exposed to the types of HPV covered by the vaccine. The Centers for Disease Control (CDC) has determined that the vaccine is safe. The most common side effect is soreness in the arm where the shot is given. On rare occasions, a person who receives the shot can experience headaches, fatigue, nausea, dizziness, or fainting. These symptoms are usually mild. Medical advances such as the HPV vaccine have, and will continue to, dramatically decrease rates of cervical cancer.
Meanwhile, the use of the Pap test has successfully reduced cervical cancer deaths by over 50% in the past 30 years. The Pap test can detect changes of the cervix that can lead to cancer. It is a simple, fast test that takes less than a minute to do. A small number of cells are gently removed from the cervix and sent to a lab for testing. An HPV test is usually taken from the same sample.
Most cervical cancers in the US occur among women who have never had a Pap smear or women who did not follow the recommendations to receive Pap smears on the schedule outlined below. How often a woman should receive a Pap test depends on her age and her history:
- Women under 21 should not have Pap smears.
- Women ages 21–29 should have a Pap test every 3 years.
- Women ages 30–65 should have a Pap test and HPV test (co-testing) every 5 years (preferred). It is acceptable to have a Pap test alone every 3 years.
- Women age 65 or older can often stop having Pap tests if they meet certain criteria.
- Women, regardless of age, who have had a hysterectomy with removal of the cervix (total hysterectomy) and have no history of cervical dysplasia (CIN 2 or CIN 3) should discontinue routine cervical cancer screening.
- Women with a history of CIN 2, CIN 3, or adenocarcinoma in situ should continue routine age based screening for at least 20 years.
These recommendations are endorsed by the US Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP).
A small number of women may require further testing if their Pap smear is abnormal. This testing is sometimes a repeat Pap smear or sometimes a colposcopy, which will help your provider look at your cervix more closely.
Although the annual Pap is no longer recommended, women need to understand that their annual well-woman check-up is very important. Please remember to schedule one with your primary care provider for this new year!
If you are a Whittier patient, you can call our Obstetrics and Gynecology Department for an appointment at 617-989-3129, or schedule a visit online at http://wshc.org/make-an-appointment/.