January was Cervical Cancer Awareness Month, but let’s not forget the importance of preventing cervical cancer all through the year!
Almost all cases of cervical cancer are caused by the Human Papilloma virus (HPV). Scientists have identified more than 60 types of HPV virus that can affect the genitals, anus and oropharynx of both men and women. Types 16 and 18 are responsible for about 70% of all cases of cervical cancer, attributing to as many as 12,000 cases of cervical cancer in the United States each year, including approximately 500 cases of cervical cancer in Pennsylvania every year.
HPV infection is very common. As many as 90% of men and women who have ever had sex have probably had one or more types of genital HPV at some time in their lives. Anyone who has had sex can get HPV, even if it was only with only one person, although infections are more likely in people who have had many sex partners. Even if a person delays sexual activity until marriage, or only has one partner, they are still at risk of HPV infection if their partner has been previously exposed. It is most often passed onto another person without knowing it.
HPV can be present within the body for years without causing any symptoms. It doesn’t always cause warts or any other symptoms. In most people, the body is able to clear the infection on its own. But sometimes the infection doesn’t go away. Chronic, or long-lasting infection, especially when it’s caused by certain high-risk HPV types, can cause cancer over time.
So how can women reduce their risk of HPV infection and cervical cancer? Cervical cancer can be found early and even prevented with two routine screening tests.
The Pap test looks for changes in cervical cells caused by HPV infection. If pre-cancerous cells are found, they can be treated, stopping cancer before it starts. More than half of the women in the United States who get cervical cancer have never had or rarely had a Pap test. Don’t be part of those statistics!
A relatively new HPV test looks for the infection itself. It’s a way to identify the specific types of HPV infection. This test is most often done in conjunction with the Pap test.
The following guidelines have been established by the American Cancer Society to diagnose cervical cancer early:
- All women should begin cervical cancer testing (screening) at age 21.
- Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (it may be used as a part of follow-up for an abnormal Pap test).
- Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This is called co-testing and should continue until age 65.
- Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.
- Women who are at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long-term steroid use) or because they were exposed to DES in utero may need to be screened more often. They should follow the recommendations of their health care team.
- Women over 65 years of age who have had regular screening in the previous 10 years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers found in the last 20 years.
- Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical pre-cancer (or cancer).
- Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the guidelines above.
- Women who have been vaccinated against HPV should still follow these guidelines.
- Pregnancy or Childbirth does not change these recommendations. Continue to follow the American Cancer Society guidelines.
Although annual screening is not recommended, women who have abnormal screening results may need to have a follow-up Pap test (sometimes with a HPV test) done in 6 months or a year.
The American Cancer Society guidelines for early detection of cervical cancer do not apply to women who have been diagnosed with cervical cancer, cervical pre-cancer, or HIV infection. These women should have follow-up testing and cervical cancer screening as recommended by their health care team.
If you have a low income, do not have insurance or are underinsured, you may be eligible for a free or low-cost Pap test. The HealthyWomen Program is a free breast and cervical cancer early detection program of the Pennsylvania Department of Health. Services include pelvic examinations, Pap smear, and follow up diagnostic testing for abnormal screening results. Visit the Healthy Women website at www.health.pa.gov or call 1-800-215-7494 for more information.
HPV vaccines
As of 2017, Gardasil 9® is the only HPV vaccine available in the United States to prevent infection with certain types of HPV, including those types that are linked to HPV-related cervical cancer. The vaccine also provides protection against HPV types linked to oral and anal cancers as well as genital warts. The vaccine is approved and highly recommended for use in males and females to prevent HPV-related cancers. To work best, the vaccines are recommended to be given at or before age 11 or 12. This allows pre-teens the best opportunity to develop optimal antibodies to protect against high-risk HPV types well before they become sexually active later in life. HPV vaccination is also recommended for females and males up to age 26 years old who have not started the vaccines, or who have started but not completed the 3-dose series. Remember, the vaccine doesn’t treat an existing infection, but is administered for “cancer prevention.”
Regular screening tests are very important because cervical cancer rarely causes changes that would be noticed by women. It is not until the cervical cancer reaches an advanced stage that may cause abnormal vaginal discharge or bleeding or pain during sex.
The Pennsylvania Cancer Coalition is taking steps to reduce the incidence and survivorship of HPV-related cervical cancers. The HPV Vaccination Workgroup, consisting of numerous statewide partners representing health systems, public health and community agencies, are all working together to increase cervical cancer awareness and prevention of disease.
Make a resolution to protect yourself or your pre-teen daughters against HPV-related cervical cancer! Get screened! Get vaccinated! This is “cancer prevention” made simple!
For more information about cervical and HPV related cancer go to:
- The Pennsylvania Department of Health website at http://www.health.pa.gov
- The Centers for Disease Control and Prevention website at: http://www.cdc.gov/cancer/cervical/index.htm, or the
- American Cancer Society website, cancer.org, or call toll-free number, 1-800-227-2345
Resources: American Cancer Society; Centers for Disease Control and Prevention; National Cancer Institute.
Joanne Sullivan, RN, BSN, is a Research Specialist at Penn State Cancer Institute and is a volunteer with the York-Adams County Immunization Coalition.