The Current Wisdom on Screening for Cervical Cancer

The Current Wisdom on Screening for Cervical Cancer

It used to be that women were encouraged to get a Pap test every year to detect microscopic cells that could be signs of cervical cancer. Thanks to this simple test, the number of women who die from cervical cancer has decreased dramatically in the past 50 years. The Pap is still important, but because so much more is now known about the cause and progression of cervical cancer, screening guidelines have changed.

Screening guidelines for cervical cancer

  • 1st Pap test at age 21, whether or not you’ve been sexually active

  • 21-29 Pap test every two years

  • 30 and older Pap and HPV test every three years

  • 65 and older may discontinue if three or more negative tests in a row and no abnormal test results in past 10 years

Results from a recently released National Cancer Institute study of more than 330,000 women upheld the recommendation that cervical cancer screening every three years is acceptable for women 30 and older.

Researchers also concluded that testing for the human papillomovirus (HPV) was “clearly superior” when it came to predicting who was at high risk of developing cervical cancer in the future. Because the Pap test is still useful in uncovering abnormal cells that could be cancer or pre cancer, the American College of Obstetricians and Gynecologists and the American Cancer Society recommend that women 30 and older be screened with both the HPV and the Pap test. An HPV test can easily be done at the same time as the Pap.

Study after study has shown that nearly 100 percent of all cervical cancers are caused by the presence of HPV. Of the more than 100 strains about 30 are spread by sexual contact. Apparently you do not need to have sexual intercourse or exchange bodily fluids to be exposed; the virus is easily transmitted through intimate skin-to-skin contact. Most strains are considered low risk and do not appear to cause cancer. About 15 are linked to cancer of the cervix, anus, vulva, vagina, penis and throat, two of which 16 and 18 cause most cases of cancer of the cervix.

Most of the time the immune system gets rid of both low and high-risk viruses without any symptoms or further problems. In a small number of women however, the HPV infection doesn’t go away and may cause normal cells to change and eventually become cancerous. There is no treatment for HPV, but there is treatment for the cell changes it may cause.

Two vaccines are also now available to protect against four types of HPV, two that cause most cases of genital warts and the two that cause most cervical cancers. They are recommended for females between 9 and 26, and while considered most effective if you haven’t had sex yet, they still offer protection after you’ve become sexually active.

Testing for HPV is not recommended as a routine for women under 30 because the infection rate is so high in that age group. “ There are a high number of false positives in 20 to 30 years olds, which is not helpful,” says Maine Medical Center’s Chief of Pathology Dr. Michael Jones. “The key thing is that they are usually transient infections. A competent immune system can get rid of the virus.” While HPV infections are common, the rate of cervical cancer at this age is low and it usually takes several years for even precancerous cells to develop.

From 30 on rates of HPV infection decrease and screening results become more meaningful.

Even though HPV is an important risk factor for cervical cancer, most women with this infection do not get cervical cancer. The American Cancer Society says usually other risk factors must also be present.

Some additional risk factors

Smoking

Weakened immune system

Long-term use of birth control pills

Multiple full term pregnancies

Younger than 17 at the time of first full-term pregnancy

Mother took DES (diethylstilbestrol) when pregnant

Family history

The recommendations for Pap and HPV testing are meant only for screening purposes. If either test is abnormal or you are considered at risk, you and your doctor need to decide on the next steps. And even if you don’t need a yearly Pap test, it doesn’t mean you don’t need an annual physical, including a pelvic exam. You do!

Dr Jones says, “Unfortunately, while it’s rare, I still see younger women who fall through the cracks. Mostly though, we diagnose it in older women, some of whom stopped getting Pap tests after they stopped having babies and then ten years later developed cervical cancer.”

Sometimes women don’t get regular exams simply because they can’t afford to. Dr. Sheila Pinette, Director of Maine CDC, urges those women to look into the Maine Breast and Cervical Health program, which has been providing eligible women statewide free access to Pap tests, pelvic exams and mammograms since 1995. The program does not cover HPV testing for screening purposes, but will as a follow-up if certain abnormalities show up on a Pap test. For information about the program and eligibility requirements, call 1-800-350-5180 (TTY: 1-800-438.5514).

At one time, cervical cancer was the leading cause of death for women in this country. While that’s no longer true, every year too many women die of a disease that when caught early, can be easily cured. Please, if you’ve been putting it off make an appointment to be screened today. If you have questions that weren’t addressed in this column, you can get more information on the National Institutes of Health website.

For more information, visit the web site of the National Institutes of Health: www.nlm.nih.gov/medlineplus/cervicalcancer.html


Diane Atwood was the health reporter on WCSH-TV for more than 20 years. She is now a freelance medical writer and also has a health and wellness blog called Catching Health. To read her blog or learn more about the writing services Diane offers, go to www.dianeatwood.com You can also send her an email: diane@dianeatwood.com

No, it’s not a cheese puff or funky flower. It’s an extreme close-up of the human papillomovirus, more commonly known as just HPV. There are more than 100 strains of HPV, only 30 of which are spread through sexual contact. Studies have shown that nearly all cervical cancers are caused by HPV, though an HPV infection does not always lead to cancer.Diane Atwood is a health and wellness communicator based in southern Maine. Her website is www.dianeatwood.com.

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