As a physician who has performed thousands of pap smears in my career, I can say that January is a very important month to gynecologists and other primary care doctors who take care of female patients. It’s Cervical Cancer Awareness Month—the perfect time to focus on and spread the word about the prevention of this still all-too-common disease. As with so many other diseases, early detection through screening tests is the key to successful treatment.
Cervical cancer does not just happen overnight. Typically it develops from pre-cancerous changes that progress over a long period of time (months to years). These changes in the cervical cells are what are picked up on pap smears. Not all women with pap abnormalities will go on to develop cancer. In fact, many of the pre-cancers may remain unchanged or even go away without treatment. When necessary, treatment of pre-cancers can prevent almost all true cervical cancers.
The number one risk factor for cervical cancer is infection with HPV (Human Papilloma Virus). HPV is a group of about 150 related viruses, many of which cause papillomas (or warts). Certain types cause warts on and around the genital organs. The types that are seldom linked to genital cancers are labeled as low-risk, and those that are strongly linked to genital cancers are labeled as high-risk.
HPV infection is very common. In most people, the body clears the infection on its own. In fact, many women may not even be aware that they have been exposed to the virus. Sometimes the infection becomes chronic and can eventually cause genital cancer (cervical, vulvar, anal, and/oral).
Although HPV is spread mostly commonly through sex, all that is needed for spread of the virus is skin-to-skin contact with an infected body part of another person. Since it is unrealistic to expect a sexually active woman to avoid skin-to-skin contact, the use of condoms to help lower the risk of exposure must be advised. Patients need to be mindful that while condom use can lower the risk of most sexually transmitted infections, they do not completely prevent it.
Other factors which have been shown to increase the chances of cervical cancer are:
- Smoking—smokers are 2x as likely to get cervical cancer as non-smokers
- Age less than 17 at 1st full-term pregnancy
- Having multiple full-term pregnancies
What is involved in cervical cancer screening?
According to the American Cancer Society’s guidelines, women should begin having pap smears at age 21. If normal, these tests should be repeated every 3 years until age 30. If abnormal, additional testing with HPV should be done to help decide what further evaluation and follow-up is needed. At age 30, pap and HPV (co-testing) should be done every 5 years until age 65, or a patient can continue to have pap smears only every 3 years. Women over 65 may stop having pap smears as long as regular screening in the past 10 years has been normal, and the patient has had no pre-cancer in the past 20 years.
Remember, routine screening is for women whose tests have remained normal. Also, each physician has his or her own preferences for screening schedules and patients’ own risk factors will be taken into consideration when deciding which tests best suit their individual needs.
In the near future, screening guidelines may change, as the HPV test alone has been approved by the FDA for screening. We may see far fewer pap smears being performed in years to come; however, at this time, the pap smear remains a very valuable tool.
Here are some things that patients can do to help ensure that their pap results are accurate:
- Schedule the appointment for a time at least 5 days after the menstrual period is over
- Don’t use tampons, birth control jellies, vaginal creams or lubricants for 2-3 days before the test
- Avoid douching for 2-3 days before the test
- Avoid intercourse for 2-3 days before the test
Most cervical cancers are diagnosed in women who have failed to undergo routine screening. Don’t let this happen to you. Have the test done, and most importantly, make sure your results are made available to you. It’s the responsible thing to do!