January is Cervical Health Awareness Month (as designated by the United States Congress, who knew!). The cervix is the lower portion of the uterus that opens into the vagina. I thought we might discuss cervical cancer screening. Generally, we think about the Pap test (Pap smear, or cervical cytology) first when we talk about cervical cancer screening.
What is the Pap test? A Pap test is a screening test (a test done to detect potential health disorders or diseases in people who do not have any symptoms of disease) that looks for precancerous changes (dysplasia) or cancerous changes in the cervical cells. The test was developed by Dr. George N. Papanicolaou in the 1920s and was widely introduced into medical practice in the 1940s after he published a paper describing the test. Before the Pap test was introduced, cervical cancer was the leading cause of cancer deaths in American women. Since the introduction of the Pap smear, death due to cervical cancer has dropped by more than 70 percent, and now ranks 13th in the U.S.. According to the American Cancer Society, over 13,000 new cases of invasive cervical cancer will be diagnosed this year, and about 4,250 women will die from cervical cancer. Cervical cancer occurs when the cells become abnormal, and grow over time without normal control over the cells. As the cancer develops, it can invade other surrounding organs, such as the vagina, the bladder, and the bowels. Early detection is important, and when detected early, the five-year survival rate approaches 92%. It usually takes cervical cells 3-7 years to change from high-grade (severe) dysplasia to cancer.
How is the Pap test performed? Cervical cells are obtained during a pelvic exam when a speculum is placed in the vagina so that the cervix can be clearly seen, and a sample is taken from the cervix with a brush or special device. The cells are examined under a microscope, sometimes with the use of a computer aiding in the examination, to look for abnormalities in the cells.
Who should get the test and how often should it be done? The recommendations have changed over the years, and now the new guidelines according to The American College of Obstetricians and Gynecologists are:
Women aged 21-29 years, should get a Pap test every 3 years.
Women aged 30-65 should have a Pap test and an HPV test (more on this later) every 5 years (“co-testing”), or a Pap test every 3 years.
Women over the age of 65 years should stop having Pap tests if they do not have a history of moderate or severe dysplasia, AND they have had either three Negative Pap test results in a row or two negative co-test results in row within the past 10 years, with the most recent test performed in the past 5 years.
Women with a history of a hysterectomy may still need Pap tests/screening, if the cervix was not removed with the hysterectomy (supracervical hysterectomy), or if they have a history of moderate or severe dysplasia, or cervical cancer.
These recommendations are for most women, but other medical history such as HIV infection, HPV infection, medical conditions causing weakened immune systems, DES (diethylstilbestrol) exposure before birth, cervical precancerous changes, or cervical cancer may need more frequent or longer screening.
You should avoid sexual activity, douching, or tampons for 24 hours before you have your Pap test.
What is HPV and how do you test for it? Human papillomavirus (HPV) is a common viral infection and it can be passed from person to person during sexual activity. HPV is the cause of most cervical cancers. The virus enters the cell’s DNA and can cause changes that can lead to cervical cancer. There are over 100 types of HPV, but there are some types associated with cancer of the cervix, vagina, vulva, anus, penis, mouth, and throat. These types are known as “high-risk types.” Most HPV infections will be cleared from the cells on their own. In some people, the infection does not clear over time. The HPV test looks for the DNA of the most common of the high-risk types. It is run from the sample taken from the cervix. HPV screening is not recommended for women ages 21-29 years old. A vaccine is available for prevention of certain types of HPV for ages 11-45 years old. Even if you have had an HPV vaccine, you should still have cervical cancer screening.
What happens if I have an abnormal Pap test or HPV test? Abnormal tests are common, due to the frequency of HPV infections. If you have an abnormal test, it does not mean that you have cervical cancer. Additional testing, such as repeating the Pap test, or colposcopy (a test that uses a microscope to look at the cervix for abnormal changes) with possible biopsy (a small sample of tissue is removed, and sent to the laboratory for examination) may be done. Your medical provider should discuss the results with you as well as the plan of care based on the findings.
Finally: It may be tempting to skip your routine GYN visits, but this can have significant consequences. If you have not had a cervical screening exam in the appropriate time frame, please call to schedule an appointment with your medical provider.