Charles Webb, MD

Cancer screenings are a vital part of a woman’s reproductive and overall health. While breast cancer is the most common reproductive cancer in women, cervical cancer is the third most common type of gynecological cancer, following endometrial and ovarian cancer.

This type of cancer starts in the cells of the cervix, the lower part of the uterus that connects to the vagina. In the United States, about 13,000 new cases of cervical cancer are diagnosed, and about 4,000 women die of this type of cancer each year.

Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44, with an average diagnosis age of 50. It rarely develops in women younger than 20. Many older women don’t realize they are still at risk of developing cervical cancer as they age, when in fact, the risk of transmission slowly increases with age. More than 20% of cervical cancers are found in women over 65. However, these cancers rarely occur in women who have been getting regular tests to screen for cervical cancer before age 65.

If caught early, cervical cancer can be treated and often cured. However, there are typically no symptoms in the early stages. If a woman does not get regular screenings, precancerous cells typically become cancer cells over time. Without symptoms, the cancerous cells may not be caught until a later stage, making them more challenging to treat. Cervical cancer screenings and following vaccination guidelines for the human papillomavirus are two important prevention steps to greatly decrease your risk of cervical cancer.

Human Papillomavirus (HPV)

Nine out of ten cases of cervical cancer are caused by HPV, the human papillomavirus. HPV is the most common sexually transmitted infection in the US, often acquired soon after initiating sexual activity. The risk of transmission is also higher with any new sex partners.

There are over 200 strains of HPV, and many HPV infections are cleared by the immune system. Some types of HPV infections may cause warts in different areas of the body, including the mouth and genitals, but don’t lead to cancer. Certain types of high-risk genital HPV infections are passed through sexual or other skin-to-skin contact and may take 20 years or longer to develop into cervical cancer. Certain HPV strains are also associated with cancer of the vagina, penis, anus, head, and neck.

The HPV vaccine was introduced in 2006 and is widely available. While getting vaccinated doesn’t mean you have no risk of contracting cervical cancer, the vaccine has the potential to prevent over 90% of cancers caused by certain high-risk HPV strains. The vaccine is seen to be most effective if it’s administered before the patient is sexually active.

Current guidelines recommend children (both boys and girls) ages 11-14 complete the two-dose vaccination series, but it is safe to give as early as 9 years old. A three-dose series is recommended for patients ages 15-27 who have not been vaccinated or did not complete the series. Parents are encouraged to talk to their pediatrician about HPV vaccinations for their children.

For anyone ages 27-45 who has not had the HPV vaccine, it is recommended to discuss the risks and benefits with your health care provider. It is not recommended for those over 45, as most have been exposed to the virus, and the immune response may not be as effective. Those who are pregnant or allergic should not take the vaccine.

Since the vaccine was introduced, the incidence of HPV infections and cervical pre-cancers (abnormal cells on the cervix that can lead to cancer) has dropped by over 80% in teen girls and young women, with an overall 40% drop for women who have been vaccinated.

Cervical Cancer Screening Guidelines

Screening for cervical cancer may include Pap tests, HPV testing, or both. For both tests, cells are taken from the cervix and sent for lab testing. The Pap test looks for any abnormal cells, and the HPV test looks for infection from the HPV strains linked to cervical cancer.

            Younger than age 21

• No screening is needed

            Ages 21-29

• Complete a Pap test alone every three years
• HPV testing alone can be considered for women ages 25-29, but Pap tests are preferred

            Ages 30-65: Choose one of three options:

• Have a Pap test and an HPV test every five years (co-testing)
• Have a Pap test alone every three years
• Have an HPV test alone every five years

Ages 65 and older: Testing is not needed if there is no history of cervical changes in the last 10 years, with the last test in the previous three to five years, depending on the type of testing completed:

• Three negative Pap tests in a row
• Two negative Pap tests in a row
• Two negative co-test results in a row within the past 10 years

Women who have been vaccinated for HPV still need to be screened for cervical cancer, as well as those who have had a hysterectomy with the cervix still intact.

The annual women’s wellness visit is also an important part of a woman’s preventive health. It includes a review of any symptoms, along with breast and pelvic exams, screenings, and labs as needed. Schedule an additional appointment with your provider or gynecologist immediately if you have any abnormal symptoms, including prolonged or heavy periods, abnormal vaginal bleeding, breast issues, or pelvic pain.

It’s important to discuss both the HPV vaccine and cancer screening guidelines with your health care provider or gynecologist to decide what works best for you. Stay proactive with prevention measures to protect the future you against cervical cancer. The result pays off big, with a much lower risk of cervical cancer in the long run.