Cervical Cancer Screening and HPV Vaccine Guidelines

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By Janet Horn, M.D., Lifescript Women’s Health Expert
Published January 24, 2010
Cervical Cancer Facts That'll Save Your Life
Cervical cancer is in the spotlight again: A new vaccine and updated Pap screening guidelines have
left women confused about how to protect themselves. In time for Cervical Health Awareness
Month, here are the answers to 10 common questions about the disease. Plus, test your women’s health
IQ with our quiz…
In 1950, the development and use of the Pap smear was a milestone in women’s health. The test became
a routine part of women’s preventive care, and cervical cancer deaths plunged almost 75% between 1955
and 1970. Still, nobody knew what caused cervical cancer.
Now we do. Certain types of human papillomavirus (HPV) are the main cause of cervical cancer and the
fight is on to squash the disease. In most cases, cervical cancer can be prevented or cured – when caught
early.
Last October, the U.S. Food and Drug Administration (FDA) approved a second vaccine,
Cervarix, against some types of HPV: It's recommended for females 10-25 years old. That same month,
another HPV vaccine, Gardasil, which has been on the market since 2006 for girls and women to
prevent certain strains of HPV infection, was approved for males age 9-26, to fight penile cancer and
genital warts due to HPV, which could be passed on to their sexual partners.
In another development on the cervical health front, in December, the American College of Obstetricians
and Gynecologists (ACOG), a nonprofit of women’s health care doctors, issued broad new Pap test
guidelines. It recommended that women:
Begin Pap testing at age 21•
Who are 22-29 years old get Pap smears every two years•
Who are age 30 and older who have had three negative Pap smears in a row get Pap smears every
three years
•
Who have had a hysterectomy no longer have Pap smears if the hysterectomy was for non-
cancerous reasons and they don't have a history of severely abnormal Pap smears. If you have had
a hysterectomy but still have your cervix, you’ll need to continue routine Pap smears.
•
Who are age 65 and older skip Pap smear screenings if they’ve had three or more normal Pap
smears in a row and no abnormal test in the prior 10 years.
•
Of course, these recommendations aren’t the final word: They’re meant to be followed only if your
gynecologist agrees that they make sense for you and your medical history.
Still, it’s crucial for women to get the facts about cervical cancer. Here’s what you need to know:
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Page 1 of 5Your Top 10 Cervical Cancer Questions Answered
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1. Should I worry about getting cervical cancer?
You shouldn’t worry about getting cervical cancer but you should know how to prevent or detect the
disease early so it can be cured.
In 2005, about 12,000 American women were diagnosed with cervical cancer; about 4,000 died from
the disease, according to the latest statistics available from the Centers for Disease Control and
Prevention (CDC).Although the cancer is most often diagnosed in women over 40 years old, the disease
grows slowly and starts many years before it’s detected. The good news is there are now methods to
detect cervical cancer in its earliest form.
2. Could I be at risk?
The main causes of cervical cancer are HPV types 6, 11, 16 and 18 – known as “high risk” types. There are
other "low-risk" strains of genital HPV that can cause benign warts but not cancer. All genital HPVs are
sexually transmitted.
Since infection is common – up to 40 million Americans may have genital HPV – any sexually active
woman may be at risk for the high-risk types and, thus, cervical cancer.
You may be at higher risk if:
You've had multiple sex partners and/or other sexually transmitted infections (STI), or partners
with a history of having multiple partners or STIs – making them more likely to have been
infected with HPV, especially those that lead to cancer.
•
You haven’t had regular Pap smears.•
You smoke cigarettes and have HPV or the above risk factors. (Tobacco has a carcinogenic effect
on HPV that hastens the cancer.)
•
You've taken corticosteroid medication (steroids) for a long time, have had an organ transplant,
are HIV-infected or have other conditions that suppress the immune system and have HPV
infection or the above risk factors.
•
You've taken birth control pills for longer than five years and have HPV infection or the first two
risk factors.
•
You've given birth to five or more children and have HPV infection or the first two risk factors.•
Your mother took diethylstilbestrol (DES) – prescribed from 1938-1971 to prevent miscarriages
or premature deliveries – when pregnant with you.
•
You don’t eat enough fruits and vegetables, which is associated with an increased risk of
cervical and other cancers and have HPV infection or the first two risk factors.
•
3. What symptoms should I look for?
Usually, there are no symptoms in the early stages. As the cancer advances, the signs may include:
Abnormal vaginal bleeding, including longer, heavier periods; bleeding between periods; and
bleeding after menopause, sexual intercourse, douching or a pelvic exam
•
Increased vaginal discharge•
Pelvic pain•
Pain during intercourse•

Other reproductive tract problems, such as a simple vaginal infection, can cause similar symptoms, so
women tend to ignore them. Don’t. See your doctor if any of the above symptoms last longer than a few
days or more than one or two cycles.
4. How can I protect myself against cervical cancer?
Protecting yourself against genital HPV infection will prevent cervical cancer. Here’s what you can do:
Get screened for HPV, especially if you have a new partner, or if your partner has STIs.•
Have regular Pap smears to detect abnormal or pre-cancerous cervical cells.•
Limit the number of sexual partners and have open discussions about STIs with a potential sex
partner. It could save your life.
•
Quit smoking. This is important for your general health too.•
Get the Gardasil or Cervarix vaccine if your doctor thinks it’s appropriate.•
Abstain from sex or use latex or polyurethane condoms. This is especially true if your partner has
a history of STIs, and especially HPV or genital warts.
•
Remember, condoms aren’t 100% effective at preventing STIs. Spermicide creams and jellies have not
been shown to uniformly prevent HPV infection, and, in some cases, increase the likelihood of infection
by causing sores in the vaginal area.
5. Should I get the HPV vaccine?
Gardasil is designed to protect against high-risk HPV types 6, 11, 16 and 18. Cervarix protects against
HPV 16 and 18, which cause about 70% of cervical cancer cases.
Gardasil and Cervarix work best before you become infected, which is why the vaccine is FDA-approved
for girls as young as 9 years old, usually before they become sexually active.
Even if a woman has been HPV infected, the vaccine may protect against strains that she may not have
been exposed to. Women over age 26 who haven’t been infected also may benefit from the vaccine, so if
you’re older than that discuss inoculation with your doctor.
Get the cervical HPV test along with regular Pap smears, and talk to your doctor about your sexual
history to see if Gardasil or Cervarix is right for you.Since the FDA has approved Gardasil for boys and
young men, they should also get it to prevent passing HPV on to their sexual partners. Plus, Gardasil
also protects against penile cancer, which can be caused by HPV 16 and 18, and from warts, which can be
caused by HPV types 6 and 11.
6. How often should I get a Pap smear?
The new guidelines by ACOG recommend getting your first Pap smear at age 21, then every two years
through age 29, and then – if you’ve had three consecutive Pap smears that were normal – every three
years thereafter.
The recommendations also say that you can stop getting Pap smears if you’re 65-70 years old – if you’ve
had three consecutive Pap smears that were normal and no abnormal tests in the prior 10 years.
But please note: Not getting a Pap smear does NOT mean to stop getting pelvic exams.
There are four important points to know about the ACOG guidelines (Getting an HPV vaccination
doesn’t change these recommendations.):
They don’t apply to women who have tested positive for HPV, who have a history of cervical
cancer, who have HIV infection, who have suppressed immune systems or were exposed to DES
•

in utero.
Your gynecologist should make the final decision as to whether these guidelines make sense for
you each time she sees you.
•
Women with histories of moderate or severe dysplasia (a possibly pre-cancerous abnormality) or
cancer should undergo annual screening for 20 years after treatment.
•
Even if you don’t need a Pap smear every year, you may still need a bimanual pelvic exam (also
known as an internal exam) more often than a Pap smear. This is especially true for women in
midlife and older since the risk for getting cancer of the uterus and ovaries increases with age,
and a pelvic exam is one of the few ways to catch these cancers early. You should discuss how
often you need a bimanual exam with your gynecologist.
•
Don’t wait for your next exam to see your gynecologist if you are experiencing any pelvic symptoms,
such as persistent pain. See your doctor when the symptoms are present.
A Pap test can be read as normal and cervical cancer missed. Or it may read as abnormal when the cervix
is normal. Either may need a repeat Pap or more tests. If abnormalities show up, your doctor will
recommend follow-up tests.
7. Does a Pap smear specifically test for HPV?
No. Cervical cells are collected and examined under a microscope for pre-cancerous abnormalities on a
Pap smear, but it doesn’t test for HPV.
The HPV test is officially recommended for all sexually active women older than 30; however, you
should get it – no matter what age you are – if you’re sexually active.The test is done at the same time as
a Pap smear by taking another sample of cervical cells with an instrument similar to a Q-tip. The HPV
test looks for the presence of the virus within the cells, but does not look at the cells themselves, as a Pap
test does.
Discuss your sexual history with your doctor, who, depending on your history, may recommend HPV
testing.
Because multiple sexually transmitted infections commonly travel together, if you’re sexually active and
concerned about HPV, you also may have been exposed to other sexually transmitted infections, such as
chlamydia, gonorrhea, syphilis and HIV. Get tested for these too.
8. Should I panic about an abnormal Pap smear?
Absolutely not. Any type of infection, including a common vaginal infection, can cause an abnormal Pap
smear. Even the way a smear is obtained can affect the way cervical cells look.
Of course, an abnormal Pap smear may indicate the presence of pre-cancerous cells. Treatment usually
prevents them from progressing to cancer. Occasionally, a test may show what are thought to be cancer
cells; at this point, your doctor will recommend further tests to see the extent of the cancer.
If your Pap smear is abnormal (or "positive"), your doctor may repeat it once, then again at regular
intervals.
She may also recommend a colposcopy, a procedure that enables her to look directly at your cervix
through a small microscope-like instrument inserted into the vagina. Several biopsies of your cervix will
then be taken to determine if cancer is present. This procedure is generally done in a doctor’s office and
may be somewhat painful, though usually only briefly.
9. If I’m diagnosed with HPV, does it mean I’m going to get cervical cancer?
No. An abnormal (or "positive") HPV test simply means that you probably have been infected with one,
or several, HPV types; it does not mean that this infection has caused cancer. And even if you’re infected
with a high-risk HPV, you still may not develop cervical cancer.

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Even among women diagnosed with a high-risk HPV and an abnormal Pap smear, only a few will
develop cervical cancer if those abnormal cells are not removed.
Still, if you are diagnosed with HPV (even if your Pap smear is normal), your doctor will advise more
frequent Pap tests and examinations. 10. How is cervical cancer treated?
Women with Pap smears showing pre-cancerous cells with only mild changes may simply be instructed
to come back for repeat Pap smears on a frequent, regular basis to make sure that they don’t turn to
cancer – this is because mild pre-cancerous changes often go away on their own.
Women with pre-cancerous cells that don’t disappear or who have cancer confined to the cervix may
undergo a surgical procedure:
Cryosurgery, which destroys cancerous tissue by freezing it•
Laser surgery, which removes cancer with a laser beam•
LEEP procedure, which uses electric current passed through a wire loop as a knife to remove the
cancerous cells.
•
In many cases, these methods preserve the uterus and cervix to allow childbearing. If the cancer is more
advanced, a hysterectomy – surgery to remove the uterus – may be necessary, making pregnancy no
longer possible.
Whether radiation or chemotherapy is used depends on the cancer’s type and stage. The earlier the
disease is found, the higher the cure rate. If treated in the earliest stages, the survival rate is 96%-99%
after five years.
If the cancer has spread outside the cervix but is still in the pelvis, the five-year survival rate with
treatment can be as low as 40%. But once the cancer has spread to distant organs, the five-year survival
rate with treatment is about 15%-20%. That’s why prevention and early detection are so important.
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