January is Cervical Cancer Awareness Month. In recognition, we asked Virginia Women’s Center’s Sara Sarraf, MD, to answer your questions about cervical cancer.
How common is cervical cancer?
According to the Centers for Disease Control (CDC), doctors diagnose about 13,000 cases of cervical cancer every year.
That’s a lot. What trends are you seeing?
That number is actually a lot lower than it used to be. There’s some good news here. First, regular screening tests and proper follow-up can prevent cervical cancer. And second, the human papillomavirus (HPV) vaccine can prevent HPV, which causes about 91% of cases of cervical cancer.
HPV is a common sexually transmitted infection. Eighty-five percent of sexually active people will contract HPV at some point in their lives. The infection often resolves itself, especially in younger people. But HPV is also linked to several types of cancer, including cancer of the penis, anus, throat, vagina, vulva and—of course—cervix.
What exactly is the cervix?
The cervix is the opening to the uterus. It’s located at the top of the vagina.
What happens when you have cervical cancer?
When you have cervical cancer, your cervical cells become abnormal and begin to grow out of control. These abnormal cells can invade the deeper tissue of the cervix or spread to other organs.
How do you screen for cervical cancer?
Screening begins with a visual inspection of the cervix during a pelvic exam. We can spot some abnormalities with the naked eye. But beginning at age 21, we also use cervical cytology—also known as a Pap test or smear —and at age 30, an HPV test.
Tell me more about the Pap test and HPV test.
We take cells from the cervix for both tests. For some, it can be a bit uncomfortable, but it’s not painful. We use a speculum, a smooth instrument, to get a clear view of the cervix and then use a small spatula and a soft brush to obtain surface cells from the cervix. The sample is then placed in a special liquid suspension and sent to the lab where a pathologist examines it for abnormalities under a microscope.
What happens if my results are abnormal?
It depends on how abnormal they are. Sometimes we simply wait for six to 12 months and repeat the Pap test. If we haven’t already done the HPV test, we might do that. And other times, we perform a colposcopy, where a doctor uses a colposcope—a special kind of microscope—to get a very close look at the cervix.
What are the risk factors for cervical cancer?
Good question. There are a few: the more sexual partners you have (and the more partners your partner has), the more likely you are to contract HPV, which — as I’ve already explained — is linked to the vast majority of cervical cancers. Having sex at an early age also increases your risk of HPV. So does having other STIs, such as gonorrhea, syphilis and HIV/AIDS. If you have a weak immune system or an autoimmune disorder, you’re also more likely to get HPV. And finally, smoking is associated with some cervical cancers.
Besides getting an HPV vaccine, what can I do to prevent cervical cancer?
Practice safe sex. And don’t smoke. If you already smoke, ask your doctor for help quitting. And, most importantly, follow the American College of Obstetrician and Gynecologist’s recommended schedule for cervical screening.
It’s important to know that most cervical cancer occurs in women who have received inadequate screening or no screening at all. “Women who get regular wellness exams and Pap tests and follow up with their doctors don’t end up with cervical cancer because dysplasia typically progresses slowly. We can usually detect abnormal cells long before they become cancerous. And if we detect any abnormal cells, we have simple, effective treatments to remove them.”
So what should I be tested for and when?
Here’s a guide:
|Age||Recommendations||Insights from Dr. Sarraf|
|< 21||You do not need screening.||“If your doctor sees anything unusual looking during the pelvic exam, they may perform more tests, but cervical abnormalities are extremely rare at this age.”|
|21 – 29||Have a Pap test every 3 years||“The Pap test is a cervical cancer screening. We don’t test for HPV at this age because it’s so common and because your immune system is so strong in your 20s that the infection usually resolves itself within 8 months.”|
|30 – 65||You can choose one of these options:
Have a Pap test and an HPV test (this is called “co-testing” every 5 years. (Recommended)
Have a Pap test every three years
Have an HPV test every 5 years
|“Your immune system is less robust at this age, and generally one has fewer sexual partners in their 30’s. If HPV is present at this age it is more likely a persistent strain. For this reason, we begin doing both a Pap test and an HPV test at age 30.”|
|65+||You do not need screening if:
You have no history of cervical changes for 20+ years and you’ve had 3 normal Pap tests in a row or 2 normal Co-tests in the last 10 year
|“If you have a history of abnormal cervical cells that didn’t resolve on their own, your doctor may recommend that you keep getting regular Pap tests for an extended period of time.”|
|It’s important to remember:
You need regular screenings—even if you’ve had the HPV vaccine.
You need regular screenings if you had a hysterectomy, but doctors didn’t remove your cervix.
|There are some exceptions:
If you have HIV, a compromised immune system, a history of cervical cancer or you were exposed to diethylstilbestrol (DES) before birth, you may need more frequent screenings.
If I don’t need a Pap smear, do I still have to come in for a checkup every year?
Yes! Even if you don’t need a Pap smear, there are plenty of reasons to do the annual well-woman exam,” explains Dr. Sarraf. “During the checkup, we do a breast exam and a pelvic exam, and we visually inspect your cervix. We also use this time to talk about birth control, safe sex, hormonal questions, vaccinations and pre-conception care if you’re thinking about having a baby.
Sara Sarraf, MD, practices at the Virginia Women’s Center West End location. Dr. Sarraf is board certified in obstetrics and gynecology and has a passion for pediatric and adolescent gynecology. To make an appointment with her or any of our healthcare providers, call 804.288.4084 or go online—virginiawomenscenter.com.