Cervical Cancer Screening

Statesman Journal Living Well – January 2016

January is Cervical Cancer Awareness Month and is a good opportunity to discuss the new guidelines for cervical cancer screening.  Cervical cancer screening can find changes in the cells of the cervix that could lead to cancer.  Screening includes the pap test and, for some women, testing for human papillomavirus (HPV).   A Pap test used to be recommended for most women every year.  This recommendation has changed with the first set of new guidelines set forth in 2006.  The guidelines were again updated in 2013 and since then medical care providers should have adjusted their actual practices and teaching.  Why did the guidelines change?  Studies over the past decades have found that there is no overall advantage to having yearly Pap tests over pap tests every 3 years.   It was also proven that 99% of actual cervical cancer cases were associated with specific types of high risk HPV.  Despite not needing a Pap test every year, you should still see your health care provider every year for well-woman care  and any other reproductive health care needs/planning.
The latest routine cervical cancer screening guidelines are as follows:

• Cervical cancer screening should start at age 21 years.  Women younger than age 21 should NOT be screened regardless of the age of sexual initiation or the presence of other behavior-related risk factors.  Those women younger than age 21 who are at risk should be screened for sexually transmitted infections.  A positive HPV test result in a young woman showing that she does have one of the cancer-causing HPV types, will most likely become negative without any treatment – thus why the screening is not recommended.
• Women aged 21 – 29 years should be tested with cervical cytology alone  (Pap test).  This screening should be done every 3 years. Co-testing with cytology and HPV testing should NOT be performed in women younger than age 30.  These women should also be tested annually for sexually transmitted infections, if appropriate.   Why is HPV testing not recommended for women younger than age 30?  Because, HPV infection is very common in younger women, but it usually goes away on its own.   Their immune system fights off the HPV virus.
• Women aged 30 – 65 years should have a Pap test and an HPV test (co-testing) every 5 years as the preferable type of screening.  The combination of a Pap test plus an HPV test can help predict whether dysplasia will be diagnosed in the next few years, even if the Pap test results are normal.  It is also acceptable to have a Pap test alone every 3 years.  STI testing for these women depends upon their individual risk factors.
• Women over age 65 years should stop having screening  for cervical cancer if they do not have a history of moderate or severe dysplasia or cancer AND they have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years.
• Women with a history of moderate or severe squamous cell dysplasia,  adenocarcinoma in situ, or cervical cancer – should continue to have regular age-based screening for 20 years after the initial post-treatment surveillance period, regardless of age.

What if I have had a hysterectomy?  You may still need to have cervical cancer screening depending upon why your hysterectomy was needed, if your cervix was removed, and whether you have a history of dysplasia in the past.  This will be decided by your health care provider.

What happens if my Pap or HPV tests return as positive?  You should be referred to a gynecologist or a provider that specializes in further testing of the cervix and the genital tract for abnormal cells and cervical cancer.  This care is individualized to each woman and their history.

Immunization against Human Papilloma Virus has been available since 2006.  There is a new HPV vaccine type that is active against 9 types of HPV instead of the 2 or 4 types that the older two types of vaccine covered.  HPV can be passed from person to person through skin-to-skin contact.  Of the more than 100 types of HPV identified, 30 of them affect the genital tissues of men or women.  About 12 types of HPV can cause genital warts and 15 of the types cause cancer of the cervix,  as well as the vulva, vagina, penis, anus and the head and neck.  Thus, immunization is a good idea.

The HPV vaccine is almost 100% effective in preventing cervical cancer and genital warts.  The vaccine is most effective if it is given before a woman is sexually active and exposed to HPV.  It can be given after she has been exposed, but the vaccine will not protect against a viral type that she is already infected with.  The ideal time to give the vaccine is age 11 – 12 for both girls and boys.  The acceptable age range for the vaccine is age 9 – 26yo.  The vaccine is given in 3 doses over a 6 month time span.

So, please make your New Year’s  resolution to get your screening done.   Schedule your Well Woman Exam today!!