How to Keep Your Cervix Fit

Cervical cancer prevention, screening, and treatment are critical components of comprehensive reproductive health care. Key components to screening include the Pap smear and Human Papilloma Virus (HPV) testing.

Let’s learn why . . .

Pap Smear

The purpose of a Pap smear is to prevent and detect early cervical cancer.

The incidence of cervical cancer in the United States has decreased MORE THAN 50% in the past 30 years because of widespread screening.

New technologies for cervical cancer screening continue to evolve, as do recommendations for managing the results.

Most cases of cervical cancer occur in women who were either never screened or were screened inadequately.

Cervical cancer screening guidelines have been revised several times in the past decade.

Here are the current recommendations:

1. Screening begins at age 21. 21-29 years of age, a Pap smear is recommended every 3 years.

2. There are now three recommended options for cervical cancer screening in individuals aged 30–65 years:

• primary hrHPV testing every 5 years,
• cervical cytology alone every 3 years, or
• co-testing with a combination of cytology and hrHPV testing every 5 years

All three screening strategies are effective, and each provides a reasonable balance of benefits (disease detection) and potential harms (more frequent follow-up testing, invasive diagnostic procedures, and unnecessary treatment in patients with false-positive results).

3. After 65 years of age, you can discontinue Pap smears if you’ve had adequate screening in previous 10 years.

Human Papilloma Virus (HPV)

An estimated 80% of sexually active people will have HPV at some point in their lives.

HPV is the most common sexually transmitted infection.

It is possible to be infected and have no symptoms. There is no way to find out how long a particular infection has been present or trace it back to a particular partner. 

There are more than 150 types of Human papillomavirus (HPV). Some are high risk and associated with cancer. Some HPV cause genital warts. 

HPV is associated with cancer of the cervix, vagina, vulva, penis, and anus, as well as mouth and throat cancer, and genital warts.

HPV is spread by skin-to-skin contact during vaginal, anal, or oral sex. 

Most HPV infection is transient and poses little risk of progression. What does that mean? Your body usually fights off the virus. Go immune system!

But what if it doesn’t clear? Only a small fraction of infections are persistent, but persistent infection at 1 year and 2 years after initial infection strongly predicts risk of the virus causing a progression of precancerous cells and cancer.

How can you prevent cervical cancer?

• Routine screening
• HPV vaccine
• Limit number of sexual partners
• Practice safe sex
• Don’t smoke

HPV vaccine

We have a vaccine for HPV. Gardasil provides immunization against 9 types of HPV. This includes types 16 and 18 which are responsible for the majority of cervical cancer and types 6 and 11 which cause genital warts.

In October 2018, the US Food and Drug Administration (FDA) approved the HPV vaccine for ages 27-45 years. The vaccine was already approved for those ages 9-26 years. The vaccine is safe and effective in preventing NEW HPV infections in this age group. If you have already been infected with one or more of the HPV types, the vaccine does not cure but may protect you against other types of HPV included in the vaccine that you aren’t infected with.

You heard me right – we have a well studied and safe vaccine that can prevent cancer. Time again we have seen dramatic drops in HPV, abnormal pap, procedures to evaluate abnormal pap (#colpscopy, #LEEP, #CKC) and cervical cancer when the vaccine is widely given.

Is the vaccine effective if already exposed to HPV?

Gardasil 9 products against 9 types of HPV. 7 high-risk (cancer causing) and 2 low-risk (genital warts) types. You may have been exposed to one but not the other. So, yes!

How effective is the HPV vaccine?

HPV vaccines are among the most effective vaccines available worldwide. 99% efficacy when administered to those not exposed to that particular type of HPV.

The vaccine is a series of shots.

If given before age 15, you only need 2 injections (6-12 months apart). After age 15, 3 injections are recommended.

What if your pap is abnormal or high risk HPV is detected?

Your providers will recommend a colposcopy. A colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It is placed just outside the opening of the vagina. A colposcope enlarges the normal view. This allows an obstetrician–gynecologist (ob-gyn) to find problems that cannot be seen by the eye alone and take biopsies to get a diagnosis.

What if my doctor says I have cervical cancer?

If your doctor says that you have cervical cancer, you will be referred to a gynecologic oncologist—a doctor who has been trained to treat cancers of a woman’s reproductive system – for a treatment plan.

Want to learn more about cervical cancer?

Listen to Sky Women episode 62: How to keep your cervix fit.