January is a great month to think about your cervical health.
It's National Cervical Health Awareness Month, a good time for women to think about this important topic. Cervical cancer — cancer of the opening into the uterus, or cervix — can be treated very successfully in most cases, especially if it is caught early. And screening can catch it early.
"Women can reduce their risk of cervical cancer by maintaining close follow ups with a primary physician or gynecologist and adhering the recommended screening guidelines," said Jinju Weiss, DO, of Baylor Family Medicine in Aubrey, TX, in an interview with dailyRx News.
Professional organizations, government entities and expert medical panels often publish screening recommendations. Cervical cancer screening recommendations were officially updated in 2012, and an expert panel also made a new recommendation in 2014.
"As a physician I still plan on seeing patients for their annual physical and routine medical care," Dr. Weiss said. "During those exams I will determine whether any further diagnostic testing would be indicated in keeping with the new guidelines."
But cervical health can be a complex topic, with all the organizations, governing bodies and confusing guidelines. Read on for the lowdown on cervical cancer screening.
Who Are the Experts?
Several organizations release guidelines, recommendations and statements on cervical cancer screening. These include the following:
- The US Preventive Services Task Force (USPSTF), an independent, volunteer group of medical experts that makes recommendations about screening and other issues.
- The American Congress of Obstetrics and Gynecology (ACOG), the national professional organization for doctors who specialize in pregnancy and women’s reproductive health.
- The American Academy of Family Physicians (AAFP), a similar organization for specialists in family practice.
- The American Cancer Society (ACS), a national nonprofit dedicated to reducing or eliminating cancer.
What Kinds of Tests Are Used?
Two tests are used in cervical cancer screening. The first is the Pap test (or Pap smear). In this test, your doctor will perform a pelvic exam and collect some cells from the cervix. The cells are sent to a lab where a lab technologist looks at them under a microscope.
Cells for the HPV test are collected in the same way, but they are examined using an automated technique rather than by a person. HPV stands for human papillomavirus, which can cause genital warts and cervical cancer.
Screening Recommendations by Age
The USPSTF, ACS, AAFP and ACOG all recommend that women start cervical cancer screening at age 21. Cervical cancer often takes years to develop, so earlier screening is often unnecessary. Screening always involves a pelvic exam and a Pap test and may also include an HPV test.
From ages 21 to 30, women should have a Pap test every three years, experts say. Unless the Pap smear is abnormal, these women do not need an HPV test.
From ages 30 to 65, women have two options. The first is a Pap test every three years. The second is a Pap test plus an HPV test every five years. The ACS says the second option is the preferred method.
Women older than 65 who have never had cervical cancer and/or have had a hysterectomy and removal of the cervix do not need to have Pap smears or HPV tests.
Other Considerations for Screening
Women who have had the HPV vaccine should still be screened according to the recommendations for their age.
No matter what your age, if you have a history of cervical cancer, you should be screened — even if you’ve had a hysterectomy.
Screening schedules can change based on certain factors. If you have an HIV infection, have had an organ transplant or were exposed to a medication called diethylstilbestrol (DES), the ACS says you should discuss an appropriate screening schedule with your doctor.
In April of 2014, the US Food and Drug Administration approved an HPV cervical screening method that can be used as a stand-alone test. A panel of experts at the University of Birmingham in Alabama issued new guidelines that allowed the use of the approved HPV test without a Pap smear for cervical screening.
The recommended screening interval for this new test is every three years. These guidelines have not been adopted by the USPSTF, ACOG, the AAFP or the ACS. They apply only to women who are 25 years old or older.
A family history of cervical cancer, especially in close relatives such as your mother or sisters, may increase your risk of cervical cancer.
Although you can’t control your history, other risk factors are under your control. Having more than three sexual partners can increase your risk, according to the Centers for Disease Control and Prevention. Always use a condom, even if you are using other kinds of birth control.
A vaccine for HPV is available, so talk to your doctor about whether you should be vaccinated.
Screening recommendations are guidelines and may not apply equally to all cases. If you have any questions, discuss them with your doctor. Together, you and your doctor can make the decision that is best for you.