What is cervical cancer screening?
Cervical cancer screening is primarily achieved by Pap smear testing with or without HPV (human papilloma virus) testing. This simple test involves collecting cells from the cervix (which is the opening to the uterus at the top of the vagina). The cells are examined to find changes that could lead to cervical cancer. These changes are categorized into low grade or high grade squamous intraepithelial lesions which occur prior to actual cancerous cells.
Most cases of cervical cancer are caused by infection with HPV. This virus is primarily spread through sexual contact. The virus enters cells and causes precancerous changes which over time can lead to cancer. Not all types of HPV cause cancer. But, some types of HPV have been linked to cancer of the cervix, as well as cancer of the vulva, vagina, penis, anus, mouth and throat. These types of HPV are known as “high-risk types”.
HPV is actually very common and most people who are sexually active will be exposed to HPV at some time in their life. HPV infection usually does not have symptoms and most infections will go away without intervention. However, in some women the infection does not clear and leads to high grade changes which are more likely to progress to cancer.
What does abnormal cervical cancer screening mean?
Most women will have an abnormal Pap smear at some point in their lifetime. An abnormal screening test does not mean cancer, it does mean additional testing is needed. This is sometimes as simple as repeat testing or more often undergoing a procedure called colposcopy with cervical biopsy. The biopsy is performed to determine if high grade changes are occurring, in which case further treatment will be necessary.
Why is cervical cancer screening important?
Undergoing screening with a Pap smear can detect abnormal changes in cervical cells before they become cancer. It is estimated to take 3-7 years for high grade changes in cervical cells to become cancerous. Women with low grade changes are monitored with more frequent testing to assure the cells return to normal. Women with high grade changes can undergo removal of the abnormal cells and therefore reduce their risk of developing cervical cancer.
When screening is performed depends on a woman’s age and health history:
1) Women aged 21-29 years should have a Pap smear every 3 years
HPV testing is not recommended in this age group
2) Women aged 30-65 years should have a Pap smear with an HPV test (also known as co-testing) every 5 years or Pap smear alone every 3 years
Newer guidelines also recommend no further Pap testing in women over 65 years if they have not had abnormal Pap smears previously and have had either 3 negative Pap smears in a row or 2 negative co-tests in a row within the past 10 years, with the most recent test in the past 5 year. Also, women who have had a hysterectomy with removal of the cervix and no history of abnormal Pap smears no longer need to undergo Pap smears.
The Pap smear remains a very important test in women’s health. In the past 30 years, the incidence of cervical cancer in the US has been reduced by 50% because of widely available screening with Pap smears. Newer technologies such as HPV testing and vaccination continue to evolve and are already contributing to further reducing the number of new cases of cervical cancer.
Article provided by: Dr. Daxa Patel, Complete Healthcare for Women, a member of the Central Palm Beach County Medical Board of Governors. Click here to learn more about the Central Palm Beach County Medical Board of Governors.