January is Cervical Health Awareness Month and, if you’re a woman, it’s a good time to give some attention to a part of your body that you may not think about very often. The cervix is the lower part of the uterus that connects to the vagina. It has the important job of widening to allow a baby to pass from the uterus to the vagina during birth. We may not talk about it too often, but a healthy cervix is an important part of reproductive and overall health.
Each year, about 12,000 women in the United States get cervical cancer, according to the Centers for Disease Control and Prevention (CDC). Yet millions of women aren’t screened for cervical cancer as often as recommended.
Here are four important things to know about cervical cancer screenings:
1. Screening recommendations depend on your age and health history.
The American College of Obstetricians and Gynecologists (ACOG) has set the following cervical cancer screening recommendations for women by age:
- Under 21: No screening
- 21-29 years old: Pap test every 3 years
- 30-65: Pap test every 3 years OR combined Pap test and HPV test every 5 years
- 65+ No screening following prior adequate screening
But one size does not fit all. “It’s important to highlight that these recommendations are for women with average risk,” says Cori Jacobson, CNM, ProMedica Physicians. “These screening guidelines aren’t meant for women who are at a higher risk, such as those with symptoms of cervical cancer, women with HIV or women with a compromised immune system. Women who have had previously abnormal screening may need more frequent testing as well.”
The ACOG recognizes that screening is not necessary for most women who have had a hysterectomy with removal of the cervix and did not previously have precancerous cervical changes or cervical cancer. So talk with your provider to learn more about what is recommended for you.
2. The Pap test looks for abnormal cells that could lead to cervical cancer.
Even if you’ve had a Pap test, you may not be fully aware of what happens during the screening and how it helps prevent cervical cancer.
“A Pap smear, or cervical cancer screening, looks for changes on the cervix that may, in rare cases, lead to cancer,” explains Jacobson. “These changes include the size of the cells, shape of the cells and how quickly the cells are growing.”
Special tools are used to get a sample of these cells. A speculum is inserted into the vagina to hold open the vaginal walls during the exam, while a brush is used to collect sample cells. These cells are then sent to a lab where they are examined for abnormalities.
“Screening tests can find early problems. That way, serious problems can be identified and removed before they become cancer,” says Jacobson.
3. An HPV screening is recommended because nearly all cervical cancer is caused by HPV.
The Human papillomavirus (HPV) is a very common sexually transmitted infection and nearly all cervical cancer is caused by this virus. Although there are many strains of the HPV virus, two types of HPV in particular (HPV types 16 and 18) are responsible for about 70% of all cervical cancer, according to the National Cancer Institute. However, that doesn’t mean that if you have HPV that you will get cervical cancer; few women with HPV will actually get cervical cancer.
Getting the HPV test is virtually the same experience as the Pap test for women. While in some cases two samples of cervical cells may need to be taken, with ProMedica practices and laboratories, the HPV screening uses the same sample from the Pap test. “It’s not an additional swab or additional procedure,” explains Jacobson. “It’s actually collected from the same sample.”
Because HPV is so prevalent in younger women, routine HPV screening isn’t recommended for women under the age of 30.
“In younger women, we can make an assumption that HPV is present. But most young women who are affected by HPV or even start to have some changes in their cervix associated with HPV will clear the infection and those changes,” says Jacobson. “Doing too early or frequent testing, especially in this population, could lead to unnecessary invasive diagnostic procedures and treatment.”
For women 30 and older, however, HPV could be a sign of something more.
“Cervical cancer is associated with persistent disease of HPV. Women are typically exposed to HPV early on in your their sexual experiences and by age 30, most women have cleared the virus,” explains Jacobson. “If HPV is found after age 30 it is more likely to signal a health problem. It may mean that a woman has had the virus for many years and her body has failed to clear the virus. Having persistent HPV infection places a woman at higher risk for cervical cancer and she may need to be screened more often.
4. An annual well woman’s exam is important for cervical health, too.
These visits are an opportunity to minimize health risk and talk with your provider about developing a healthy lifestyle. It’s also an opportunity to make sure your reproductive organs, including your cervix, are healthy.
Your annual well woman exam will include a physical exam of your body. Your provider will perform a breast exam, and a pelvic exam if you are over the age of 21. When performing your pelvic exam, your provider will look at the external genitalia (vulvar area) and use a speculum to look at the tissue inside the vagina and at the cervix to make sure it’s healthy and normal. They will then check your uterus and ovaries with a gloved hand. So, while the Pap and HPV tests may not be needed each year, the annual exam is an important visit.
“It’s still recommended to come in for a well woman’s exam on a yearly basis,” says Jacobson. “It’s just that portion of the cervical cancer screening portion that, for most women, is not needed every year.”