Improvements in the way doctors look for and treat cervical cancer are being made every day. In fact, the American Cancer Society (ACS) recently revamped its guidelines for cervical cancer screenings to reflect the latest technologies and scientific findings. Still, many women don’t know everything they should about this disease. “Doctors don’t always discuss with their patients what causes cervical cancer and the different types of Pap tests to detect it,” says Charles Levenback, M.D., a professor of gynecologic oncology at the University of Texas M.D. Anderson Cancer Center in Houston. “It’s important to ask your doctor questions and do your own research.” Here are some crucial facts from top medical experts:
FACT #1: Most cervical cancer cases are preventable.
The disease doesn’t occur suddenly. It can take anywhere from five to fifteen years for cervical changes to turn into invasive cancer. “That provides a large window of opportunity to spot cellular abnormalities before cancer develops,” says Diane Solomon, M.D., a cytopathologist and senior cervical cancer researcher at the National Cancer Institute in Bethesda, Maryland. That’s why women need to get regular Pap tests, the exam that catches these abnormalities. When detected early, cervical cancer is virtually 100 percent curable. Half of all women diagnosed with invasive cervical cancer each year in the U.S. have never had a Pap test.
All women should have annual Pap smears starting three years after becoming sexually active but no later than age 21. When using the new liquid-based Pap (ThinPrep or SurePath, which are available at the Health Center), testing every two years is recommended.
FACT #2: The disease is caused by the HPV virus.
Scientists have identified the sexually transmitted human papillomavirus as the main cause of cervical cancer. Women who become sexually active at an early age, have multiple sexual partners or have sex with men who have had many partners are the ones most likely to contract this virus.
There are more than 100 types of the virus, and fewer than 20 are linked to the development of cervical cancer. (Strains that cause external genital warts do not have the potential to become cancerous.) Experts estimate that 75 percent of all sexually active women become infected with HPV during their lifetime, but most of these infections go away on their own without causing cervical abnormalities. If HPV persists, however, cellular abnormalities may develop.
Ask your clinician about getting tested for HPV if you have Pap results that are ambiguous or show minor abnormalities, known as ASCUS (atypical squamous cells of undertimined significance). This step better detects precancerous cells or cellular changes than follow-up Pap tests. The test can be done immediately in the laboratory following inconclusive liquid-based Pap findings — an option that doesn’t exist with the regular Pap test. A positive HPV test means that the strains that are known to cause cervical cancer are present in your body and you may need a colposcopy (a cervical exam with a magnifying instrument) and perhaps a biopsy to analyze the tissue. A negative HPV test means that there’s a less than 1 percent chance that precancerous lesions or abnormalities are present, and you can return to regular yearly screenings via the Pap smear.
Don’t panic if you test positive for HPV. “A positive result does not mean that you have cervical cancer,” says Dr. Solomon. It indicates that there may be an abnormality that requires treatment.
FACT #3: Monogamy and practicing safe sex are not guarantees that you’re HPV free.
While condoms can guard against contracting HIV and other sexually transmitted diseases, they do not protect as well against HPV. That’s because HPV infections can exist on the skin in genital areas not covered by condoms, such as the scrotum,, vulva, anus, or the skin between the anus and genitalia. Some researchers believe that the virus can remain in the body for years in a dormant state. Experts have not yet determined whether the transmission can occur when virus levels are very low or undetectable.
The ACS has no guidelines regarding safer sex practices but notes that limiting the number of lifetime sexual partners and not having sex with people who have had many partners can reduce the risk of cervical cancer.
Even though they don’t provide absolute protection, condoms are still the best method of prevention. In addition, condoms ward off other STDs that can put you at higher risk for contracting HPV.
FACT #4: Young women are at the highest risk of contracting HPV.
HPV infections and minor cellular changes that can lead to cervical cancer are most common in women between ages 19 and 30. Fortunately, regular screening will pick up cellular changes early on before invasive cancer develops.
Continue getting annual Pap tests throughout your twenties (or every 2 years with the liquid-based Pap). After age 30, if you’ve had three normal results in a row, you should get screened once every two or three years. At age 70, you can stop having Pap tests altogether, as long as you’ve been screened regularly and had three normal test results in the past 10 years.
FYI: HPV vaccine on the horizon
A recent study showed that an experiment HPV vaccine was 100 percent effective in preventing one precancerous strain of the virus. Researchers are now working on a version that would protect against more types of HPV. “This could reduce future cervical cancer cases by 80 percent,” says Solomon. It’s developers hope to have it available to the public by 2007.