Cervical Cancer: 7 Surprising Facts

About 14,000 women will be diagnosed with cervical cancer this year, with 4,300 people potentially dying from the disease, according to the American Cancer Society. The good news is that effective screenings and treatments for precancerous changes of the cervix have made this once-common cancer largely preventable.

There’s also an extremely effective vaccine against the human papillomavirus (HPV), which causes over 90% of cervical cancer cases.

“It’s pretty remarkable,” says Dr. Evelyn Cantillo, a gynecologic oncologist at NewYork-Presbyterian/Weill Cornell Medical Center and an assistant professor of obstetrics and gynecology at Weill Cornell Medicine. “The vaccine, together with women getting screened on time, can hopefully eliminate cervical cancer.”

Here, Dr. Cantillo shares surprising facts about cervical cancer and ways people with a cervix can protect themselves.

To screen for cancer, women receive a Pap smear, a sample of cervical cells that are examined under a microscope, usually accompanied by a test for HPV. In some cases, only the Pap smear or the HPV test will be performed.

“A Pap smear tells us if there are abnormalities,” says Dr. Cantillo. “An HPV test tells us if high risk HPV, which are the types that increase risk for developing cervical cancer, are present.”

Cervical cancer is usually slow growing. If your screening test and HPV test are both normal, you don’t need one every year.

Your age determines how often to get screened. Women ages 21 to 29 should get Pap tests every three years, the CDC advises. “HPV tests aren’t recommended at the age of 21,” says Dr. Cantillo, because HPV infections are more common in young women and most go away on their own. “The risk of cervical cancer in someone under age 25 is exceedingly low.” At age 25, it is acceptable to start including HPV testing with Pap smears.

Women ages 30 to 65 can get either:

• A Pap smear every three years
• An HPV test every five years
• A co-test with both a Pap and HPV test every five years (one swab is used for the combined test)

What you are offered may depend on what is available from your provider. Keep in mind that your screening schedule may change if you have an abnormal test.

Many women confuse the two because they often happen at the same time. The pelvic exam is a physical exam that includes an inspection of your external and internal genitalia. It may or may not include a cervical cancer screening test.

Also, many women only see their gynecologist when they are due for a screening, which can be a five-year gap. But Dr. Cantillo advises women to visit their gynecologist every year, even when they are not due for cervical cancer screening.

“Just like you get your heart, lungs, and skin checked year to year, you should get your reproductive system checked,” she says. Gynecologists can pick up many things from a pelvic exam, including ovarian cysts and growths in the uterus, and they check your overall reproductive health. They also provide birth control, pre-pregnancy and menopause counseling. Regular visits are important, even if your gynecologist doesn’t perform a pelvic exam each time.

The HPV vaccine, which was introduced in 2006, is extremely effective. “The data we have from the larger studies that have been done show that it decreases the rate of cervical cancer by over 90%,” says Dr. Cantillo.

But it’s not foolproof. The vaccine protects against the HPV strains that cause most cases of cervical cancer, but not every type is covered. “So while the vaccine is really important, you still need to get screened,” says Dr. Cantillo.

“The best time for HPV vaccination is before someone becomes sexually active,” says Dr. Cantillo. That’s why the vaccine series is targeted for girls and boys ages 11 to 12 and approved for children as young as 9.

But it’s recommended for women up to age 26 and approved for women up to age 45.

“As we’re getting more data, we’re finding that there’s effectiveness even in older patients,” says Dr. Cantillo. “It’s just not as large as it would be if they had been vaccinated when they were children.” Check with your doctor if the HPV vaccine is right for you.

Between the vaccine and on-schedule screenings, most people are well protected from cervical cancer. But you can boost your defenses by using barrier contraception. “HPV is transmitted through skin-to-skin contact, so condoms add some protection,” Dr. Cantillo says.

Not smoking is also important. “Smoking is a risk factor for the persistence of HPV,” says Dr. Cantillo. Women who smoke are about twice as likely to get cervical cancer as those who don’t smoke. Tobacco by-products have been found in the cervical mucus of women who smoke and can damage cervical cells, allowing cancer to develop.

Of the roughly 50 million Pap smears performed each year, about 3.8% come back abnormal, according to the National Institutes of Health. Most of these abnormalities are not due to cervical cancer. “There are a lot of different things that can cause abnormalities,” says Dr. Cantillo. “That simply means they need more investigation.”

A vaginal infection (bacterial or yeast) or sexually transmitted infections can cause an abnormal test. Postmenopausal women with vaginal atrophy may also experience abnormal results, Dr. Cantillo says.

A positive HPV test means that you have an HPV infection that can lead to cervical cancer. But it is not a cancer diagnosis.

“The important thing is that you take the next steps to make sure that it is not something dangerous or concerning,” says Dr. Cantillo. Your doctor may advise you to return for a repeat screening or want to take a closer look at the cervix and take a sample of cells (biopsy) to test further, and if needed, remove the abnormal cells or tissue.

Many older women assume they can’t get cervical cancer. In fact, more than 20% of new cervical cancer cases occur in those over 65. So you need regular screening at least up to age 65. “The guidelines recommend stopping cervical cancer screening at age 65, but it depends on whether women have had adequate screening up to that point,” Dr. Cantillo says.

If you haven’t had cervical precancer in the past, you can stop screening at age 65 if you have had three consecutive Pap tests or two consecutive HPV tests or co-tests within the past 10 years and the test results were negative. If you have risk factors, such as a smoking habit or new sexual partners after 65, however, your doctor may recommend continuing screening, says Dr. Cantillo.

Dr. Cantillo urges all women to make sure they see their test results, ask questions if they are unsure of what the results mean, and make sure there is a plan in place for an abnormal result. “Also, it is incredibly important to have a good relationship with a provider since this will encourage you to follow up,” she says.