By Dr. Ewa Arnold, Grace Cottage Family Health
as appeared in the Brattleboro Reformer’s Graceful Health series, January 15, 2016
A question for women, in recognition of National Cervical Cancer Awareness Month: The Papanicolaou (Pap) test takes less than five minutes to perform and, if done according to the recommended schedule, it can boost a woman’s chance of surviving cervical cancer to as high as 91 percent. Given that statistic, why wouldn’t you get the test?
To put this into perspective, women with early cervical cancer and pre-cancer often have no symptoms, so the Pap test is the only way for them to be diagnosed. If the cancer is detected at this stage, when the cancer is still localized to the cervix, the survival rate is very high. But the survival rate drops dramatically for those who are diagnosed after the cancer becomes invasive, meaning it has spread to nearby organs. According to the National Cancer Institute, for women at this stage, the survival rate drops to no higher than 57%.
The test, therefore, is the key to survival. More than half of the women diagnosed with invasive cervical cancer have never been tested or have let their testing lapse.
You may not like having a Pap test, but it’s so important and it doesn’t take long. The doctor uses a cervical brush or spatula to scrape a small amount of cells from several areas of the cervix (located between the vagina and the uterus). That’s it.
The Pap smear is a very accurate screening test for indicating the presence of abnormal cells on the cervix. If the test finds abnormal cells, further tests will be used to diagnose the nature of these cells, determining if they are cancer or not, and if so, which kind. If they are cancerous or precancerous, they can usually be destroyed completely by an outpatient procedure that either extracts the affected tissue, freezes it, or vaporizes it with laser. Most often, that’s the end of it, although regular screenings must be performed to make sure the cancer does not come back.
By comparison, more advanced cervical cancers require much more invasive treatments, including hysterectomy and perhaps removal of lymph glands, depending on how advanced the cancer is and how far it has spread. Treatment at this stage could also include radiation and/or chemotherapy.
Most women can avoid this completely because cervical cancer generally grows slowly enough that a Pap test can detect it early on. Therefore, it makes sense to follow the recommended guidelines for when to have a Pap test, as well as when to include the HPV test, often used in conjunction with the Pap test to help detect early cancers and pre-cancers.
HPVs are very common and have been linked to cervical cancer. According to the U.S. Centers for Disease Control, “HPV is the most common sexually transmitted infection … so common that nearly all sexually active men and women get it at some point in their lives.” The National Cancer Institute reports that, “Virtually all cases of cervical cancer are caused by HPV.”
Most often, HPV goes away on its own, but when it doesn’t, it can cause genital warts or cancer. There’s no way to predict who will be affected, and we do not have a treatment for HPV, only for the diseases it causes. We do know that those with weakened immune systems are most susceptible. The best way to prevent getting HPV is to be vaccinated, something that is now recommended for young people between 11 and 26 years old.
Some genetic and lifestyle factors increase a woman’s chance of getting cervical cancer. Studies have shown that early onset of sexual activity (earlier than age 21), multiple sexual partners, a history of sexually transmitted infections, immune deficiencies, ethnicity, socioeconomic status, use of oral contraceptives, and a history of smoking can all affect a woman’s tendency to develop cervical cancer. The first two risk factors increase a woman’s chance of contracting the HPV virus. HPV vaccination, along with Pap and HPV screening, are the most effective ways to prevent death by cervical cancer.
The American Cancer Society recommends the following testing schedule:
- All women should begin cervical cancer screening at age 21.
- Women age 21 to 29 should have a Pap test every 3 years. HPV testing should not be used for screening in this age group except as part of follow-up for an abnormal Pap test because HPV is so common in this population and because it usually goes away on its own.
- Between age 30 and 65, the preferred way to screen is with a Pap and an HPV test every 5 years. Another reasonable option for women in this age range is to get just a Pap test every 3 years.
- Women over 65 who have had regular screenings in the previous 10 years can stop cervical cancer screening as long as they haven’t had any serious pre-cancers found in the last 20 years. They should, however, continue to have regular pelvic exams.
- Women at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long-term steroid use) or because they were exposed to DES in utero may need to be screened more often. They should follow the recommendations of their health care team.
- Women who have had a total hysterectomy (removal of uterus and cervix) should stop having Pap and HPV tests, unless the hysterectomy was done as a treatment for cervical pre-cancer or cancer. If the hysterectomy did not include removal of the cervix, the woman should continue cervical cancer screening according to the guidelines above.
If the cost of the test is holding you back, there’s no need for that. This test is covered free of charge by most insurance companies, and if you are low-income and don’t have insurance, you can call Ladies First, part of the Vermont Department of Health, for help (800-464-4343).
This is a lot of information to take in, but the most important thing to remember is this: women have a quick and easy way to avoid cervical cancer, by getting screened regularly.
Grace Cottage Family Health has several kind and gentle female providers who are available to perform the Pap and HPV tests. If you don’t already have a regular primary care provider, please give us a call at 802-365-4331. Whatever else you do, wherever you go, just please get the test.
Bio: Dr. Ewa Arnold is a graduate of the University of Guelph in Ontario, Canada, and Jagiellonian University in Krakow, Poland. She completed her family practice residency at the UVM College of Medicine in Burlington.
