by Gary A. Richwald, MD, MPH
January is Cervical Health Awareness Month. More specifically, January 21-27 is Cervical Cancer Prevention Week, and for good reason: nearly 13,000 women in the United States are diagnosed with cervical cancer each year, and more than 4000 of them will die from it. Luckily, this form of cancer is now largely preventable. Women can take steps to reduce their chances of contracting human papillomavirus (HPV), a widespread virus that can cause pre-cancerous changes in the cervix.
How Does Cervical Cancer Form?
Cervical cancer is caused by high risk types of HPV, the most common sexually transmitted infection in the United States. Almost half of American adults ages 18-59 have had a genital HPV infection. This doesn’t mean that everyone who has HPV will also contract cervical cancer. For younger women, their immune system is likely to clear up the infection on its own. However, women between the ages of 30 – 64 who have a “high-risk” form of the virus (hrHPV) are at greater risk. This is because, over time, a persistent hrHPV infection can cause changes in the cells of the cervix. Without treatment, these changes can develop into precancerous cells and then cervical cancer.
About Genital HPV
HPV can be transferred via skin-to-skin contact with the infected area of someone else that is infected. The virus is typically spread via vaginal, anal, and possibly oral sex. In particular, two hrHPV strains (types 16 and 18) actually cause 70% of precancerous and cancerous cervical lesions. As with many other sexually transmitted infections, symptoms are rarely present.
Preventing Cervical Cancer
There are several effective ways to prevent or reduce your risk of getting cervical cancer. Some involve lifestyle changes, while others make use of vaccines and testing.
To reduce your risk of contracting HPV:
- Don’t begin smoking, and quit if you can. Smoking cigarettes doubles a person’s risk of developing cervical cancer. Studies show that tobacco by-products damage the DNA of cervix cells, which may contribute to the development of cancer.
- Consider limiting your number of sexual partners. Studies have shown that women who have multiple sexual partners have an increased risk of developing HPV and cervical cancer.
- Practice safer sex. Using condoms properly every time you have sex greatly reduces your risk of contracting STIs, including HPV. However, HPV may infect areas that are not covered by a condom, so complete protection is not always possible.
To prevent HPV:
- Get an HPV Vaccine. There are several vaccines that help protect against hrHPV. These vaccines are most effective before someone becomes sexually active and are thus often recommended for children ages 11 or 12.
Screening for Cervical Cancer
Because prevention strategies are not always completely effective and because the vaccines are relatively new, the Centers for Disease Control and the United States Preventive Services Task Force recommend that women are screened regularly for cervical cancer.
There are two different kinds of tests available: the Pap test and a HPV test. The Pap test (also known as a Pap smear) looks for cell changes on the cervix that might become cancerous if they aren’t treated. The HPV test looks for HPV infections that cause these cell changes.
Both of these tests can be performed at a health clinic or a doctor’s office. The HPV test can also be performed at home, with at-home testing kits. At home kits, which are produced by several different companies including myLAB Box and Nurx, may be particularly helpful for women who live in rural and poor areas.
If You Are 21 to 29 Years Old:
Have a Pap test alone every 3 years.
If You Are 30 to 65 Years Old:
You have three different options for screening:
1. Have a Pap test alone every 3 years.
2. Do hrHPV testing alone every 5 years.
3. Have a Pap test in combination with hrHPV testing (cotesting) every 5 years.
If You Are 66 or Older:
If you have had adequate prior screening and are not otherwise at high risk for cervical cancer, the USPSTF recommends against screening for cervical cancer.
For more information, see the National Cervical Cancer Coalition, a project of the American Sexual Health Association.