Pap smears and preventing cervical cancer

Pap smears and preventing cervical cancer Lisa Sousou

January is Cervical Health Awareness Month. Did you know that cervical cancer used to be the most common cause of cancer death among women in the United States? Deaths in the U.S. from cervical cancer have declined more than 70 percent since the 1950s, after the introduction and widespread adoptionof cervical cancer screening. It is possible to drastically reduce your risk of developing cervical cancer by simply keeping up with regular Pap smears.

What is cervical cancer, and what causes it?

The cervix is the tip of the uterus, which protrudes into the back of the vagina. Almost all cervical cancers are caused by an extremely common virus called human papilloma virus, or HPV. Genital, including cervical, infections with this virus are sexually transmitted; almost all sexually active people will be infected with it at some point in their lives. Most people’s bodies do fight off and clear the virus eventually, and in most people, it does not cause any major or persistent problems. In some less common cases, the virus persists long-term, and in a proportion of these cases, it can cause cervical cancer. In men, it is common for HPV infection to have no symptoms. Some types of HPV can cause genital warts in men or women. Other types do not cause warts or anything visible but can still be transmitted to a sexual partner. In women, some types of HPV can cause changes in the cells of the cervix. These changes are called dysplasia. Over time, as the cells change more and more, dysplasia can progress from mild to moderate and then to severe. Most cases of mild cervical dysplasia, especially in young women, will resolve back to normal eventually. Some cases will progress to moderate and then to severe dysplasia. If severe dysplasia is not treated, it can progress to cervical cancer. This timeframe typically takes years.

What is a Pap smear, and how does it help reduce cervical cancer risk?

If you are sexually active, especially with a new partner, using condoms can help reduce risk of catching HPV. If you do have sex without a condom, having regular Pap smears is the best way to reduce your risk.

A Pap smear (or Papanicolaou smear, named after George Papanicolaou, its inventor) is a simple screening test whereby a sample of cells is obtained from the surface of the cervix, using a soft brush, and is examined in the lab for dysplasia or cancer. For many years, Pap smears were recommended yearly for all women once sexually active. In recent years, these guidelines were modified, and Pap smears are now recommended every three years starting at age 21. If any Pap results are abnormal, closer monitoring with more frequent Pap smears - up to yearly - are recommended, and sometimes further testing or biopsy of the cervix is done. Paps are recommended to be continued until age 65, at which time they can be discontinued if they are consistently normal.

The point of the Pap smear is to catch cervical dysplasia in its early stages, when it is mild, so that it can be monitored for any progression, or until it resolves back to normal. Moderate or severe dysplasia is treated by removal of the dysplastic cervical tissue, which removes the HPV-affected cells, and thereby aborts the risk of progression to cancer. Cervical cancer typically develops so slowly that regular Paps are sufficient to catch early dysplasia before it leads to cancer.

In women who are 30 or older, a test for high-risk types of HPV is often recommended in addition to the Pap. Combined Pap smear and HPV testing, called “cotesting,” may only need to be performed every five years. Some types of HPV are more associated with risk for cervical cancer than others. If a high-risk HPV type is detected, further testing or cervical biopsy may be recommended, whereas if HPV testing is negative, monitoring may be all that is required.

Are there other ways to help reduce cervical cancer risk?

The HPV vaccine helps protect against types of HPV which are associated with cervical, vaginal, and vulvar cancer. It is recommended to be given at age 11-12, but can be given up to age 26, and may even be an option up to age 45 if personal risk merits it. Using condoms and limiting the number of sexual partners can also decrease your risk of HPV infection, and quitting smoking is helpful as well.

Of all cancers, cervical cancer is one of the most preventable, with regular screenings and prompt management of dysplasia. A gynecological provider or your primary care provider can perform cervical screenings. Make it a goal for the new year to schedule your well-woman exam and Pap! SWM

Resources for free or reduced-cost cervical cancer screenings for women without health insurance:

New York State Cancer Services Program: (866) 442-CANCER (2262) Oswego County Opportunities Centers for Reproductive Health: (315) 598-4740 or (315) 342-0888 (Fulton, Oswego, and Mexico) Family Planning Service: (315) 325-2010 (Syracuse and North Syracuse) Planned Parenthood: (866) 600-6886 (Syracuse)