Cervical cancer is one of the forms of cancer that can be detected early and even prevented entirely. This can be made possible by regular screening and HPV vaccination. In August 2018, the U.S. Preventive Services Task Force (USPSTF) published new screening recommendations regarding the prevention and early detection of cervical cancer. The screening is for women who have a cervix and display no symptoms of cervical cancer. This is an update to the 2012 USPSTF guidelines, and one of the major changes involves Annual Pap tests. The guideline has changed the requirement to every 3 years. The other major change involves average-risk women aged 30–65 years.
Cervical Cancer and Annual Screening
Cancer starts with changes in one cell or a small group of cells that begin to grow out of control. Cells can start in any part of the body and spread to other areas. Cervical cancer occurs in the cells of the cervix, the lower part of the uterus. This part is also referred to as the uterine cervix. The development of a fetus takes place in the upper part of the uterus. The cervix is the birth canal and serves as the connection between the bodies of the uterus and the vagina. Generally, the cervix has two distinct parts covered with different types of cells.
- Endocervix- the part of the cervix closest to the body of the uterus. It is covered with glandular cells.
- Exocervix or ectocervix- the part of the cervix next to the vagina. It is covered in squamous cells.
These two types of cells meet at a place referred to as the transformation zone. The location of this zone changes if you give birth and as you get older. In most cases, cervical cancer starts in the cells found in the transformation zone. However, before cervical cancer appears, the cells of the cervix gradually go through precancerous changes. Healthcare practitioners use different terms to describe these precancerous changes, including squamous intraepithelial lesions (SIL), cervical intraepithelial neoplasia (CIN), and dysplasia. The precancerous changes can be detected by the Pap test or high-risk human papillomavirus (hrHPV) testing and treated to prevent the development of cancer.
The majority of cervical cancer cases are caused by infection with human papillomavirus (HPV). This virus is usually transmitted from one individual to another by sexual contact. The risk of an average sexually active person contracting HPV at some time in their lives is about 80 percent. For most individuals, the virus is cleared by their immune system before it is detected. The immune system may also cause cells to change. In some people, however, the HPV will remain and causes changes that may develop into cancer.
While cervical cancers typically start from pre-cancers, only a few women with these cells in their cervix will develop cancer. Cervical cancer pre-cancer usually takes several years to turn into true (invasive) cervical cancer, but the change can also occur within a year. For the majority of women, precancerous cells will disappear without any treatment. Treating all cervical pre-cancers can help prevent their development into cervical cancers.
Types of Cervical Cancers
Cervical pre-cancers and cervical cancers are typically classified based on their appearance under a microscope. The main types of cervical cancers are:
- Squamous cell carcinomas
Up to 9 of 10 cervical cancers are squamous cell carcinomas. These types of cancers develop from squamous cells in the exocervix. Under the microscope, the cancer cells have features of squamous cells. Most often, squamous cell carcinomas start in the transformation zone.
Cervical adenocarcinomas are cancers that develop from the glandular cells of the cervix. They grow from the mucus-producing gland cells of the endocervix. This type of cervical cancer appears to have increased in the past 20-30 years.
- Adenosquamous Carcinomas
Adenosquamous carcinomas are less common and have features of both adenocarcinomas and squamous cell carcinomas. They are also referred to as mixed carcinomas.
While nearly all cervical cancers are either adenocarcinomas or squamous cell carcinomas, other forms of cancer can develop in the cervix as well. These other types of cancer, such as sarcoma, melanoma, and lymphoma, develop more commonly in other areas of the body.
Annual Cervical Cancer Screening
Cervical cancer screening is very important in a woman’s routine health care. The main goal of screening is to detect precancerous lesions caused by HPV in order to have them removed and prevent invasive cancers from developing. The other goal of screening is to help with early detection of cervical cancers when they can usually be treated successfully.
Government data shows that regular cervical screening has significantly reduced the number of cervical cancer cases and associated deaths. For years, the Pap test or Pap smear, a cytology-based screening, was the only method of screening. The use of these tests reduced cervical cancer cases as well as deaths in countries where screening is common. However, with the introduction of methods that directly test for HPV, cervical cancer screening now includes there methods:
- Pap testing
- HPV testing- looks for the presence of high-risk human papillomavirus in cervical cells
- HPV/Pap co-testing- checks the same cell sample for both cervical cell changes and high-risk HPV types.
How Cervical Cancer Screening is Performed
A health professional inserts an instrument known as a speculum into a woman’s vagina while she lies on an exam table. This instrument helps widen the vagina to allow for a clear view of the cervix and the upper part of the vagina. The procedure also allows the doctor to take a sample of the cervical cells using a cervical brush or plastic or wooden scraper. The sample cells are then placed in a vial of liquid preservative. The vial or slide is then sent to a laboratory where the cervical cells are examined under a microscope with a liquid-based Pap cytology test and/or tested for the presence of high-risk HPV types.
New Guidelines for Annual Screening and HPV Vaccination
The U.S. Preventive Service Task Force (USPSTF) reviewed the 2012 guidelines for annual cervical cancer screening and HPV vaccination. The reviewed guidelines say that women aged 30 to 65 can be screened for cervical cancer with a test for high-risk HPV strains every 5 years, without a concurrent Pap test. In the previous guideline, the USPSTF had recommended the use of both the Pap test and the HPV test every 5 years, for women between 30 to 60 years of age. While co-testing is still a recommended way to screen for cervical cancer, it’s now less preferred due to the fact that its use may result in a woman undergoing more tests overall, compared with either Pap testing alone or HPV testing, according to the guidelines. Women ages 30 to 65 can alternatively undergo cervical cancer screening with the Pap test alone every 3 years.
Although now there are more choices for cervical cancer screening, what really matters is for women to get screened, regardless of which strategy is used.
Here are the important things you should know about the updated cervical cancer screening guidelines:
- Women ages 21 to 29 should be screened every 3 years using a Pap test (cervical cytology). HPV testing is not recommended for women in this age group because it’s often cleared by the immune system.
- Women under the age of 21 shouldn’t undergo cervical cancer screening
- There are certain risk factors that may warrant more frequent screening or continued screening for women older than 65 years of age. The risk factors include:
- being immunosuppressed
- having been treated for cervical cancer or a precancerous cervical lesion
- being infected with the Human Immunodeficiency Virus (HIV)
- having been exposed to diethylstilbestrol before birth
- Women above age 65 don’t require screening if they’re up to date on their screening, they do not have risk factors for cervical cancer, and their tests in the past 10 years were negative
- Women ages 30 to 65, have 3 screening options: a Pap test every 3 years, a test for “high-risk” types of HPV every 5 years, or co-testing with both Pap and HPV test every 5 years. If you’re under this age group, you should consult with a gynecologist about which testing approach would be best for you.
- Women who had a total hysterectomy should stop the annual screening. This recommendation only applies if the uterus and cervix were removed as a treatment for cervical pre-cancer or cancer. For women who have had a supracervical hysterectomy (removal of the uterus, but not the cervix) should continue with the annual screening for cervical cancer.
- Women who have gotten the HPV vaccination should still follow the American Cancer Society’s guidelines
As stated by the USPSTF, annual screenings are no longer recommended. However, these guidelines don’t apply to women exhibiting symptoms of cervical cancer, irrespective of their sexual history. They also don’t apply to women who have been previously diagnosed with a high-grade precancerous lesion or cervical cancer, or women with the condition that weakens their immune system, like HIV.
The Human Papillomavirus (HPV)
HPV refers to a viral infection that is usually spread through skin-to-skin sexual contact. The human papillomavirus is comprised of more than 100 different viruses. At least 30 strains of HPV are associated with the development of cancer. According to the Centers for Disease Control and Prevention (CDC), HPV infections are so common that almost all men and women will have the infection at some point in their lives. Currently, almost 80 million Americans are infected with some strain of HPV. Also, about 14 million Americans become infected every year. About 1% of sexually active adults have noticeable genital warts at some point in their lives.
In the U.S., about 12,000 women are diagnosed with cervical cancer every year. The disease is responsible for more than 4,000 deaths on an annual basis. In fact, high-risk forms of HPV can be linked to over 96% of cervical cancers and 93% of anal cancers. Oropharyngeal cancers (cancer of the middle part of the throat) are also linked to high-risk strains. HPV can also cause cancer of the vagina, anus, vulva, and penis.
The term Papilloma refers to a type of wart that from some types of HPV. This virus exists in epithelial cells, which are thin, flat cells located on the surface of the skin. They are also found on the surface of the anus, vulva, vagina, cervix, inside the mouth, and throat. Of the 100 HPV types, about of them cause warts on other body parts, such as the feet or hands. The other 40 or so get into the body through sexual contact. Typically, they are drawn to the mucous membranes in the body, such as the moist layers surrounding the genitals and the anus. However, not all HPV viruses cause serious health issues.
Each HPV has its own number designation. High-risk types of HPV include HPV 16 and HPV 18, which are linked to about 70% of cervical cancers. Low-risk strains of HPV, like HPV 11 and HPV 6, are responsible for about 90% of genital warts that look like bumps and rarely develop into cancer. Genital warts caused by HPV can manifest weeks or months after a person has had sexual intercourse with an infected partner.
It’s not obvious to tell if a person has HPV by looking at them or even searching for genital warts. In fact, most individuals have no symptoms of infection and may only find out after an abnormal Pap smear. However, even those with symptoms often misunderstand or overlook the symptoms. A study by the National Cancer Institute found that over 50% of the women who have had genital warts were not aware that they had HPV. Under two-thirds of the women did not know HPV could result in cancer.
Ideally, the HPV vaccine should be given to females before they become sexually active and exposed to HPV. Sexually active females may as well benefit from the vaccination, only that they get fewer benefits. This is due to the fact that they may have previously been exposed to one or more strains of HPV being targeted by the vaccines. However, few women are infected with all HPV types that the vaccines are intended to protect against, so most young women could still benefit.
The HPV vaccination is recommended for girls ages 11-12. The vaccination is also recommended for girls and women age 13 to 26 who have not yet been vaccinated or those who have not completed the vaccine series. The vaccine can also be administered to 9-year-old girls. CDC recommends two doses of HPV for girls who receive their first dose before 15 years of age. The timing of the doses is 6-12 months. However, a third dose is recommended if the interval between these two doses is less than five months. If a girl receives her first dose at 15 years of age or older, 3 doses are required.
In 2006, the U.S Food and Drug Administrator (FDA) approved Gardasil as the first vaccine in the fight against HPV. The vaccine was showing positive results in offering protection against certain cancers and diseases that resulted from 4 types of HPV. The Gardasil vaccine was discontinued after Gardasil 9 was approved in 2014. Gardasil 9 is recommended for males and females between ages 9 to 26. However, the CDC recommends administering Gardasil 9 vaccine to boys and girls at the age of 11 or 12. In essence, the vaccine should be given just before they become sexually active.
Side effects of the HPV vaccine may include:
- Swelling at the site, or
- Joint or muscle pain.
Most individuals assume that they’re risk-free from a particular disease after receiving the vaccine. With HPV vaccine, this risk-free assumption doesn’t apply since not all strains of the HPV virus are a target, and so there’s no guarantee of not developing cancer.
Important Things to Note about HPV Vaccination
Girls and women don’t require a Pap test or HPV test to determine if they should be vaccinated. Nevertheless, women should continue to be screened for cervical cancer, even after completing the recommended HPV vaccination series. This is important because the vaccine does not target ALL types of HPV.
The HPV vaccine is highly effective in protecting against targeted strains HPV and the most common health issues associated with them. The vaccine, however, is less effective in preventing diseases that are related to HPV in young women who have previously been exposed to HPV. This is because this vaccine only offers protection before an individual is exposed to it. The vaccine is not a treatment for existing HPV infections or HPV-related health problems.
Currently, HPV vaccination isn’t recommended for women older than 26 years of age. Clinical tests revealed that the vaccination provided limited or no protection against HPV-associated diseases. The best way to prevent cervical cancer for women aged over ages 26 years is to get routine cervical cancer screening as recommended.
Who should not get the HPV vaccine?
Pregnant women and individuals who are moderately or severely ill should not be vaccinated. Tell your doctor about any severe allergies, including allergies to latex or yeast. Also, you should not get the vaccine if you have had a life-threatening reaction to a previous dose or any element of the vaccine.
How long does the HPV vaccine last?
Research suggests that the protection offered by the HPV vaccine is long-lasting. Current studies show no evidence of weakened protection for vaccinated individuals tracked for 10 years.
Can I benefit from the HPV Vaccine if I am already sexually active?
Yes. You could still benefit from the vaccine even if you’ve already been infected by one type of HPV. This is because the vaccine can offer protection from other strains that may cause health problems. As already mentioned, however, the vaccine will only protect you from certain, but not all, types of HPV that you haven’t been exposed to already.
How safe is the HPV vaccine?
The HPV vaccine has been approved by the FDA and the CDC as safe and effective. Before its approval, the vaccine was studied globally in thousands of individuals, and the studies revealed no serious safety concerns. The side effects reported in these studies were mild, including fever, pain, nausea, and dizziness. Fainting has also been noted after HPV vaccination, especially in adolescents. Since fainting can lead to falls and even injuries, individuals should be seated or lying down when the vaccination is being administered. After vaccination, the individual should remain in the same position for about 15 minutes to help prevent fainting and injuries. The FDA and CDC continue monitoring the safety of the vaccine.
What are some of the benefits of getting HPV Vaccination?
- It reduces the chances of Verruca: the vaccine inhibits the wanton spread of skin cells and thus greatly reduces the appearance of warts. Verruca forms as blemishes. Getting HPV vaccination reduces the risk of developing Verruca.
- Offers peace of mind: you may not know you have been infected by the HPV because it does not cause any symptoms. If you haven’t had the vaccination, you could be constantly worried if you’ve contracted the virus or the related health problems. However, receiving the vaccination gives you peace of mind because you know you have some protection against some types of HPV and cervical cancer.
- Benefits outweigh the pain of injection: Many people are put off from the idea of being vaccinated because vaccines can be quite painful, especially if they involve injections. While it’s possible to experience pain or discomfort and a slight red mark from the needle, the complications from HPV such as warts and cancer can be life-altering.
Finding an Annual Screening and HPV Vaccination Near Me
If you’d like to learn more about HPV vaccination or schedule an annual screening for cervical cancer, contact All Women’s Care. We’re a comprehensive healthcare clinic providing a full range of obstetrics and gynecology services to women of all ages in the Los Angeles area. Our team strives to make your experience as comfortable as possible. Call us at 213-250-9461 or fill out our online contact form to schedule an appointment.