How can I lower my risk of developing cervical cancer, and what lifestyle changes can help with prevention?
We now know that cervical cancer is exclusively caused by sexually transmitted HPV, and there are a few ways we can reduce our risk of contracting this virus. The Gardasil vaccine protects against 9 of the most aggressive strains of HPV and is available for males and females from age 9 to 26, and women up to age 45 in a 2 or 3 vaccine series depending on age.
Using condoms is another way to protect yourself against the spread of sexually transmitted HPV. Since there is no commercially available HPV test for men, it is impossible to know which male partner might have already been exposed and thus transmitted the virus.
Getting routine gynecologic exams with age and risk appropriate screenings namely pap smears.
Are there any factors that increase my risk of developing cervical cancer, and how can I mitigate them?
Having unprotected sex is the biggest risk factor – so condoms go a long way. We know that individuals with compromised immune systems or who are on medications that weaken their immune system are at a greater risk of an HPV
infection lingering and thus creating more abnormal cells on the cervix. Another big risk factor is not seeking routine pap smears when they are due, particularly if you have a history of abnormal pap smears. With modern medicine
we can treat abnormal pap smears before they become cancerous, and we detect these changes on a pap smear.
What exactly is a pap smear, and how does it detect cervical cancer or precancerous cells?
A pap smear is when we use a soft bristled brush or plastic tool to brush or scape a sampling of cells off the surface of the cervix. These cells are then sent to a lab to look for changes in the cells and depending on age, the presence of HPV. We consider a pap smear to be a screening test, which means if the results are abnormal we may need to do additional testing to determine our level of concern and potential next steps.
At what age should I start getting regular pap smears, and how often should I have them?
Current guidelines recommend immunocompetent women should begin getting pap smears at age 25, and as long as they are normal should be repeated every 3 years. Women should still have a well women visit with physical exam annually to look for other concerns or changes.
What should I expect during a pap smear appointment, and is the procedure uncomfortable?
Although the exam for a pap smear can be mentally uncomfortable and even a little awkward for most of us, it should not be physically painful. Your provider will use a lubricated speculum inserted into the vagina to visualize your cervix
and take a sample.
How accurate are pap smears in detecting cervical cancer, and are there any false positives or negatives I should be aware of?
Pap smears are not 100% accurate, so we do have to use clinical interpretation combined with each patients history to gauge our level of concern when viewing and interpreting results. It is possible that a result may indicate an abnormality
when there is not actually one, particularly in cases of inflammation or vaginal infection. Only follow-up testing and evaluation can determine is this is in fact the case.
Can HPV vaccination help prevent cervical cancer, and should I consider getting vaccinated?
Yes! Cervical cancer is the only type of cancer that we really have a preventative vaccine for, however because of its association with sexual activity it has sometimes been difficult for parents to consider vaccinating their child. The ideal
time for anyone to get vaccinated is prior to the onset of sexual activity due to potential HPV exposure.
Are there other types of cancer or health issues that pap smears can help detect early?
Although rare, we can sometimes detect endometrial or uterine cancer with a pap smear if abnormal cells are able to be reached in the cervix.
What can I do if my pap smear results come back abnormal, and what does further Testing or Treatment Involve?
It depends on your age and the type of abnormal result. We know women under age 30 tend to have very robust immune systems, and thus the ability to fight off HPV and the changes it can cause. As we age our immune system doesn’t work as quickly or efficiently, so we sometimes test and intervene more aggressively. If we recommend follow-up testing this generally means a colposcopy which is a diagnostic test to look for and biopsy abnormal cells to determine the degree of abnormality and how it should be treated.
How important is it to follow up on routine pap smear recommendations, and what are the benefits of regular screening?
Very important! Early detection of abnormalities on a pap smear gives us the opportunity to intervene before these changes become more serious. This can mean less aggressive intervention, closer follow-up, avoidance of major surgery,
and preservation of childbearing potential.
What can I expect during the follow-up process if my pap smear results indicate abnormalities or precancerous cells?
At a minimum, once a women has an abnormal pap smear she will need a follow-up pap smear in 1 year. Depending on the result and your age, we may recommend a colposcopy to determine the presence of dysplasia. In certain
circumstances we may recommend procedures to remove abnormal cells, called excisional procedures.
Are there any changes in pap smear guidelines or recommendations that women should be aware of?
A lot! Gone are the days of starting pap smears the first time you go to the gynecologist regardless of age. Lots of research has gone into best practices to determine not only at what age and how often we should perform pap smears, but also how we should treat and manage abnormal results. Now we start at age 25 and only do them every 3 years instead of annually if they are normal. We also stop age 65 or after hysterectomy in women with no abnormal history.