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Cervical cancer: Protect yourself with a Pap test

Cancer of the cervix can strike women at almost any time, but it usually appears between ages 35 and 55. More than 20 percent of cervical cancer cases are diagnosed in women older than 65.

The cancer develops when cells on the cervix—the necklike opening that connects the uterus to the vagina—undergo abnormal changes and begin to grow out of control. Fortunately, cervical cancer is a slow-growing disease. More than 90 percent of the time, precancerous changes are detected during a Pap test and can be successfully treated to stop cancer before it has fully developed. That’s why it’s critical to follow screening guidelines for the disease.

Preventing precancers

About 95 percent of cervical cancer cases occur as a result of exposure to a sexually transmitted disease called the human papillomavirus (HPV). Although HPV often goes away on its own without treatment, it can lead to precancerous changes. Since the virus doesn’t always cause warts or other signs, women can have HPV without knowing it.

A vaccine to immunize against the types of HPV most likely to cause cancer has recently been approved by the U.S. Food and Drug Administration. The American Cancer Society recommends the vaccine for females ages 11 to 12, with “catch up” vaccination for those ages 13 to 18. However, women should continue to limit exposure to HPV by delaying intercourse when they’re young and limiting their number of partners.

Women who smoke are twice as likely as nonsmoking women to get cervical cancer. Other risk factors for the disease include:

  • chlamydia infection
  • human immunodeficiency virus
  • a diet low in fruits and vegetables
  • excess weight
  • long-term use of oral contraceptives (five years or more)
  • seven or more full-term pregnancies
  • low socioeconomic status
  • a family history of cervical cancer
  • being the daughter of a mother who took the hormonal drug diethylstilbestrol (DES) while she was pregnant with her

Detecting and treating precancers and cancer

Women with early cervical cancer or precancers usually don’t experience symptoms, so doctors rely on the Pap test to screen for suspicious cell changes. A Pap test is performed during a routine pelvic exam. Your doctor scrapes or brushes a sample of cells from your cervix and sends them to a lab. If the results show an ambiguous or minor abnormality, your doctor will probably instruct you to repeat the test in several months. In most cases, the repeat test will show a normal result.

In some cases, depending on the abnormality found, a doctor may order tests such as a biopsy or endocervical curettage in which cells are scraped from the endocervical canal to find out whether precancerous cells or cancer is present. Women older than age 30 may also be given an HPV DNA test to determine if they have the virus.

Preinvasive cervical cancer occurs when precancers are confined to the cervical lining’s first layer. Abnormal tissue can be removed in the doctor’s office or hospital. Doctors can destroy precancerous cells by freezing them with liquid nitrogen (cryosurgery) or burning them off with a laser.

When invasive cervical cancer is confined to the cervix, doctors treat it using hysterectomy or radiation therapy. When it spreads to other parts of the body, doctors order diagnostic tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans to determine how large the cancer is and how far it’s spread. Surgery (including hysterectomy), radiation, chemotherapy or any combination of these may be used.

Screening guidelines

The American Cancer Society recommends women follow these guidelines:

  • All women should begin cervical cancer testing about three years after they begin having intercourse, but no later than when they are 21 years old. Testing should be done every year with a regular Pap test or every two years using the newer liquid-based Pap test.
  • Beginning at age 30, women who have had three normal Pap test results in a row may be tested every two to three years with either the regular or newer liquid-based Pap test.
  • Women in all age groups who have risk factors for cervical cancer, such as HIV infection or a weakened immune system, should continue to be tested yearly.
  • Women over age 30 have another alternative-to get tested every three years (but not more frequently) with the Pap test plus the HPV DNA test.
  • Women ages 70 and up who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop screening. Women in this age group who have risk factors should continue to be screened as long as they are in good health.
  • Women who have had a total hysterectomy (removal of the uterus and cervix) may stop getting tested unless the surgery was performed to treat cervical cancer or precancer.

Thanks to earlier detection and treatment, death rates due to cervical cancer dropped 74 percent between 1955 and 1992. Still, an estimated 3,870 American women will die from the disease this year. Getting a regular Pap smear is the best way to avoid becoming a statistic.

Cervical cancer rates vary across the country

Cervical cancer rates are highest in areas where low-income, poorly educated women are less likely to have easy access to healthcare services, according to a recent report from the National Cancer Institute. Women most at risk for dying from the disease are African-American women in the south, women living along the Mexican border, white women in Appalachia, American Indians in the Northern Plains, Vietnamese-American women and Alaska natives.