Preventing Cervical Cancer With Vaccines and Checkups
U.S. cervical cancer rates have dropped by almost half since the 1970s because of screening and vaccines. Still, about 14,500 women develop it each year and 4,300 die, according to the National Cancer Institute.
That’s why Einstein Healthcare Network specialists in pediatric and women’s health emphasize the importance of prevention.
The vaccine against human papilloma virus (HPV), the principal cause of cervical cancer, is recommended for children and young adults. Women also should get regular screening with a Pap test, HPV test or both.
The cervix is the narrow lower end of the uterus (womb) that connects the organ to the vagina (birth canal). The main cause of cervical cancer is long-lasting infection with certain types of HPV, a common virus passed primarily from person to person by intimate sexual contact.
Most people who are sexually experienced get HPV at some time in their lives. For most, it doesn’t cause symptoms and the virus goes away on its own.
If the body doesn’t clear the virus, some types of HPV can cause changes to the cervix that can lead to cervical cancer. Other types of HPV can cause genital warts.
The good news is that we have the HPV vaccine, the Pap test that screens for abnormalities to cells in the cervix, and the HPV test. These screening tools help find a problem early, often allowing treatment to begin even before cancer develops.
When found early, cervical cancer is highly treatable, which means long survival and good quality of life.
HPV Vaccine Prevents Cancer
Much of the information about HPV focuses on women, since having the virus increases the risk of cervical cancer, but HPV can cause health problems in anyone.
“Everyone needs to get the HPV vaccine,” says Joy Friedman, MD, Director of Adolescent Services at Einstein Medical Center Philadelphia and Director of the Teen Clinic.
“HPV causes 100% of cervical cancer and 90% of anal cancer, as well as cancers in the back of the throat, at the base of the tongue, and in the tonsils. The vaccine prevents more than 90% of cancers caused by the virus,” Dr. Friedman says.
After years of rigorous safety testing, the Food and Drug Administration approved the Gardasil-9 vaccine to prevent HPV-related cancers: cervical, vaginal and vulvar cancer in girls, and genital and anal cancer in boys.
The vaccine can be given to pre-teens starting at age 9 and through age 45 in adults.
“We start to give the HPV vaccine from age 9 and aim to complete the series by age 12, which is the ideal time since we include it with other vaccines children get when they come in for their annual well visits,” Dr. Friedman says. “I explain to parents that it’s a vaccine to prevent cancer, so families welcome it.”
Patients under the age of 15 get two doses, with the second dose given six to 12 months after the first.
Younger children have the most robust response to the vaccine, Dr. Friedman says. “If we wait until the adolescent is 15 or older, then they need three, instead of two, shots to get the needed immune response. ”
Sometimes parents express a concern that giving the HPV vaccine is like giving adolescents permission to have sex, Dr. Friedman says. “I explain that this is simply not true. Studies show that getting the HPV vaccine is not associated with teens becoming sexually active sooner.”
When to Get Screened for Cervical Cancer
Whether they have received the HPV vaccine or not, women can be protected by screening with the Pap test (also called Pap smear) and the HPV test.
At Einstein Medical Center Philadelphia, healthcare providers follow the national guidelines recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Colposcopy and Cervical Pathology (ASCCP).
Alycia Ham, DNP, RNC-OB, CRNP, a Certified Registered Nurse Practitioner in Obstetrics and Gynecology, lists these guidelines for cervical cancer screening:
- Women at age 21 to 29 get a Pap test every three years.
- Based on the results of the Pap test, they also may get an HPV test.
- Women ages 30 to 65 get a Pap test and an HPV test every five years.
- Routine Pap and HPV tests are not necessary after age 65 if the woman has a history of screenings with normal results and is not at high risk of cervical cancer.
If you’ve had a partial hysterectomy – when the uterus is removed but the lower end of the uterus (cervix) remains – the recommendation may be to continue Pap tests until age 65.
If you’ve had a total hysterectomy – when both the uterus and cervix are removed – for a cancerous or precancerous condition, regular Pap tests may still be recommended past age 65 to monitor for precancerous change.
But if you’ve had a total hysterectomy for a noncancerous condition, you can stop having Pap tests.
During a Pap test, a healthcare provider uses an instrument to obtain cells from the cervix. The cells are analyzed under a microscope for abnormal or precancerous cells that could turn into cervical cancer.
An HPV test detects the presence of HPV and what type you have. Certain types of HPV increase the risk of cervical cancer.
“The combination Pap-HPV test is performed at the same time, and the HPV test is done using the same sample from the Pap test or by collecting a second sample from the cervical canal,” says Dr. Ham, who has a doctoral degree in nursing practice.
The HPV test is available only to women, but men can be infected with HPV and pass it to their sex partners which is why it’s important to get the HPV vaccine.
Risk Factors for Cervical Cancer
Besides HPV infection, certain factors increase the risk of cervical cancer.
- Smoking – women who smoke are twice as likely to develop cervical cancer as nonsmokers.
- A weakened immune system.
- Having multiple sex partners. Using barrier protection such as condoms can reduce the risk, though barrier protection does not completely eliminate the risk.
- Having a partner with one or more risk factors for HPV infection, such as multiple sex partners.
Most of the time cervical cancer causes no symptoms until it has spread to other areas of the body. Symptoms may include abnormal vaginal bleeding between periods, after sex or after menopause.
“It’s important for patients to understand their test results and any follow-up care or treatment that’s needed,” says Dr. Ham. “And even though they get a Pap test every three years or a Pap and HPV test every five years, they still need to come in every year for a general gyn check-up and to discuss any gyn issues.”
Find out more about Einstein gynecology care.