TRHS Blog Post: Cervical Cancer Awareness Month
January is cervical cancer awareness month. Here’s to not just a month or a year, but a lifetime of a healthy cervix! How can women advocate for their own cervical health?
- Routine pap smear and follow up if abnormal
- Stop smoking
- Immunize against human papilloma virus (HPV)
All three of these are really equally important. Let’s break each of them down:
Routine Pap and HPV testing: (and follow up for abnormals!)
There are 12,800 new cases of (and 4200 deaths) cervical cancer each year in the United States.
This is a largely preventable cancer! How can it be prevented? Routine pap testing!
When was your last pap smear? Are you due?
Screening with Pap testing is recommended starting at age 21 every 3 years. Once a woman turns 30, she can have Pap and HPV testing (referred to as “co-testing”) every 5 years. Women with normal screening may consider stopping testing after age 65, but only after reviewing their individual testing history with their primary care provider. Pap testing is safe during all stages of pregnancy.
With any abnormal test results, follow up intervals are shorter and there are clear guidelines that your provider will use to make sure you have the care you need. Remember, “abnormal” does not mean “cancer”. Abnormal pap smears happen often – six out of ten women will have an abnormal pap smear in their lifetime. And about 70-80% of women will clear high risk HPV infection within 3 years. Doctors, nurse practitioners and physician assistants think of pap smear results in a spectrum – abnormal results can come back as “ASCUS” (some atypical cells but unclear why), “LSIL” (low grade changes to most cells, usually due to HPV), “HSIL” (high grade changes, most likely due to HPV) or “AGC” (atypical cells from the cervical canal or uterus, not due to HPV).
Of these, the result most concerning for pre-cancer is HSIL, but all of them need follow up with your provider.
If you smoke, you take longer to clear the HPV virus, and you’re less likely to clear it in general. Smoking absolutely increases the risk of cervical, vulvar, vaginal cancers in women. (As well as many other types of cancer we won’t discuss more in this post!)
Almost all (99.7%) cervical cancer is due to HPV. The virus is transmitted by skin to skin contact (has even been found under fingernails…). Most sexually active people will have HPV at some point in their lives, even if they only have one partner. Fortunately, a large majority of people will clear the infection on their own.
Not all types of HPV cause cancer. There are high risk and low risk types. Thirteen of the more than 100 types of HPV are high risk and known to cause cervical cancer. Majority of cancer is due to types 16 and 18. About 15-30% of women will have high risk HPV in their lifetime.
High risk HPV is also involved in 72% of oropharyngeal (mouth and throat) cancers (61% is HPV 16). The virus is also found in other types of cancer: tonsillar, base of tongue, penile, anal, vulvar, vaginal. HPV also appears to be on the rise, and the prevalence of high risk types 16 and 18 is higher in males than in females per the Centers for Disease Control (CDC).
Can high risk HPV be prevented, too? For boys and girls? Yes, read on!
The HPV vaccine covers the most common types of high risk HPV (16 and 18) seen in >70% of cervical cancer. However – it doesn’t stop there, it also covers seven other high risk types, making it a 9-valent vaccine. It can be given in 2 doses (6-12 months apart) for boys and girls under 15, and 3 doses for children over 15 or who had two doses less than 6 months apart. Vaccinating early starts cancer prevention earlier, and means less shots for your child.
Dietary Considerations: B6, B12, Turmeric, Green Tea
Recently, I attended the ASCCP (American Society for Colposcopy and Cervical Pathology) meeting in Tampa, FL. A couple of lecturers there mentioned the above natural ingredients may have a part in decreasing risk of cervical cancer, but there’s much more to study and we do not know too much to routinely recommend this as a way to prevent cancer.
Remember, the best way to prevent cervical cancer is pap testing!
Healthy Sexual Relationships:
Safer sex with barrier contraceptive can reduce, but not eliminate the chance of HPV transmission. Condom use 100% of the time only recedes HPV transmission by 70%. As noted above, even people with only one sexual partner in their lifetime are at risk for HPV, but certainly the risk increases with more sexual partners.
So, in summary – prevention is worth a lot when it comes to cervical cancer – it’s life saving! Cervical cancer is a very preventable cancer with routine pap screening, and risk can further be brought down for future generations through the HPV vaccine, approved for young men and women ages 9 to 26.
Wishing a healthy 2019 to all.
Dr. Cara Sullivan
 American Cancer Society, Cancer Facts and Figures 2017. Atlanta: American Cancer Society 2017.
 ASCCP Conference, 2018. Epidemiology of HPV and Cervical Cancer. Schiffman, Castle et al. Lancet. 2007.
 Giuliano AR et al. Cancer Causes Control. 2002; 13:839-846.