Outsmart Cervical Cancer with Paps, Vaccines
by Darra McMullen,
Women’s Health Network Writer/Researcher
Author’s Note: Due to December’s “holiday crush”, the planned input from a cervical cancer expert could not be arranged until later in January. The results of that interview will be made available ASAP, but for now, please enjoy the following article, which contains a lot of relevant, useful, basic cervical cancer information. The article originally appeared just a few years ago on the GHWCC website; the information is still accurate and helpful, and if you missed the article the first time around, you now have a second chance to review it while we wait to hear the latest news from a cervical cancer expert – coming soon.
Cervical cancer is now much less common in the United States than it used to be just a few decades ago, and we can all thank the invention of the Pap test and American women’s adherence to frequent testing for that decline in cervical cancer rates. Still, to keep this awful disease’s rate of occurrence on a steady downward slide, there are some basic facts about the disease and its prevention that we should all understand.
To begin, the cervix is the lower part of the uterus that connects the main body of the uterus to the vagina. Almost always, cervical cancer is caused by a virus known as HPV. There are a few rare exceptions where the cause of the cervical cancer is unclear, but the vast majority of cervical cancer cases are linked to HPV infection. HPV is an abbreviation for human papilloma virus, of which there are more than 100 related types. About 60 types are found on the skin and can cause the common wart with which we’re all familiar. The remaining 40+ types of HPV are called genital HPV because they affect the anal and genital areas only, not other skin areas, such as on the hands or feet.
These roughly 40 types of genital HPV are divided into two groups called “low-risk” and “high-risk” HPV. “Low-risk” genital HPV causes genital warts and can even cause changes in cervix cells, but not changes that lead to cancer. “High-risk” HPV, on the other hand, has been linked with genital or anal cancers in both women and men. It is these “high-risk” HPV viruses that cause cervix cell changes that lead to pre-cancers or cancer.
Fortunately, much can be done with regard to early detection of the disease, treatment, and prevention of infection in the first place. Let’s start with how HPV is contracted. According to the American Cancer Society, “Genital HPV is passed from one person to another by direct skin-to-skin contact during vaginal, oral, or anal sex. It is not spread through blood or body fluids.” Genital HPV is very common; approximately 50% to 75% of people who have ever had sex will get HPV at some time during their lives. Certain estimates name a rate as high as 80% of sexually experienced individuals are expected to contract some form of HPV. Yet, comparatively few people go on to develop cancer. The reason for this low rate is two-fold. Not all HPV infections are of the type to cause cancer. Also, the human body tends to clear the virus over time. Usually, from six months to two years after contracting HPV, the human body succeeds in extinguishing the infection; and therefore, the HPV viruses that can cause pre-cancerous cells to form never have a chance to spread or cause problems.
For the relatively small percentage of women (about 10%) who don’t clear the virus from their bodies naturally over time, they may find themselves at higher risk for pre-cancerous cell formation. Still, not every woman who has detectable levels of HPV over several years will go on to develop pre-cancerous or cancerous cells. Some individuals seem to be able to live with HPV and suffer few effects.
For those women who do develop pre-cancerous or cancerous cell changes, there are a number of treatment options available, which are often quite effective and lifesaving. The key to successful treatment is to discover the pre-cancerous or cancerous cells early in their development. Pre-cancerous cells, if destroyed at this early stage, will never develop into actual cancer. Similarly, early stage cancerous tumors are much more successfully treated than those in later stages.
With early detection of problem cells so vital to positive outcomes, in steps the need for regular Pap tests, which provide that essential information. Between 1955 and 1992, cervical cancer death rates declined by nearly 70%. The primary reason for the change was the increased use of the Pap test. In more recent years, the death rate from cervical cancer continues to decline by about 3% per year for American women. The Pap test has been a huge help in the fight against cervical cancer.
Although the Pap test is a wonderful means of identifying problem cells, even the Pap has its limitations. For one thing, the test is interpreted by humans, who can mistakes. Also, a number of other factors can make the chances of obtaining an accurate result less likely. To increase the likelihood of catching problem cells early, the American Cancer Society makes the following recommendations:
•All women should begin getting Pap tests three years after they start having vaginal intercourse. A woman who waits until after age 18 to have sex should begin screening by age 21. Pap tests should be performed every year until age 30. Women with no exceptional risk factors who have had three normal Pap test results in a row by age 30 may then be tested less often, generally every two to three years. Women who have exceptional risk factors, such as HIV (AIDs virus), other cancers, or a weakened immune system from other causes should continue to get Pap tests yearly.
•Women age 70 and older who have had three or more normal Pap results in a row can choose to stop screening altogether unless they fall into a high risk factor group due to other health conditions. Women are urged to consult their doctors about their individual health situations before electing to cease testing.
•Women who have undergone a total hysterectomy, including removal of the cervix, may also cease Pap testing, unless the reason for removing the cervix was because of pre-cancer or cancer formation. If so, those women are advised to consult their doctors about appropriate screening for the possibility of future cancer risk in other areas of the body.
To help reduce the number of factors that can cause an inaccurate Pap reading, always do the following prior to the actual Pap test:
•Don’t schedule the appointment during a menstrual period.
•Don’t have sexual intercourse for 48 hours before the test.
•Don’t douche, use tampons, birth control foams, jellies, or other vaginal creams or vaginal medicines for 48 hours before the test.
Besides frequent screenings (Pap tests), there is another way to help prevent cervical cancer - vaccination, which can prevent becoming infected with two types of HPV that most often cause cervical cancer. Vaccination with either Gardasil or Cervarix, which are vaccines designed to protect the previously unexposed person from ever contracting HPV, can be helpful. These vaccines are generally recommended for people who are not yet sexually active, and therefore, highly unlikely to have been exposed to any HPV viruses. Girls and young women, ages 9 to 26 years, are urged to consider getting vaccinated by the American Cancer Society. Boys and young men, aged 9 - 26, are also eligible for vaccination. Males can get cancers of the head, neck, anus, and penis from HPV, as well as genital warts; therefore, HPV viruses do pose a threat to males as well. There is evidence that vaccination provides at least some protection, perhaps quite a bit, to males for both cancer protection and genital warts. Gardasil also contains protection against the two types of HPV that cause most genital warts (about 90%) in both males and females.
There are some downsides to vaccination, which should be considered before making a final decision to vaccinate. There is a greater than normal (as compared to other types of vaccines) risk of fainting immediately after receiving the injection. Because of this risk, there is a mandatory waiting period of 15 minutes after receiving the shot before patients are allowed to leave. Although most patients recover from a fainting spell with no further problems, some scattered individual accounts have complained of other side effects well after the injection was received.
Individuals with multiple allergies, especially to yeast, should consult their doctors before deciding to proceed with vaccination. Likewise, individuals who have histories of medical difficulty with vaccines in general should consult their doctors before proceeding. Anyone who has had a bad experience with the first shot (in the series of three) for HPV should not receive additional HPV vaccinations.
Another issue to consider with HPV vaccination is the cost. Always check with your insurance company or state or federal health authorities about your individual options before proceeding uninformed.
Possible vaccination benefits to older males and females, from ages 27 and up, are being studied. Although most people have generally been exposed to HPV by this age, there is reason to believe that vaccination, even after virus exposure, may somehow help prevent the virus from causing troublesome cellular changes in the body.
Whether young or older, all women should remain vigilant with Pap test screening. Even HPV vaccinated young women should still get regular Pap tests. The vaccine can help prevent only about 70% of cervical cancer risk. There’s still that 30% risk lurking out there for the vaccinated group and a greater risk than that for the unvaccinated.
Early detection is a lifesaver; always make use of your friend, the Pap.