Cervical cancer - screening and prevention
Cancer cervix - screening; HPV - cervical cancer screening; Dysplasia - cervical cancer screening; Cervical cancer - HPV vaccine
A Pap test is a simple, relatively inexpensive procedure that can easily detect cancerous or precancerous conditions.
Lifestyle and Safer Sex Habits
Almost all cervical cancers are caused by the HPV (human papilloma virus).
- HPV is a common virus that spreads through sexual contact.
- Certain types of HPV are more likely to lead to cervical cancer. These are called high-risk types of HPV.
- Other types of HPV cause genital warts.
HPV can be passed from person to person even when there are no visible warts or other symptoms.
Vaccines to Prevent Cervical Cancer
A vaccine is available to protect against the HPV types that cause most cervical cancer in women. The vaccine is:
- Recommended for girls, boys, women, and men ages 9 through 26. It also may be given to adults ages 27 to 45 if they are at risk for HPV and have not already been vaccinated.
- Given as 2 shots in girls ages 9 through 14, and as 3 shots in teens 15 years or older.
- Best for girls to get by age 11 or before becoming sexually active. However, girls and younger women who are already sexually active can still be protected by the vaccine if they've never been infected.
These safer sex practices can also help reduce your risk of getting HPV and cervical cancer:
- Always use condoms. But be aware that condoms cannot fully protect you. This is because the virus or warts can also be on the nearby skin.
- Have only one sexual partner, whom you know is infection-free.
- Limit the number of sexual partners you have over time.
- Do not get involved with partners who take part in high-risk sexual activities.
- Do not smoke. Cigarette smoking increases the risk of getting cervical cancer.
Pap Smears
Cervical cancer often develops slowly. It starts as precancerous changes called dysplasia. Dysplasia can be detected by a medical test called a Pap smear or Pap test.
Dysplasia is fully treatable. That is why it is important for women to get regular screening tests, so that precancerous cells can be removed before they can become cancer.
At times, the HPV test may be used along with a Pap test. The HPV test can identify the high-risk types of HPV that are known to cause cervical cancer.
Pap test screening should start at age 21. After the first test:
- Women ages 21 through 29 who are at average risk should have a Pap test every 3 years. HPV testing is not recommended for this age group.
- Women ages 30 through 65 have the option to get the HPV test every 5 years with or without a Pap test.
- Women with HIV ages 21 to 29 should have a Pap test every year; after 3 normal tests in a row, test every 3 years.
- Women with HIV ages 30 and older, HPV test with Pap test or just Pap test every year. If screening was normal with Pap test and HPV test, repeat testing every 3 years. If screening was by Pap test only, repeat yearly and after 3 normal tests in a row, every 3 years. Testing should continue throughout your lifetime.
- If you or your sexual partner has other new partners, you should have a Pap test every 3 years.
- Women age over 65 can stop having Pap tests as long as they have had 3 normal tests within the past 10 years and are otherwise not at high risk for cervical cancer.
- Women who have been treated for precancer (cervical dysplasia) should continue to have Pap tests for 20 years after treatment or until age 65, whichever is longer.
- Women who have had a hysterectomy that preserves the cervix (called a supracervical hysterectomy) should continue to have Pap test screening according to the guidelines listed above.
- Women who have had their cervix removed at the time of hysterectomy no longer need Pap tests, unless the hysterectomy was done for cervical cancer or pre-cancer in which cases screening should be continued.
If you're a woman 21 or over, it's important to begin getting regular pelvic examinations to take charge of your health. An important part of this pelvic exam may include a test, called a Pap smear, to detect the often life-threatening disease, cervical cancer, even before it starts. And here's the key, cervical cells become abnormal years before they turn to cancer. That gives an excellent window of opportunity. So, what is a Pap smear? A Pap smear is a microscopic examination of cells scraped from the opening of the cervix. The cervix is the lower part of the uterus, or womb, that opens at the top of the vagina. The test looks for cervical cancer or abnormal cells. Most cervical cancers can be found, and treated early, or even before they start, if women have routine Pap smears and pelvic examinations. For this test, you will lie on a table and place your feet in stirrups. The doctor will insert an instrument called a speculum into the vagina and open it slightly to see inside the vaginal canal. Cells are gently scraped from the cervix area, and sent to a lab for examination. When a Pap smear shows abnormal changes, you will need further testing. The next step depends on the results of the Pap smear, and on your previous history of Pap smears, and risk factors you may have for cervical cancer. You may need a biopsy using a light and a low-powered microscope, called colposcopy. You may also need a test to check for infection with human papilloma virus, or HPV, which can cause cervical cancer. If you are diagnosed with cervical cancer, the doctor will order more tests to determine how you should be treated, and how far the cancer has spread. This is called staging. Treatment will depend on the stage of the cancer, the size and shape of the tumor, your age and general health, and your desire to have children in the future. Early cervical cancer can be treated with surgery to remove the abnormal tissue, or freeze abnormal cells, or burn abnormal tissue. Treatment for more advanced cervical cancer may include radical hysterectomy, removal of the uterus and much of the surrounding tissue, including lymph nodes and the upper part of the vagina. Radiation may be used to treat cancer that has spread beyond the pelvis, or if cancer returns. The woman may also have chemotherapy to kill the cancer if the cervical cancer's advanced. The Pap smear test is not 100% accurate and cervical cancer may be missed in a small number of cases. Fortunately, cervical cancer develops very slowly in most women and follow-up Pap smears should identify worrisome changes in plenty of time for treatment. Make sure your doctor knows about all the medicines you are taking. Some, including estrogen and progestins, may affect the result of your Pap smear. Pap smears can be a wonderful, life saving tool.
References
American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists' Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group. Human Papillomavirus Vaccination: ACOG Committee Opinion, Number 809. Obstet Gynecol. 2020;136(2):e15-e21. PMID: 32732766
Centers for Disease Control and Prevention website. Clinical overview of HPV.
Clinicalinfo.hiv.gov website. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV.
Salcedo MP, Phoolcharoen N, Schmeler KM. Intraepithelial neoplasia of the lower genital tract (cervix, vagina, vulva): etiology, screening, diagnosis, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 29.
US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674-686. PMID: 30140884
Version Info
Last reviewed on: 8/23/2023
Reviewed by: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 08/15/2024.
