FREQUENTLY ASKED QUESTIONS ABOUT CERVICAL CANCER & THE HUMAN PAPILLOMAVIRUS (HPV)

What is cervical cancer?

Cervical cancer begins in the cervix, the part of the uterus or womb that opens to the vagina. Before doctors started using the Pap test in the 1950s, cervical cancer was the leading cause of death from cancer in American women. Today in the United States, the Pap test saves the lives of 70% of the women who might otherwise have died from cervical cancer. Recent advances in screening and work on a vaccine could help the effort to wipe out cervical cancer.-
Every year, about 10,370 women in the United States get cervical cancer and more than 3,700 women die from it. Worldwide, cervical cancer kills almost a quarter-million women each year, according to the Pan American Health Organization.

What causes cervical cancer?

A virus—the human papillomavirus, or HPV—causes almost all cases of cervical cancer. HPV is a common sexually transmitted virus that usually goes away by itself. Most people with HPV never even know they have it.

There are two types of HPV—"low risk" and "high risk." Some low risk HPV infections can cause genital warts. Sometimes, if the high-risk type of HPV does not go away on its own, it may cause abnormal, or pre-cancerous, cells to form. If these abnormal cells are not found and treated, they may become cancer. An HPV infection rarely leads to cervical cancer. In most women, the cells in the cervix return to normal after the body's immune system destroys the HPV infection.

How is cervical cancer detected?

The American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) say that:

Women should be screened for cervical cancer about 3 years after they start having sexual intercourse. Screenings should start by the time a woman is 21 years old.
Women should be screened every year with a regular Pap test. As an alternative, the newer liquid based Pap test can be used every year or every 2 years. All women 30 years old or younger should get cervical cytology (cancer) screening at least every two years.
Some women age 30 and older who have had 3 normal Pap tests in a row don't need to get a Pap test every year. They can get the test every 2 or 3 years. Talk with your doctor about the best screening schedule for you (and follow the recommended program!) Even though women with normal results don't need to be screened every year, they should go to their doctors every year for a check up, including a pelvic exam. The recently FDA-approved HPV test is also appropriate for women age 30 and older, in conjunction with a Pap test. If a woman does not have HPV and her Pap test is normal, she should be rescreened no more frequently than once every 3 years.
According to ACS, women age 70 and older who have had 3 or more normal Pap test results in a row and no abnormal test in the last 10 years don't have to get a Pap test again. Since there has not been a lot of research on the risks that older women have of getting cervical cancer, ACOG recommends that women over the age of 70 should still get Pap tests every 2 or 3 years. Talk to your doctor to decide the best plan for you.

What's New in Cervical Cancer Screening?

Liquid-based Pap Test

Liquid-based cytology refers to a new way to process Pap test results. Instead of smearing the sample on a glass microscope slide, the cervical cells are placed in liquid in a small bottle. Some of the liquid is placed on a slide and then examined under a microscope.

Research has shown that liquid-based Pap tests can be more accurate than the conventional way of preparing the slides because blood and mucous are removed, making the cells easier to see. Pap testing using the liquid-based method of slide preparation is somewhat more expensive, and not all clinics have this option available. Other clinics use only the liquid-based method.-

Both the American Cancer Society and the American College of Obstetricians and Gynecology say that both conventional and liquid-based methods are effective cancer screening options. The important thing is to get tested.

HPV Test

For women 30 or older...
The Food and Drug Administration (FDA) recently approved a new way to test for cervical cancer in women 30 and older, which the ACS and ACOG state is an appropriate option for screening women in this age group. The new option uses an FDA approved HPV test in conjunction with a Pap test. While a Pap is 51% to 85% accurate in identifying women with cervical cancer or its early signs, studies show that this number is increased to approximately 100% when an HPV test is used in conjunction with a Pap test in women age 30 and older. Together, these tests help a woman’s doctor find the cancer-causing or high-risk HPV, along with screening for pre-cancer changes in the cells. Women in this age group may also choose to have a regular Pap test without an HPV test.-

If the new HPV test is performed along with a screening Pap test, the results will fall into one of the categories below:

If the results of both the Pap and HPV tests are negative (normal), you won't need to be tested again for 3 years.
If the Pap test is negative (normal) and the HPV test is positive, repeat the Pap test and HPV test in 6 to 12 months.
If both tests are positive, talk with your doctor about what to do next.

For women under 30...-
Women under the age of 30 should not get the new combined test. HPV testing in routine screening is not helpful in this age group. Pap tests, however, are very important at this time of life. Young women have more frequent HPV infections (which are likely to be temporary) and more frequent changes in sex partners. During these years, when HPV infection and Pap test abnormalities are common, it is recommended that women be screened often (every 1-2 years depending on the type of Pap test). Fortunately, in young women, most HPV infections and Pap test abnormalities clear up on their own before the infection causes any cell changes or symptoms.

If a woman’s Pap test result is inconclusive – also known as “atypical squamous cells of undetermined significance” – then medical guidelines recommend HPV testing as the preferred approach for determining if further evaluation is needed.

Why should I be screened for cervical cancer?

A woman who is dying of cervical cancer recently said “I just didn’t get it…..I wish that I’d known more.” With over 10,000 cases of cervical cancer each year in the United States, it is clear that she is not alone. Each death from cervical cancer is a tragedy – a tragedy made worse by the fact that most cases are preventable. Pap tests are remarkable because they help to find changes before cancer starts. Pap tests effectively fight what used to be the number one cause of cancer death in women. -

Hopefully you do not know anyone who’s had cervical cancer. However, that’s not because the disease has gone away – the virus (HPV) that causes the cancer is as prevalent as ever. Regular screening tests can make the difference between life and death.

Who gets cervical cancer?

Since almost all cervical cancers are caused by HPV, any woman who has sex can get cervical cancer. Most women who've had sex have been infected with HPV at some time in their life. The women at highest risk for cervical cancer are women in whom infection with one of the high risk types persists for years. Other risk factors for cervical cancer include smoking and HIV infection. The women who are most at risk for the disease are women who do not get screened regularly.

How do I know if I have HPV?

In most cases, you won't have any symptoms of an HPV infection. The only way to know if you have an HPV infection is to have a direct test for the virus. The only way to tell if a high-risk HPV infection has caused the cells in your cervix to change is to have a Pap test. Signs of an HPV infection may appear weeks, months, or years after the first infection, which is why it is important to have regular tests.

Is there a test for HPV?

Yes, there is an HPV test that can detect high-risk types of HPV that can cause changes in your cervical cells. Women 30 years of age and older have the option of having both the Pap test and the HPV test. If your Pap test shows that you have questionable changes in your cervical cells, your doctor may do an HPV test to find out more about the abnormal cells. If your Pap test shows a definite pre-cancerous abnormality an HPV test is not needed. Virtually all of these changes are caused by HPV.

Can HPV be treated?

There is no treatment for the virus. There are treatments for cervical changes that HPV can cause. If your Pap and HPV tests show that cells in your cervix have changed, you should discuss treatment options with your doctor.

What is a Pap test? What's the difference between a Pap test and an HPV test?

Doctors use the Pap test to see if there are any cell changes. The Pap test looks at a sample of cells from your cervix to see if there are any cells that are abnormal. The Pap test is a good way to find cancer cells and cells that might become cancerous in the future. The Pap test can be performed as a normal part of a routine pelvic exam.

The HPV test checks directly for high-risk viruses. Both the Pap and HPV tests use a small, soft brush to collect cervical cells. The cells are sent to a lab, where they are examined under a microscope. Whether you have both tests or the Pap test alone, you won't notice any difference in your exam.

Is there a vaccine for HPV?

The availability of a vaccine for HPV is likely in the near future and could go a long way towards preventing cervical cancer. Clinical studies have shown that preventive HPV vaccines were 100% effective at preventing cervical cell changes associated with the two high-risk HPV types that are responsible for approximately 70% of all cervical cancer cases.

How do you know if you have cervical cancer?

Cervical cancer or early cervical pre-cancers often have no signs or symptoms. That's why it's important to get Pap tests regularly. If you have any of these symptoms, call your doctor right away.

Any unusual discharge from the vagina
Blood spots or light bleeding when you're not having your period
Bleeding or pain during sex

Just because you have these symptoms, it doesn't mean you have cervical cancer. You can have these symptoms for other reasons. Check with your doctor to find out what's causing your symptoms. Finding cervical cancer early means you have a better chance of treating it successfully.

How should I prepare for my cervical cancer screening tests?

Don't take the tests if you're having your menstrual period.
Don't douche for 2 days before the tests.
Don't have sexual intercourse for 2 days before the test.
Don't use tampons or birth control foams, jellies, or other vaginal creams or vaginal medicines for 2 days before the test.

Can cervical cancer be treated?

Yes, cervical cancer can be treated with surgery, radiation, or chemotherapy. If you have cervical cancer, discuss treatment options with your doctor to decide the best way to treat the cancer. Scientists are working to find a vaccine that will stop women from getting this kind of cancer.

When do I need to see a specialist?

If you have cervical cancer, you'll likely be treated by one or more of the following specialists: a gynecologic oncologist, a radiation oncologist and a medical oncologist. An oncologist is a doctor specially trained in diagnosing and treating cancer.

If you have been diagnosed with precancerous changes, it's not essential that you see an oncologist. Depending on the degree of the change seen, your gynecologist or your primary care doctor may monitor your condition and provide treatment.

Do I need a Pap test if I've had a hysterectomy?

The answer to this question depends on why you had a hysterectomy.

If you had a hysterectomy to treat cervical cancer, you should continue to have regular Pap tests to make sure the cancer hasn't come back.
If you had a hysterectomy to treat pre-cancerous changes in your cervix you should continue to have regular tests for at least a few years after the surgery.
If you had a hysterectomy to treat uterine or ovarian cancer, your doctor may advise you to have Pap tests regularly, since the tests are helpful in finding recurrences of these cancers.
If you had a hysterectomy where your cervix was not removed (called a subtotal or supracervical hysterectomy), you should have regular tests until you are at least 70 years old. Since your cervix wasn't removed, there is still a chance you could develop cervical cancer.
If you had a total hysterectomy (the entire uterus, including the cervix was removed) for a reason other than cancer or pre-cancer, you may not need to have the Pap or HPV test any more. Check with your doctor first, since some conditions may mean that you should continue to be tested.
If you had a hysterectomy and have an immune system disease (such as AIDS) or are taking medicines that suppress your immune system (such as after a kidney transplant), you may be more likely to develop problems from an HPV infection. You should be tested regularly.

Many women don't know why they had a hysterectomy or what kind of hysterectomy they had. If you go to a new doctor after the surgery bring whatever records you might still have from your surgery. With records and an examination he or she will be able to tell what kind of hysterectomy you had and whether or not you need to continue to have Pap tests.

You should discuss your situation and your risk factors for HPV infection with your doctor. No matter what you decide about the Pap and HPV tests, you should continue to have regular pelvic exams.

A Few Things to Remember

The single most important thing that a woman can do is to participate in a regular screening program. All women who are screened enjoy a dramatic reduction in the risk of cervical cancer compared to women who do not get tested. Make your appointment today!
Most cervical cancer is preventable. Early detection of abnormal cell changes is important. Cervical cancer is rare and almost always prevented through regular screening and treatment of pre-cancerous changes.
Almost all women will have HPV at some point, but very few will develop cervical cancer. Most HPV infections are temporary and will go away on their own. An HPV infection that does not go away over a period of years might lead to cervical cancer.
The new screening options, including liquid-based Pap tests and the test for high-risk HPV, are important developments for women and their physicians. In the future an HPV vaccine may prevent many Pap test abnormalities and most cervical cancer.

NOTE: This document is derived primarily from materials from the National Cervical Cancer Public Education Campaign, of which Women In Government is a member, as well as from other published sources. The lead partner of the National Cervical Cancer Public Education Campaign is the Gynecologic Cancer Foundation. Most of the information contained here can be found at http://www.cervicalcancercampaign.org.