Most cervical cancer can be prevented. There are 2 ways to prevent this disease. The first way is to find and treat pre-cancers before they become cancer, and the second is to prevent the pre-cancers.
Finding and treating pre-cancers before they become cancer
A well-proven way to prevent cancer of the cervix is to have testing (screening) to find pre-cancers before they can turn into cancer. The Pap test (Pap smear) and the HPV test are the tests used for this. If a pre-cancer is found and treated, it can stop cervical cancer before it really starts. Most cervical cancers are found in women who have not had Pap tests when they should.
The American Cancer Society recommends the following:
- All women should begin cervical cancer testing (screening) at age 21. For women aged 21 to 29, testing should be with a Pap test every 3 years. HPV testing should not be used for screening in this age group (although it may be used as a part of follow-up for an abnormal Pap test).
- Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This should keep on being done until age 65.
- Another option for women 30 to 65 is to get tested every 3 years with just the Pap test.
- Women who are at high risk of cervical cancer (for instance, because of a weak immune system from HIV infection, organ transplant, or long term steroid use or because they were exposed to DES in utero) may need to be screened more often. They should follow the recommendations of their healthcare team.
- Women over 65 years of age who have had regular screening in the past 10 years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers found in the last 20 years. Women who have had certain pre-cancers should keep on being tested for at least 20 years after the pre-cancer was found.
- Women who have had a hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests) unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy that left behind the cervix should continue to follow the guidelines above.
- Women of any age should NOT be screened every year by any screening method.
- Women who have been vaccinated against HPV should still follow these guidelines.
Some women believe that they can stop cervical cancer screening once they have stopped having children. This is not correct. They should continue to follow American Cancer Society guidelines.
Although screening every year should not be done, women who have abnormal screening results may need to have a follow-up Pap test done in 6 months or a year.
The American Cancer Society guidelines for finding cervical cancer early do not apply to women who have been diagnosed with cervical cancer. These women should have follow-up testing as recommended by their healthcare team.
Pelvic exam versus Pap test
Many people confuse pelvic exams with Pap tests, perhaps because they are often done at the same time. The pelvic exam is part of a woman's regular health care. During this exam, the doctor looks at and feels the reproductive organs. Some women think that they do not need pelvic exams once they have stopped having children. This is not true.
The pelvic exam may help find diseases of the female organs. But it won't find cancer of the cervix at an early stage. To do that, the Pap test is needed. The Pap test is often done just before the pelvic exam. The doctor will remove cells from the cervix by gently brushing or scraping. The cells are sent to a lab to be looked at under a microscope.
How important is cervical cancer screening?
In countries where women cannot get routine cervical cancer screening tests, death from cervical cancer is much more common. In fact, cervical cancer is the major cause of cancer deaths in women in many of these countries. These cancers are usually found at a late stage rather than as pre-cancers or early cancers.
Not all American women have cervical cancer screening. Older women, those without health insurance, and women who are recent immigrants are less likely to have regular cervical cancer screening.
But there are ways to help all women in this country get the testing they need. A program called the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offers free or low cost testing to women without health insurance. Each state's Department of Health has information on this program.
How is a Pap test done?
The doctor uses a metal or plastic instrument (a speculum) to open the vagina. Then a sample of mucus and cells is lightly scraped from the cervix. This sample is sent to the lab to be looked at under a microscope. If anything unusual is found your doctor will let you know. Because the system for reporting Pap test results is complex, ask your doctor to explain your results in a way that is clear to you. If your test shows something not normal, your doctor will want to do other tests to find out what is going on. Be sure to ask your doctor to explain exactly what your results mean and when to schedule your next Pap test.
Here are some things you can do to make your Pap test more accurate:
- Try to have the test when you will not be having your period.
- Do not douche for 2 days before the test.
- Do not have sex for 2 days before the test.
- Do not douche or use tampons, birth control foams, jellies, or other vaginal creams or medicines for 2 days before the test.
Even though the Pap test is the best way to prevent cervical cancer or to find it early, it is not perfect. Because even good labs can miss some cell changes, you should have the test as often as the ACS guidelines above recommend. Women who are no longer having children still need to have pelvic exams and Pap tests.
There are several ways to treat women with abnormal Pap test results. These methods include cryosurgery (use of a metal probe to freeze and kill the abnormal cells) and laser surgery. If you have an abnormal Pap test, ask your doctor to explain what that means in your case and what treatment options you have.
The HPV DNA test
As noted above, infection with HPV is the most important risk factor for cancer of the cervix. Doctors can now test for the types of HPV that are most likely to cause this cancer. They do this by looking at the DNA of cervical cells. Samples of cells are taken in much the same way as for the Pap test. This test is used in 2 ways:
- The HPV DNA test can be used along with the Pap test to screen for cervical cancer in women 30 years of age and older It does NOT replace the Pap test. It is not used for women under 30 because it's not as useful then. Younger women who are having sex are much more likely than older women to have HPV, most of which will go away by itself.
- It can also be used in women with slightly abnormal Pap test results to see if more testing or treatment might be needed.
To learn more, see the ACS document, What Women Should Know About Cervix Cancer and the Human Papilloma Virus.
Follow-up tests
If you have an abnormal result on a Pap test, other tests will need to be done to find out if a cancer or a pre-cancer is really there and to decide what treatment (if any) is needed. These tests are discussed in the section, "How is cervical cancer found."
Things to do to prevent pre-cancers
Try to avoid HPV
Since HPV is the main cause of cervical cancer and pre-cancer, avoiding exposure to HPV could help you prevent this disease.
Doing certain things can increase your chance of getting an HPV infection, for example:
- Having sex at an early age
- Having many sex partners
- Having a partner who has had many sex partners
- Having sex with men who are not circumcised
Here are some things that lower the risk of HPV:
Delay sex: Waiting to have sex until you are older can help you avoid HPV. It also helps to limit how many people you have sex with and to avoid having sex with someone who has had many other sex partners. Remember that someone can have HPV for years yet have no symptoms. HPV does not always cause warts or any other symptoms. Someone can have the virus and pass it on without knowing it.
Male circumcision: Men who have had the foreskin of the penis removed (are circumcised) have a lower chance of becoming and staying infected with HPV. They also have a lower chance of passing HPV along to their partner. The reasons for this are unclear.
Use condoms: Condoms can help protect against HPV. Condoms cannot protect completely against HPV, but they also protect against HIV and some other sexual diseases.
Don’t smoke: Not smoking is another important way to reduce the risk of cervical pre-cancer and cancer.
Get the HPV vaccine: There are now vaccines (Gardasil® and Cervarix®) that can protect people against certain types of HPV. These vaccines are only used to prevent-- not treat-- an HPV infection. Cervarix was approved in 2009 for use in the United States by the FDA, while Gardasil has been approved for use in this country since 2006. Both vaccines are approved to prevent cervical cancer and pre-cancer and protect against infection by the HPV types that are most often linked to cervical cancer. Gardasil is also approved to prevent anal, vaginal, and vulvar cancers and pre-cancers and to prevent anal and genital warts. Cervarix also provides some protection against infection and pre-cancers of the cervix by some other high-risk HPV types. It has also been shown to prevent anal infection with certain HPV types. Cervarix is approved for use in girls and young women ages 10 to 25 years, while Gardasil is approved for use in both sexes aged 9 to 26 years old.
These vaccines are given as a series of 3 shots over 6 months. Side effects of the vaccine are mild. The most common side effect is short-term redness, swelling, and soreness at the place where the shot was given. Rarely, a young woman will faint shortly after the vaccine injection. These vaccines should be given with caution to anyone with severe allergies.
To work best, the HPV vaccine should be given before a person starts having sex. The American Cancer Society) recommends that the vaccine be given to females aged 11 to 12 (and as early as age 9 years if the doctor recommends it). The Society also recommends that "catch-up" vaccinations should be given to females up to age 18 who have not yet had the vaccine. Women age 19 to 26 should talk to their doctors about whether the vaccine is right for them. It is important to know that the vaccine doesn't protect against all cancer-causing types of HPV, so cervical cancer screening is still needed.
Both types of the vaccine cost a lot -- at least $375 for the full series, not counting the doctor's fee or the cost of giving the shots. While it should be covered by most health plans, you may want to check your coverage before getting the vaccine.
For more details about the vaccine and HPV, please see our document, Human Papilloma Virus (HPV), Cancer, and HPV Vaccines -- Frequently Asked Questions.
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