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 (or Pap smear) is the most common way to do 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 having the Pap test about 3 years after they start having sex (vaginal intercourse), but no later than age 21.

• The test should be done every year if the regular Pap test is used, or every 2 years if the liquid-based Pap test is used.

• Beginning at age 30, many women who have had 3 normal test results in a row may get the Pap test every 2 to 3 years. Another option for women over 30 is to have a Pap test every 3 years plus the HPV DNA test. (See below for more information about this test.)

• Women who have certain risk factors (like HIV infection or weak immune systems) should get a Pap test every year.

• Women 70 years of age or older who have had 3 or more normal Pap tests in a row (and no abnormal tests in the last 10 years) may choose to stop having the test. But women who have had cervical cancer or who have other risk factors (as mentioned above) should keep on having the test as long as they are in good health.

• Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having the test unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a simple hysterectomy (the cervix was not removed) should continue to follow the guidelines above.

Some women believe that they can stop having Pap tests once they have stopped having children. This is not correct. They should continue to follow American Cancer Society guidelines.

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 the Pap test?

In countries where women cannot get routine Pap 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 Pap test screening. For instance, the elderly, African-Americans, low-income women, and women who are recent immigrants are less likely to have regular Pap tests.

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.

Here are some things you can do to make your Pap test more accurate:

• Try to plan 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:

• It can be used as a screening test (along with the Pap test) in women over 30. 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 Every Woman Should Know About Cervical Cancer and the Human Papilloma Virus

Things you can do to prevent pre-cancers

Try to avoid HPV

You can prevent most pre-cancers of the cervix by avoiding exposure to HPV. 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

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. It does not always cause warts or any other symptoms. Someone can have the virus and pass it on without knowing it.

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 just approved for use in the United States by the FDA, while Gardasil has been approved for use in this country since 2006. In October 2009, the FDA also approved the use of Gardasil in males to prevent genital warts. Cervarix is approved for use in girls and young women ages 10 to 25 years, while Gardasil is approved for those 9 to 26 years old.

The vaccines now in use 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.

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 Pap tests are still needed.

Both types of the vaccine cost a lot -- at least $375 (not counting the doctor's fee or the cost of giving the shots). While it should be covered by most medical insurance 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: Questions and Answers.

Last Medical Review: 09/24/2009
Last Revised: 09/24/2009