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PATIENT PAGES

Early Detection of Cervical Cancer

From the American Cancer Society

    CERVICAL CANCER FACTS

• The cervix is part of the uterus or womb. Cancers that start in the cervix are called cervical cancer.
  
• This year, about 13,000 women will develop invasive cervical cancer and about 4,100 women will die of the disease. Most of the deaths could be prevented if more women had tests to find cervical cancer early.
  
• Cervical cancer is usually caused by a sexually transmitted virus called the human papilloma virus (HPV). But most HPV infections will not lead to cancer.
  
• Cigarette smoking increases the risk of cervical cancer.
  

    UNDERSTANDING TESTS FOR CERVICAL CANCER

Today, there are two types of Pap tests:

1. The regular Pap test, in which cells from a woman’s cervix are smeared on a microscope slide.
   
2. The liquid-based Pap test, in which the cells are placed in a special liquid first and then onto the slide.
   

In both types of tests, cells from the cervix are checked under a microscope in order to find cervical cancer at a stage that is easy to cure. They can also find early changes in the cells, which can be treated to stop a cancer from developing.

Pap tests are good, but not perfect. Their results sometimes appear normal even when a woman has abnormal cells of the cervix or cancer. Fortunately, most cervical precancers grow slowly. So having a Pap test at least every three years will find almost all cervical abnormalities before they progress to cancer. Cervical cancer is very curable if found early.

    HPV AND CERVICAL CANCER

Almost all cervical cancers contain DNA from certain types of HPV. Infection with these HPV types may lead to changes in the cells of the cervix. Certain changes, called high-grade lesions, may progress to cervical cancer if not treated. Most HPV infections, however, go away by themselves and cause no symptoms or cell changes. One purpose of cervical cancer screening is to find high-grade changes that can progress to cancer. If found, they can be removed. This can prevent them from becoming cervical cancer.

Research has shown that tests for HPV may be a useful addition to Pap tests in women older than age 30. HPV tests are already used to help doctors decide which women with certain kinds of small changes in the cells of their cervix need further testing. However, the US Food and Drug Administration has not approved HPV tests (as of October 2002) for use in routine testing for women who have not had an abnormal Pap test result.

    THE AMERICAN CANCER SOCIETY RECOMMENDATIONS

1. Cervical cancer screening should begin approximately three years after a woman begins having vaginal intercourse, but no later than 21 years of age.
   
2. Cervical screening should be done every year with regular Pap tests or every two years using liquid-based tests. At or after age 30, women who have had three normal test results in a row may get screened every two to three years. But the doctor may suggest getting the test more often if a woman has certain risk factors such as HIV infection or a weak immune system.
   
3. Women 70 years of age and older who have had three or more normal Pap tests and no abnormal Pap tests in the last 10 years may choose to stop cervical cancer screening.
   
4. Screening after total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue cervical cancer screening at least until age 70.
   

    INCREASING THE ACCURACY OF YOUR PAP TEST

There are things you can do to make your Pap test as accurate as possible:

• Try not to schedule an appointment for a time during your menstrual period.
  
• Do not douche for 48 hours prior to the test.
  
• Do not have sexual intercourse for 48 hours before the test.
  
• Do not use tampons, birth control foams, jellies, or other vaginal creams or vaginal medications for 48 hours before the test.
  

    PELVIC EXAMINATION VERSUS PAP TEST

Many people confuse pelvic examinations with Pap tests. The pelvic exam is part of a woman’s routine health care. During a pelvic exam, the doctor looks at and feels the reproductive organs, including the uterus and the ovaries, and may screen for sexually transmitted diseases. But the pelvic exam will not find cervical cancer at an early stage, and cannot find abnormal cells of the cervix. The Pap test is usually done just before the pelvic exam, when the doctor removes cells from the cervix by gently scraping or brushing with a special instrument. Pelvic exams may help find other types of cancers and reproductive problems, but only Pap tests will provide information on early cervical cancer or precancers.

    Footnotes

These pages may be photocopied and given to your patients.

This article has been cited by other articles:

				T Aldrich, D Becker, S G Garcia, and D Lara Mexican physicians' knowledge and attitudes about the human papillomavirus and cervical cancer: a national survey Sex. Transm. Inf., April 1, 2005; 81(2): 135 - 141. [Abstract] [Full Text] [PDF]

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