Cervical Cancer Risk Assessment

Cervical cancer was once one of the most common causes of cancer death among women in the United States, but today many cases of cervical cancer are prevented through widespread use of the Pap test.

In June 2006, the FDA approved the first vaccine to prevent infection by some strains of HPV, a major cause of cervical cancer. The vaccine is approved for females ages 9 to 26 and women with Pap smear abnormalities.

Cervical cancer tends to develop in midlife; about half of women diagnosed with it are between 35 and 55 years old; about 20 percent are older than 65 (American Cancer Society, 2005 statistic). Early cervical cancer and precancerous conditions of the cervix have no symptoms. This assessment will help you determine your relative risk for cervical cancer. This assessment is valid for women between the ages of 21 and 69 who have had sexual intercourse at least once and who have not had a hysterectomy with removal of the cervix.

Understanding Risk Factors for Cervical Cancer

The most important risk factor for cervical cancer is being infected with the human papillomavirus (HPV). Most women diagnosed with cervical cancer have this virus. HPV is passed on through skin contact with an infected part of the body, usually on or near the sexual organs, the ACS says. Your risk for getting this virus increases if you have sex at an early age, if you have more than one sexual partner during your lifetime, if your partner has had multiple sex partners, or if you have sex with uncircumcised males.

HPV refers to a group of more than 100 types of viruses that cause genital warts. Only a few of these viruses cause cervical cancer; about half of all cervical cancer cases are caused by only two types, HPV 16 and HPV 18, the ACS says. Yet most women who are infected with these types of HPV don't develop cervical cancer.

HPV infection does not always cause warts or other symptoms, so you can pass it to another person without knowing it. Although condoms protect against many sexually transmitted diseases (STDs), they don't offer total protection against HPV, the ACS says. This is because HPV can be passed on by skin contact with an infected area of the body that can't be covered with a condom. Even when no warts are present, HPV can reside in the skin and be passed on. A vaccine that protects against infection with HPV 16 and 18 is expected to be approved in the near future.

According to the ASC, other factors that increase your risk for cervical cancer are:

• HIV infection. HIV, the virus that causes AIDS, damages the body's immune system. This puts a woman at greater risk for HPV infection, which may increase the risk for cervical cancer, the ACS says. Gardisil, an FDA-approved vaccine, can prevent infection by some strains of HPV.
• Chlamydia. Chlamydia is a common sexually transmitted disease with few symptoms. Recent research suggests that a past or current Chlamydia infection may put a woman at greater risk for cervical cancer.
• Genital herpes. Some research suggests that infection with HSV-2 in some women may help the human papillomavirus to infect the cervix.
• Family history of cervical cancer or cervical dysplasia. Women whose mother or sisters have had cervical cancer or cervical dysplasia are at greater risk themselves for cervical cancer. It has been suggested by some researchers that some women may not fight off HPV infection as well as others owing to an inherited condition.
• Smoking. Women who smoke are about twice as likely as nonsmokers to get cervical cancer. Tobacco smoke contains many cancer-causing chemicals that are carried throughout the body in the blood. These chemicals have been found in the cervix of women who smoke.
• Poor diet. Women who consume few fruits or vegetables may be at higher risk for cervical cancer.

The Importance of Screening

The increased use of the Pap test has dramatically reduced deaths from cervical cancer. Pap tests find early cancers or changes in the cells of the cervix that could lead to cancer. Cervical cancer develops slowly, usually taking years to progress from a precancerous condition to cancer. For many women, the precancerous changes will not progress to cancer or will go away without any treatment. Precancerous conditions can be treated, preventing cancer from developing.

The ACS recommends that:

• A woman should have her first Pap test about three years after she begins having vaginal intercourse, but no later than age 21. She should be tested every year, or every two years, with the newer liquid-based Pap test.
• At age 30, a woman may be tested every two to three years — if she has had three normal Pap tests in a row. Some women should continue to be tested every year: those whose mothers took diethylstilbestrol (DES) while pregnant; those who have HIV; and those whose immune system has been weakened by an organ transplant, chemotherapy or chronic steroid use.
• At age 70, a woman may stop getting a Pap test if she meets these criteria: She has had three normal Pap tests in a row and no abnormal Pap tests in 10 years. Women 70 and older should continue to get a Pap test if they have a history of cervical cancer; if their mothers took DES while pregnant; or if they have HIV or a weakened immune system.
• A woman who has had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer testing, unless the surgery was done as a treatment for cervical cancer or a precancerous condition. A woman who has had a hysterectomy that did not remove the cervix should continue to follow the guidelines above.
• Some women incorrectly believe that they do not need a Pap test once they have stopped having children. They should continue with these tests according to the ACS guidelines.

Tips for an Accurate Pap Test

To make sure your Pap test results are accurate, the ACS says to avoid the following:

• Scheduling your test for a time when you are having your menstrual period.
• Douching within two days (48 hours) of your test.
• Having sexual intercourse within two days (48 hours) of your test.
• Using tampons, vaginal medications, foams, creams or jellies within two days (48 hours) of your test.

Pap Test, Pelvic Exam: The Difference

A pelvic exam is not a Pap test, but both are done during the same office visit. The Pap test is usually done first. For the Pap test, the health care provider inserts an instrument into the vagina to hold it open, then gently scrapes or brushes the cervix with another instrument to remove a small number of cells. This sample is sent to the laboratory. During a pelvic exam, a health care provider checks the health of a woman's uterus and ovaries by feeling them through the abdomen. For the exam, the provider inserts two fingers into the vagina and presses to steady the uterus; the other hand pushes on the abdomen to feel the uterus and ovaries. A pelvic exam cannot find cervical cancer in its early stages or abnormal cervical cells.

Treatment of Cervical Cancer

A health care provider may suggest one of the following treatments for precancerous changes of the cervix or for cancer found only in the outer layer of cells the cervix (cancer that has not invaded deeper tissues):

• Cryosurgery. Abnormal cells in the cervix are killed by freezing them.
• Laser surgery. A laser beam burns off abnormal cells or removes a small piece of tissue for examination.

For more advanced cancers, a cone biopsy may be done first to establish the cancer diagnosis. In a cone biopsy (conization), a cone-shaped piece of tissue is removed from the cervix. Treatment for more advanced cancers may be hysterectomy, internal or external radiation, chemotherapy, or a combination of these.