January is Cervical Cancer Awareness Month

More than 13,000 women in the United States are diagnosed with cervical cancer each year. Cervical cancer is the fourth most common type of cancer for women worldwide but as it develops over time, it as also one of the most preventable types of cancer. Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44.

What is Cervical Cancer?

Cervical Cancer starts in the cells lining the cervix, which is the lower part of the uterus (womb). For reference, a fetus grows in the body of the uterus and the cervix connects the body of the uterus to the vagina (or birth canal).

Most cervical cancers begin in the cells of the transformation zone - an area where the endocervix and exocervix meet. These cells don't suddenly change into cancer cells, they gradually develop from normal cells to pre-cancerous cells that then turn into cancer. These changes can be detected by the Pap test.

It usually takes several years for cervical pre-cancer cells to change to cervical cancer, but it can happen in less than a year. Treating all cervical pre-cancers can prevent almost all true cervical cancers.

What are the risk factors?

The human papillomavirus (HPV) is found in about 99% of cervical cancers. HPV is a group of more than 150 related viruses, some of which cause a type of growth called papillomas or warts. HPV can infect cells on the surface of the skin, the lining of the genitals, anus, mouth and throat.

HPV is estimated to be the most common sexually transmitted infection in the US. The majority of women infected with the HPV virus do not develop cervical cancer as most infections resolved on their own. Infections that do not resolve on their own are known as a persistent infection. Women with a persistent HPV infection are at a greater risk of developing cervical cancer abnormalities than women whose infection resolve on their own.

Other risk factors include:

  • Smoking

  • Having a weakened immune system

  • Chlamydia infection

  • A diet low in fruits and vegetables

  • Being overweight

  • Long-term use of oral contraceptives (birth control pills)

  • Intrauterine device (IUD) use

  • Having multiple full-term pregnancies

  • Having a family history of cervical cancer

Can Cervical Cancer be prevented?

Most forms of cervical cancers start with pre-cancerous cell changes and there are ways to stop it from progressing further. One way is to find and treat pre-cancerous cells before they become cervical cancer, and the second is to prevent pre-cancerous cell changes all together.

The Pap test or Pap smear and the HPV test are well-proven methods to prevent cervical cancer is to have a screening to find pre-cancerous cells. If any pre-cancer cells are found, it can be treated - stopping cervical cancer before it starts.

The American Cancer Society recommends that women follow these guidelines to help find cervical cancer early:

  • All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (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 is called co-testing and should continue until age 65. Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.

Limiting the number of sex partners and avoiding sex with people who have had many sex partners may lower your risk of exposure to HPV. But since HPV is very common, having sexual activity with even one other person can put you at risk. Someone can have HPV for years and still have no symptoms. Someone can have the virus and pass it on without knowing it.

Vaccines are also available to protect young people against certain HPV infections. These vaccines work to prevent HPV infection, not treat an infection that is already there. That is why it is recommended HPV vaccines should be given before a person is exposed to HPV (such as through sexual activity).

The American Cancer Society recommendations for HPV vaccine use:

  • Routine HPV vaccination for girls and boys should be started at age 11 or 12. The vaccination series can be started as early as age 9.

  • HPV vaccination is also recommended for females 13 to 26 years old and for males 13 to 21 years old who have not started the vaccines, or who have started but not completed the series.

  • Males 22 to 26 years old may also be vaccinated.