January is Cervical Cancer Awareness Month. Cervical cancer is one of the few cancers that is almost always preventable. Yet, many women don't know that their actions can dramatically reduce their risk of developing this form of gynecologic cancer. The number of women developing cervical cancer has decreased by almost 50% since the 1970s. Increased utilization of the Pap test to detect pre-cancerous cells or early-stage cervical cancer is the major reason for this decline in the United States.
What Causes Cervical Cancer?
The cervix is the lower part of a woman's uterus (womb). The womb holds the growing baby as it develops over the nine months of pregnancy. Once the baby is ready to be born, the cervix gradually opens (dilates) to allow the baby to be born.
Cervical cancer occurs when cells in the cervix begin to change and grow out of control and form tumors. This process is gradual, often over many years. When the cells change, the condition is called dysplasia, which means abnormal (pre-cancerous) cells in layman's terms.
According to the National Cervical Cancer Coalition (NCCC), just over 90% of all cervical cancers are caused by human papillomavirus (HPV). HPVs are a common family of over 100 viruses – most of these are low-risk and don't cause cancer. Almost every person who is sexually active has been exposed to HPV. HPV doesn't always cause symptoms, so many people never know that they've had HPV. Women can get HPV even if they've only had sex with one other person.
More than 70% of cervical cancer is caused by just two kinds of the HPV virus — HPV-16 and HPV-18. The NCCC estimates that over 80% of women over 50 have had an HPV infection. Only a very small percentage of women exposed to HPV develop cervical cancer. These women don't clear the infection, and the infection becomes "persistent." Over the years (from just several to decades), it causes changes in the cells of the cervix. Eventually, some of these abnormal cells may change into cancer.
Does Cervical Cancer Have Symptoms?
In the earliest stages, cervical cancer doesn't create any symptoms. That's why it's so important for all women to have a Pap test regularly. Any woman who experiences any of these symptoms should schedule an appointment with their OB/GYN or their health department. These symptoms include:
Abnormal bleeding – between menstrual periods, after having sexual intercourse, after douching, after a pelvic exam, or after menopause.
Pain during intercourse or pelvic pain not related to your period.
Unusual discharge – may be watery or thick or have a foul odor
What Can You Do To Reduce Your Risk for Cervical Cancer?
Fortunately, cervical cancer is one of the most preventable cancers. Why? Because there is a screening test that is readily available and very accurate. And now, there is a vaccine. Plus, women can make changes in their lifestyle to reduce their risk of cervical cancer.
5 Actions That Can Reduce Your Risks of Developing Cervical Cancer
There are several important things you can do to reduce your risk of contracting HPV and/or cervical cancer, and those include:
The American Cancer Society (ACS) recommends that women begin cervical cancer screenings when they reach their 25th birthday. Women between the ages of 25 and 65 should have a primary HPV test every five years. If the primary HPV test is not available at a patient's screening location, then a co-test (combining the Pap test with HPV test) can be used every three years.
The most important fact to remember is that either of these screening methods is effective but must be performed regularly.
The ACS has some additional guidelines set in place regarding screenings which include:
Women over 65 who have been regularly screened for the past ten years and have had normal results and have no history of CIN2 or other serious findings in the last 25 years can discontinue cervical cancer screenings.
Women who had a complete hysterectomy (not related to a pre-cancerous or cancerous diagnosis) can stop cervical cancer screenings.
Women who received the HPV vaccinations should continue getting Pap tests.
Older women with a suppressed immune system (because of an organ transplant, HIV infection, or long-term steroid use) should follow the advice of their gynecologic cancer specialist.
Most insurances cover the cost of Pap test screenings at 100%. If you don't have healthcare insurance, the National Cervical Cancer Coalition publishes resources that may be available for low-cost or free Pap testing in Oregon and Washington.
Be sure to follow-up on your gynecologist's recommendations to treat pre-cancerous cells found in a Pap test.
2. Consider the HPV Vaccine
The HPV vaccine is a game-changer in the battle against cancers caused by the human papillomavirus (HPV). Not only does the HPV vaccine protect against cervical cancer, but it also helps prevent vulva, vaginal, anal, penile, and oropharyngeal (head and neck) cancers. The HPV vaccine is recommended for both adolescent girls and boys and adults up to 26. And in certain circumstances, the HPV vaccine can be useful in adults up to 45.
The vaccine available in the United States works by protecting against HPV types 16 and 18, responsible for about 70% of cervical cancers. The U.S. vaccine provides protection against genital warts. The U.S. vaccine also contains five other HPV types responsible for up to 20% of other cervical cancers.
The American Cancer Society recommends that both girls and boys get vaccinated at 11 or 12 years old, but vaccination can begin as early as 9. HPV vaccinations are more effective when given at earlier ages. The American Academy of Pediatrics (AAP) recommends earlier vaccination as part of every child's routine vaccinations.
Adults up to age 26 should receive "catch-up" HPV vaccinations if they haven't been fully vaccinated. (Children under the age of 15 need two doses; those over 15, including adults up to 26, need three doses for full protection.)
There is little evidence to suggest that HPV vaccinations in older adults will prevent cervical or any other type of HPV-caused cancer.
3. Use Latex Condoms and Practice Safer Sex
Ask your partner to use condoms when having intercourse. Condoms don't completely protect against HPV infections. HPV can be transmitted without penetration. Even skin-to-skin contact can transmit HPV. Oral and anal sex can spread HPV; sex toys can even transmit HPV.
4. Limit the Number of Sexual Partners
Limit the number of sexual partners you have. Don't have sex with someone that you know has had many other sexual partners. Most people with HPV don't have any symptoms, so they don't know that they could be passing on the virus to you.
5. Don't Smoke
Smoking is linked to the development of cervical cancer. Try to stop smoking — talk to your doctor or health department about a smoking cessation program. You'll become healthier and help lower your risk of other cancers too.
What else can we do to help prevent cervical cancer?
One of the most important factors in preventing cervical cancer and other cancers is to live a healthy lifestyle. A few simple lifestyle changes will help keep your immune system strong.
Maintain a healthy weight. Little changes made over several months can help you achieve a healthier weight.
Eat more fruits and vegetables. Fruits and vegetables contain valuable vitamins and minerals that help boost your immune system.
Get moving. Study after study shows that a sedentary lifestyle adversely impacts our health. Walk a little bit more every day. Take the stairs instead of the elevator. Get moving with your children outdoors.
Cervical Cancer is Preventable
Cervical cancer is one of the most preventable cancers. The HPV test helps identify women who are higher risk for cervical cancer. The Pap test helps identify pre-cancerous condition so they can be treated and not develop into cancer. Plus you can make smarter decisions about your sexual behavior.
If you're the parent or grandparent of children approaching adolescence, talk to their pediatrician about the HPV vaccine. You'll be helping ensure that your daughter or granddaughter maintains a healthy reproductive system.
The decisions you make in your daily life can influence your cancer risk. Take the steps needed to change any lifestyle habits that could be working against you so you can beat cervical cancer.
Originally published February 2018. Revised December 2020.