Women can take steps to protect against cervical cancer

January is Cervical Cancer Awareness Month and a good opportunity to discuss the new guidelines for cervical cancer screening.

Cervical cancer screening can find changes in the cells of the cervix that could lead to cancer. Screening includes the pap test and, for some women, testing for human papillomavirus (HPV).

A pap test used to be recommended for most women every year. This recommendation has changed with the first set of new guidelines set forth in 2006. The guidelines were again updated in 2013, and since then, medical care providers should have adjusted their actual practices and teaching. Why did the guidelines change? Studies over the past decades have found that there is no overall advantage to having pap tests yearly instead of every three years. It also was proven that 99 percent of actual cervical cancer cases were associated with specific types of high-risk HPV.

Despite not needing a pap test every year, you should still see your health care provider every year for well-woman care and any other reproductive health care needs/planning.

The latest routine cervical cancer screening guidelines are as follows:

Women older than 21: Cervical cancer screening should start at age 21. Women younger than age 21 should not be screened regardless of the age of sexual initiation or the presence of other behavior-related risk factors. Those women younger than 21 who are at risk should be screened for sexually transmitted infections. A positive HPV test result in a young woman showing that she does have one of the cancer-causing HPV types will most likely become negative without any treatment, hence why screening is not recommended.

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Women ages 21 to 29: Women in their 20s should be tested with cervical cytology alone (pap test). This screening should be done every three years. Co-testing with cytology and HPV testing should not be performed in women younger than 30. These women also should be tested annually for sexually transmitted infections, if appropriate. Why is HPV testing not recommended for women younger than 30? HPV infection is common in younger women, but it usually goes away on its own. Their immune system fights off the HPV virus.

Women ages 30 to 65: These women should have a pap test and an HPV test (co-testing) every five years as the preferable type of screening. The combination of a pap test plus an HPV test can help predict whether dysplasia will be diagnosed in the next few years, even if the pap test results are normal. It also is acceptable to have a pap test alone every three years. Sexually transmitted infections testing for these women depends upon their individual risk factors.

Women older than 65: If there is no history of moderate or severe dysplasia or cancer and a woman has had either three negative pap test results in a row or two negative co-test results in a row within the past 10 years, a woman can stop having screening for cervical cancer.

Women with a history of moderate or severe squamous cell dysplasia, adenocarcinoma in situ or cervical cancer should continue to have regular age-based screening for 20 years after the initial post-treatment surveillance period, regardless of age.

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What if I have had a hysterectomy? You may still need to have cervical cancer screening depending upon why your hysterectomy was needed, if your cervix was removed and whether you have a history of dysplasia in the past. This will be decided by your health care provider.

What happens if my Pap or HPV tests return as positive? You should be referred to a gynecologist or a provider that specializes in further testing of the cervix and the genital tract for abnormal cells and cervical cancer. This care is individualized to each woman and their history.

So, please make your New Year’s resolution to get your screening done. Schedule your well woman exam today.

Susan Taylor is an MD, OB/GYN at Santiam Hospital in Stayton.

HPV vaccine can prevent cancer

HPV vaccine

Immunization against Human Papilloma Virus has been available since 2006. There is a new HPV vaccine type that is active against nine types of HPV instead of the two or four types that the older two types of vaccine covered.

HPV can be passed from person to person through skin-to-skin contact. Of the more than 100 types of HPV identified, 30 of them affect the genital tissues of men or women. About 12 types of HPV can cause genital warts and 15 of the types cause cancer of the cervix, as well as the vulva, vagina, penis, anus and the head and neck. Thus, immunization is a good idea.

The HPV vaccine is almost 100 percent effective in preventing cervical cancer and genital warts. The vaccine is most effective if it is given before a woman is sexually active and exposed to HPV. It can be given after she has been exposed, but the vaccine will not protect against a viral type that she is already infected with. The ideal time to give the vaccine is ages 11 to 12 for both girls and boys. The acceptable age range for the vaccine is age 9 to 26. The vaccine is given in three doses over a 6-month time span.