Cervical Health

First of all, a refresher course. What’s the cervix and where is it? Think of it as a soft cylinder-shaped passageway between the uterus and the vagina. In the rounded head of the cervix is a tiny opening that widens slightly every month to release menstrual blood from the uterus, and (amazingly) opens to the size of a baby’s head during childbirth. And, that my dears is a lot of stretching!

In the early 1900s cervical cancer was the number one cause of cancer deaths in women. By 1950 that statistic was cut in half due to the development of the Pap test which screened for cellular abnormalities beginning in the cervix. 

Today, cervical cancer is one of the few cancers that is almost totally preventable due to the discovery in the early1980’s that this cancer was caused by certain strains of the human papillomavirus (HPV), which is sexually transmitted.

HPV Review

Just as a quick reminder: 80% of all people will be exposed to the HPV virus at some point in their lives. 80%! That means it’s normal to be exposed and a person can be responsible, have 1 partner, using condoms and still get exposed. Most HPV, in fact, 90% of the time, our own body’s immune system will clear the virus and it will not progress to cancer. 

But that means that 10% of the time, the HPV will persist and not go away, which could then become problematic.

The next breakthrough came in 2006 when the HPV vaccine, Gardasil, was introduced, protecting against HPV-16 and HPV-18 as well as two strains of the HPV virus that cause genital warts. Other versions of the vaccine have become available since, protecting against various strains. The process in which the normal cells of the cervix gradually develop pre-cancerous abnormalities that turn into cancer is very slow. 

How to Get Protected

Discuss with your healthcare provider what steps are appropriate for you; HPV vaccination, regular screening with the Pap test and following up on abnormal test results.

• Immunization against HPV can prevent up to 70% of HPV-related cervical cancer cases.
• Gardasil 9 is the only HPV vaccine currently available in the United States and is now approved for use in males and females between the ages of 9 and 45.
• In girls and boys younger than 15, a 2-dose schedule is recommended; patients ages 15 through 45 require 3 doses.

Why do we recommend vaccination so early?

This is a question I hear all the time. The reason is that the vaccine produces a much more robust immune response when it’s given before age 15, which means that it provides more protection and is more effective when given to boys and girls before puberty. 

The suggested timing of the vaccine is NOT related to when we think people might become sexually active, it’s about increasing levels of protection so that when people are older and become exposed to HPV they will be more likely to be resistant. 

• Regular cervical cancer screening remains a good preventive tool and should be performed using the Pap test, (named after Dr. Papanicolaou) the high-risk HPV-only test, or the Pap-HPV co-test.

When do you need a Pap?

The Current Guidelines:

Women ages 21-29 should get a Pap smear every three years

Women ages 30-65 can get an HPV test every five years, or a Pap test every three years, or a combination every five years

Women over 65 who have had recent clear tests probably don’t need testing any more

Women under 21 probably do not need testing

“In the U.S., it’s pretty rare that I see someone with advanced cervical cancer who never had a Pap,” Dr. Kathleen Schmeler, a cervical cancer specialist at the University of Texas MD Anderson Cancer Center, said in an interview with NBC News.

“They almost always tell the story that ‘10, 15 years ago I had abnormal Pap but I didn’t go back because I lost my insurance.’ I hear that a lot,” Schmeler said. Lack of access to health care can cause a woman to die from a completely preventable illness. A Pap smear, or test, will find precancerous changes in the cervix or a less threatening strain of HPV infection.

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“It is not like you get HPV and then you get cancer,” Schmeler said. It only happens in a few people, and the process usually takes years. In fact, it can take 5-10 years for HPV to progress to a pre-cancerous lesion or cancer. 

In the coming years, tampon-like home test products will undoubtedly become available for HPV detection. 

But the standard should become preventative vaccines for all boys and girls. “We have an amazing preventive vaccine,” Schmeler said. “We really need to vaccinate kids before they become sexually active so that we can prevent all of this.”