Cervical Health Awareness Month – What you should know.
If you are a woman between the ages 21 and 65, chances are you’ve become accustomed to getting your yearly pap smear. With advances in medical knowledge, pap smear screening guidelines have evolved over the years. The majority of cases of cervical cancer occur in women who have been inadequately screened or not screened at all.
Most cases of cervical cancer are directly related to the Human Papilloma Virus (HPV). HPV is divided into two groups — high risk and low risk. Infection with high risk HPV is a risk factor for the development of abnormal pap smears and cancer. Low risk HPV testing is not recommended and had no role in screening for cervical cancer.
In 2012, screening guidelines were adapted to reflect the medical advances and knowledge gained in the last decade. We know that most HPV infection is temporary and unlikely to lead to cervical cancer. Only a small fraction of infections are persistent, but persistent infections more strongly predict development of cervical dysplasia (pre-cancer) and cervical cancer.
The goals of screening are now aimed more precisely at detecting these conditions. Regarding appropriate screening intervals, it is important to note that most HPV-relates dysplasia and cancer are very slow to progress. On average, severe dysplasia may take three to seven years to progress to invasive cervical cancer; for this reason, less frequent testing is necessary.
In women younger than 21, HPV infections leading to cancer is almost unheard of; therefore women under 21 should not have a pap test.
Important strategies for prevention of Cervical Cancer include HPV vaccination and counseling about safe sex practices to limit exposure to sexually transmitted infections. Women who have received the vaccine should be screened according to the same guidelines — the vaccine is not 100 percent preventative.
Women ages 21-29 should have a pap test every three years. Women ages 30-65 should have a pap test and an HPV test (co-testing) every five years. Alternatively, a pap test alone can be done every three years, however, co-testing is the preferred option.
Women over 65 can stop being screened unless they have had treatment for cervical dysplasia or cervical cancer in the 20 years prior. They must also have evidence of adequate negative prior screening results over the past 10 years. This is defined as three consecutive negative Pap test or two consecutive negative co-test results.
With every set of new guidelines there will be exceptions, and women with any of the following risk factors may require more frequent screening — HIV infection, compromised immune system (for example, a transplant patient), women exposed in utero to DES, and women previously treated for moderate to severe dysplasia or greater.
Careful attention to every individual women is the dedicated job of an OB-GYN physician and a thorough understanding of the screening process is essential to prevention for cervical cancer.
Although screening may occur less often, it is still recommended that women see their health care provider every year for well-women care and reproductive health care and information.
Women’s care providers at Haywood Regional Medical Center include Robin Matthews, MD, David Kirk, MD, and Jenny Van Winkle, MD, all board certified physicians. The hospital recently welcomed the addition of a certified nurse-midwife, Jody Schmit.
Appointments may be made by calling 828.452.5042. Services include obstetrics, well-women gynecological exams, adolescent gynecological care, ultrasounds, minimally invasive hysterectomy, abnormal pap smear treatments, endometrial ablation, infertility evaluation, breast and cervical cancer screenings, contraceptive management including IUDs, hormone replacement, incontinence, pelvic pain, pelvic prolapse, perimenopausal symptoms, laparoscopic surgery, and treatment of menstrual disorders.