January is Cervical Cancer month. The incidence of cervical cancer has decreased more than 50% in the past 30 years because of wide spread screening with the Pap smear. In 1975, the rate was 14.8 per 100,000 women in the United States. In 2006, it had been reduced to 6.5 per 100,000 women. Death from cervical cancer has also decreased significantly. The American Cancer Society estimated that in 2009, there were about 11,000 new cases of cervical cancer and about 4,000 deaths from the disease. Of the 11,000 new cases that were diagnosed, it is estimated that 50% of those women had never had a Pap smear done and another 10% had not been screened within the past 5 years.
The Pap smear is a screening test for cervical cancer. The test is performed in your healthcare provider’s office. The Pap smear is obtained when your healthcare provider performs a pelvic examination and inserts an instrument referred to as a speculum inside the vagina. The speculum may be either made of metal or plastic. The speculum opens the vagina and once it is properly positioned, allows the healthcare provider to see the cervix. The cervix is the lower portion of the uterus and contains cells on the outside and inside that are taken for further evaluation. The cells are removed with a brush that contains bristles and a flat spatula. These cells are suspended in fluid and sent to the lab.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that screening start at age 21. How frequently a Pap smear is performed is determined by the age of the patient, onset of sexual activity, prior abnormal results, medical problems that may require more frequent surveillance, and/or use of contraceptives. The interval can be increased to every three years in the woman who has had three consecutive normal Pap smears.
The causative factors for cervical cancer include exposure to the human papilloma virus (HPV), early sexual activity, cigarette smoking and multiple sexual partners. Preventive measures include use of condoms, monogamous relationships and early administration of the HPV vaccine. To date, more than 100 strains of virus have been identified. The recommendation is that both females and males are vaccinated prior to exposure to sexual activity.
New recommendations require that all persons 30 years of age and older be tested for the presence of low or high risk viral strains along with the standard screening of the Pap smear and appropriate management recommended. The risk of cervical cancer decreases with age. ACOG recommends that women continue screening until they reach 70 or have a hysterectomy which is the removal of the cervix and uterus.
The key to prevention is being consistent with your appointments and early detection of any abnormalities which may increase your risk of cervical cancer. Cervical cancer usually has no symptoms. You may feel perfectly well. However, abnormal bleeding not related to any other known causes such as fibroids, hormonal abnormalities, cervical or uterine polyps, may be a sign. Other signs include bleeding between cycles, pelvic pain, discharge with a foul odor.
The treatment for cervical cancer varies depending on the stage of cancer. It could be surgical, radiation, chemotherapy or a combination of all three. The more advanced the cancer, the more treatment required.
Your healthcare provider will determine the schedule for your routine screening. The staff at any of our locations in Reston, Ashburn or Chantilly are available for any of your healthcare needs.