Once feared as much as other female cancers, cervical cancer is on the run, thanks to HPV vaccines. Today’s women, however, are caught between the pre-Gardasil and post-Gardasil generations.
Medical advances have made cervical cancer screening more accurate, which reduces the steps needed to catch it before signs and symptoms occur.
Cervical cancer was the number one cancer killer of women when Dr. George Papanicolaou (1883–1962)—the “Pap” in Pap smear—demonstrated that loose cells of the cervix could be identified as cancerous and even pre-cancerous simply with a microscope. Consequently, the scourge of cervical cancer declined; but make no mistake: it is still around. Today’s methods of cervical cancer screening, however, have not only improved the benefits of the routine Pap, but may have eliminated this test altogether for many women. Even better, new technology has made it easier for you as a patient. Easier means more will do it, and more doing it means less cervical cancer still.
Today’s cancer screening is not your mother’s screening.
In August 2018, the U.S. Preventive Services Task Force (USPST), an independent panel of national experts in disease prevention and evidence-based medicine, updated cervical cancer screening guidelines such that HPV testing alone is now the recommended screening method for women 30-65. Infection with HPV is the principal cause of greater than 90% of cervical cancer cases.
HPV testing is gentler than a Pap smear, resulting in less or no cramping during the test and less or no spotting after. The simplicity and the need for less frequent testing will only encourage screening before any of the earliest signs or symptoms of cervical cancer begin.
Newest recommendations offer women a choice.
No, the Pap smear is not dead. But the latest validation of HPV testing alone offers women over 30 a choice:
- Women under 21: no screening is necessary.
- Women 21–29: Pap smears only, every 3 years.
- Women 30–65: either HPV testing alone every 5 years, a Pap every 3 years, or co-testing (HPV + Pap) every 5 years.
- Women over 65 who have had a hysterectomy or no prior history of cervical cancer, previous positive screening, cervical cancer signs, or cervical cancer symptoms: discontinue screening altogether.
What are the cervical cancer signs and symptoms?
Since this particular cancer begins microscopically and progresses slowly, signs and symptoms can be delayed for years, which supports the rationale for following the above guidelines before anything were to sneak up on you.
Signs and symptoms are two different things: signs are observed by your physician, but symptoms are what you yourself experience. There is often considerable overlap between them.
Cervical cancer signs: include abnormal tissue on the cervix, vaginal discharge, anemia, lymphadenopathy (lymph node swelling), swelling of one or both legs (edema), hip or leg fracture(s).
Cervical cancer symptoms: include irregular vaginal bleeding, bleeding after intercourse, weight loss, vaginal discharge, fatigue, difficulty with urination or bowel movements, pelvic pain, and painful intercourse.
Unknown is unhealthy, unlucky, and possibly even undone.
In spite of the “never-screened” being at highest risk, if you are one of these women, you can enter the low-risk group with just one screening—a huge incentive to finally agreeing to visit your doctor. That is a small investment for a huge return—peace of mind.
The great advantage of HPV screening.
Cervical cancer itself is not HPV or HPV infection. Instead, it is your body’s reaction to HPV. Cancerous and precancerous cervical cells, as seen on a Pap, however, have already been affected, meaning the process—albeit slow—has begun. Even more confusing, pre-cancerous cells (“dysplasia”) can reach a certain point of abnormality and then pause, sometimes indefinitely. Therefore, pre-cancer may never progress to the “real” thing. All of these discoveries have fine-tuned the art of cervical cancer screening over the last few decades. Thus, HPV testing can allow closer surveillance which can help eliminate your risk as soon as anything first goes awry. In other words, forewarned is forearmed.
Stopping HPV before it even arrives.
The HPV vaccine was introduced in 2006. Since that time, the number of HPV subtypes (varieties that cause changes from warts to actual cervical cancer) have been increasingly included as targets for this pre-emptive strike, having your antibodies ready to attack and prevent any of 9 types of HPV from gaining a foothold in your body. The time to begin vaccination, logically, is before one’s first sexual activity (age 9-12, for both boys and girls), but successful prevention has been proven even for those well into their sexual lives.
Does the HPV vaccine make other precautions unnecessary?
You do the math: covering the 9 worst types of HPV will prevent 90% of cervical, anal, throat, and possibly other cancers. Time will tell whether that 90% will rise in the statistics as more results are tabulated, but until then, you should respect that other 10%.
What about you? What is your take-home message?
- Today’s newest recommendations make keeping up with state-of-the-art precautions easier than ever. Gone are the days of Pap smears every year (or even every 6 months), replaced by a schedule that is easily incorporated into your busy lifestyle—inserting a brief visit to your gynecologist only every 3–5 years—or even not at all for most of you under 21 or over 65. If you have never been screened, imagine the peace of mind that “catching up” with all of the low-risk women will give you.
- On the “front end,” once the newest generation of sexually inactive adolescents has achieved the much-anticipated milestone of universal HPV vaccination, cervical cancer can join the ranks of smallpox and polio as having been eradicated. This will happen in your lifetime.
None of these easy precautions will work, however, unless you make that appointment, easily done with a simple click. It is high time to retire the teal-colored ribbon.
