Most cervical cancer is caused by the human papilloma virus (HPV). This virus enters cells and causes changes that can lead to cancer. HPV is transmitted from person to person through sexual activity and genital contact.
Most people who are sexually active will get exposed to HPV at some point in their life: 13 million people in the U.S. become infected with HPV each year.
HPV infection causes no symptoms, so most people do not know they have an HPV infection. Thankfully, most HPV infections are cleared by the body’s immune system and go away on their own, but those that don’t, can cause cancer.
What Is Cervical Cancer Screening?
Cervical cancer screening looks for changes in the cells of the cervix that could lead to cancer. The cervix is the lower part of the uterus (womb) which opens into the vagina. Cell changes can develop on the cervix that, if not found and treated, can lead to cervical cancer.
Why Is Cervical Cancer Screening Important?
Cervical cancer screening detects cell changes before they become cancer. It takes time for cell changes to become cancer. By identifying cell changes early, patients can have more frequent screening, and those with high-grade changes can have treatments to remove the abnormal cells. Cervical cancer screening saves lives!
When Does Cervical Cancer Screening Start? How Often Should It Be Done?
Cervical cancer screening starts at age 21.
People with a cervix should have cervical cancer screening on a regular basis. Frequency of screening depends upon your age. We recommend a PAP test every 3 years between the ages of 21-29.
How Is Cervical Cancer Screening Done?
A PAP test screens for abnormal cell changes of the cervix. Patients will lie down on an exam table. The provider will place an instrument called a speculum into the patient’s vagina so they can see the cervix. The provider will then use a brush to take a few cells from the surface of and inside the cervix. A PAP test may be mildly uncomfortable but should not be painful. You may have some vaginal bleeding afterwards.
How Is a Pelvic Exam Different from a PAP Test?
A PAP test screens for abnormal cell changes of the cervix by collected cells from the cervix using a brush.
A pelvic exam evaluates the anatomy of the reproductive tract. A pelvic exam includes three parts:
Inspection of the external genitalia, urethral opening and vaginal entrance
Speculum exam of the vagina and cervix
Examination of the uterus, cervix and adnexa – in some cases, this may also include a rectovaginal exam
If a speculum and/or internal exam is needed, patients will undress from the waist down, lay on the exam table, place their feet on footrests and relax their knees to the side. The provider will inspect the external genitalia first, then place a lubricated speculum into the vagina. The speculum helps moves the vaginal walls to the side, so that the provider can see the vagina and the cervix.
The provider will then take the speculum out of the vagina and place one or two fingers into the vagina and one hand on the lower abdomen. The provider's hands are used to examine the size and position of the uterus, cervix and ovaries. They are also checking for any masses and tenderness.
Any type of pelvic exam will always be performed after the patient consents to the exam and with a chaperone present.
If I or My Child Has Received the HPV Vaccine, Do We Still Need a PAP Test?
Yes. While the HPV vaccine greatly reduces the risk of HPV-related cervical cancer and genital warts, not all cervical cancer is caused by HPV. Getting a PAP test is still necessary to screen for any abnormal cervical cell changes or cervical cancer.
Do I Need Cervical Cancer Screening if I’ve Never Had Sex?
Routine cervical cancer screening begins at age 21 regardless of a person’s sexual activity. Most, but not all cervical cancer is caused by the human papilloma virus. Also, HPV can be spread by genital contact without vaginal intercourse. So, it is important to screen for cell changes even if you have never had sex.
What Happens if I Have an Abnormal Cervical Cancer Screening Test?
An abnormal result does not mean you have cervical cancer. Many cell changes can go back to normal cells on their own. If you have an abnormal PAP test, your provider will discuss the next steps. You may need more frequent screening, or further testing to ensure there are not high-grade cell changes or cancer cells.
Other than Cervical Cancer Screening, How Do I Protect Myself from Cervical Cancer?
Getting the HPV vaccine greatly reduces the risk of cervical cancer. Also, avoid smoking, which increases the risk of HPV infections progressing to cervical cancer.
Kate McCracken, MD FACOG is a distinguished member of Nationwide Children’s Pediatric and Adolescent Gynecology team.
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